|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
23500032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 INITIAL PREVENT MED NEW PT 40-64YR
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21799460
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
25500070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21600070
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21600070
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21599386
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
21599386
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$253.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99386 PREVENTIVE MED NEW PT 40-64YRS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
25500070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$307.70
|
| Rate for Payer: First Health Commercial |
$325.80
|
| Rate for Payer: First Health Workers Compensation |
$139.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$325.80
|
| Rate for Payer: GEHA Commercial |
$289.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$325.80
|
| Rate for Payer: Humana ChoiceCare |
$94.12
|
| Rate for Payer: Multiplan All |
$329.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.20
|
| Rate for Payer: OMNI Networks Commercial |
$253.40
|
| Rate for Payer: One Health Plan PPO/POS |
$325.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$343.90
|
| Rate for Payer: Three Rivers Provider Network All |
$271.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$318.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$336.66
|
| Rate for Payer: Zelis Auto |
$144.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.83
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21999387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21999387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21799461
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21799461
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
23500033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 INITIAL PREVENT MED NEW PT 65+YR
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
23500033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
25500071
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
25500071
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21600071
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21599387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21600071
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS +
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21599387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS+
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21099387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99387 PREVENTIVE MED NEW PT 65YRS+
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
21099387
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
99391 EST PAT INF REEVAL (0-1 YR)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
21600072
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99391 EST PAT INF REEVAL (0-1 YR)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
21599391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$170.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
99391 EST PAT INF REEVAL (0-1 YR)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
8599391
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$170.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
