|
HCY SCREENING EST PT 65 & OVER
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5299397
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$195.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$235.62
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$220.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT 65 & OVER
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5299397
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$297.00
|
|
|
HCY SCREENING EST PT 65 & OVER
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
9699397
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$297.00
|
|
|
HCY SCREENING EST PT 65 & OVER
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
9699397
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$195.36
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$235.62
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$220.11
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
4199394
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$211.50
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
9599394
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$211.50
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
9599394
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$139.12
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$167.79
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
4299394
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$139.12
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$167.79
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
4199394
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$139.12
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$167.79
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 12 - 17
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
4299394
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$211.50
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
9699392
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
9599392
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
9699392
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
4499392
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
9599392
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 1 - 4
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
4499392
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$130.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$157.08
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$146.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 18 - 39
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
9599395
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$229.50
|
|
|
HCY SCREENING EST PT AGE 18 - 39
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
4299395
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$229.50
|
|
|
HCY SCREENING EST PT AGE 18 - 39
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
9599395
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$150.96
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$182.07
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$170.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 18 - 39
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
4299395
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$150.96
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$182.07
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$170.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 40 - 64
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
4299396
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$256.50
|
|
|
HCY SCREENING EST PT AGE 40 - 64
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
4299396
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$203.49 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$168.72
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$203.49
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING EST PT AGE 40 - 64
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
9599396
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$256.50
|
|
|
HCY SCREENING EST PT AGE 40 - 64
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
9599396
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$203.49 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$168.72
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$203.49
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY Screening EST PT AGE 5 - 11
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
4499393
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$198.00
|
|
