|
HCY SCREENING NEW PATIENT AGE 1 - 4
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
5299382
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$225.00
|
|
|
HCY SCREENING NEW PATIENT AGE 1 - 4
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
5299382
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$148.00
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$178.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$166.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 18 - 39
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
5299385
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$283.50
|
|
|
HCY SCREENING NEW PATIENT AGE 18 - 39
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
5299385
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$186.48
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$224.91
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$210.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 40 - 64
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
5299386
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$222.00
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$267.75
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 40 - 64
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
5299386
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$337.50
|
|
|
HCY SCREENING NEW PATIENT AGE 40 - 64
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
9699386
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$337.50
|
|
|
HCY SCREENING NEW PATIENT AGE 40 - 64
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
9699386
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$222.00
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$267.75
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$250.12
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 5 - 11
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
5299383
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$234.00
|
|
|
HCY SCREENING NEW PATIENT AGE 5 - 11
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
5299383
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$153.92
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$185.64
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 65 AND OVE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
9699387
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$351.00
|
|
|
HCY SCREENING NEW PATIENT AGE 65 AND OVE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
9699387
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$230.88
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$260.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT AGE 65 & OVER
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
5299387
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$351.00
|
|
|
HCY SCREENING NEW PATIENT AGE 65 & OVER
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
5299387
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$278.46 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$230.88
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$260.13
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PATIENT NEWBORN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
9699381
|
|
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 NEW PATIENT NEWBORN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
9699381
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$211.50
|
|
|
HCY SCREENING NEW PATIENT NEWBORN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
5299381
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$211.50
|
|
|
HCY SCREENING NEW PATIENT NEWBORN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
5299381
|
|
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 NEW PT AGE 12 - 17
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
4299384
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$261.00
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
3999384
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$171.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$207.06
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
9599384
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$261.00
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
3999384
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$261.00
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
9699384
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$261.00
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
9599384
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$171.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$207.06
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
HCY SCREENING NEW PT AGE 12 - 17
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
4299384
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$207.06 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$171.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$207.06
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.43
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
