|
ABD. ABCESS I&D
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
4110061
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$205.20
|
|
|
ABD. ABCESS I&D
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
4110061
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$134.98 |
| Max. Negotiated Rate |
$830.64 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$366.45
|
| Rate for Payer: Aetna Medicare Advantage |
$415.32
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$134.98
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$162.79
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$415.32
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$329.81
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$392.10
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$415.32
|
| Rate for Payer: Humana Commercial |
$830.64
|
| Rate for Payer: Humana Medicare Advantage |
$415.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$152.08
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$366.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
ABD COMBINE DRESS
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
281534
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$14.40
|
|
|
ABD COMBINE DRESS
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
281534
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$9.47
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$11.42
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.76
|
|
|
ABD.HYSERECTOMY/COLPOURETHROCYSTOPEXY
|
Facility
|
OP
|
$3,704.00
|
|
|
Service Code
|
CPT 58152
|
| Hospital Charge Code |
5258152
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$2,644.66 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$2,192.77
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$2,644.66
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,470.57
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
ABD.HYSERECTOMY/COLPOURETHROCYSTOPEXY
|
Facility
|
IP
|
$3,704.00
|
|
|
Service Code
|
CPT 58152
|
| Hospital Charge Code |
5258152
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$3,333.60
|
|
|
ABD. HYSTERECTOMY
|
Professional
|
Both
|
$3,704.00
|
|
|
Service Code
|
CPT 58152
|
| Hospital Charge Code |
4158152
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$938.50 |
| Max. Negotiated Rate |
$1,296.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,051.97
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care |
$938.50
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$1,051.97
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$938.50
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$1,032.35
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$1,051.97
|
| Rate for Payer: Optum Medicare Advantage |
$1,296.40
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$938.50
|
|
|
ABD. HYSTERECTOMY (TOT.)
|
Facility
|
IP
|
$2,663.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
5258150
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$2,396.70
|
|
|
ABD. HYSTERECTOMY (TOT.)
|
Facility
|
OP
|
$2,663.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
5258150
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$1,901.38 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$1,576.50
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$1,901.38
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,776.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
ABDOMINAL AND TRANSANAL APPROACH
|
Professional
|
Both
|
$4,349.00
|
|
|
Service Code
|
CPT 44147
|
| Hospital Charge Code |
4144147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,455.15 |
| Max. Negotiated Rate |
$1,695.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,695.08
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care |
$1,455.15
|
| Rate for Payer: Cash Price |
$3,914.10
|
| Rate for Payer: Cash Price |
$3,914.10
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$1,695.08
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$1,455.15
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$1,600.66
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$1,695.08
|
| Rate for Payer: Optum Medicare Advantage |
$1,522.15
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$1,455.15
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$18,388.43
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$18,388.43 |
| Max. Negotiated Rate |
$18,388.43 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$18,388.43
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$18,388.43
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$18,388.43
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$18,388.43
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,810.57
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$4,810.57 |
| Max. Negotiated Rate |
$4,810.57 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$4,810.57
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$4,810.57
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$4,810.57
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$4,810.57
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$11,942.85
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$11,942.85 |
| Max. Negotiated Rate |
$11,942.85 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$11,942.85
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$11,942.85
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$11,942.85
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$11,942.85
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$7,344.23
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$7,344.23 |
| Max. Negotiated Rate |
$7,344.23 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$7,344.23
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$7,344.23
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$7,344.23
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$7,344.23
|
|
|
ABD SUPPORT
|
Facility
|
IP
|
$166.00
|
|
| Hospital Charge Code |
281798
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$149.40
|
|
|
ABD SUPPORT
|
Facility
|
OP
|
$166.00
|
|
| Hospital Charge Code |
281798
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$118.52 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$98.27
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$118.52
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$59.76
|
|
|
ABD TOMOGRAPHY
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
321146
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$630.90
|
|
|
ABD TOMOGRAPHY
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
321146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.24 |
| Max. Negotiated Rate |
$500.51 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$94.24
|
| Rate for Payer: Aetna Medicare Advantage |
$106.81
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$414.99
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$500.51
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$106.81
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$94.24
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$100.84
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$106.81
|
| Rate for Payer: Humana Commercial |
$213.62
|
| Rate for Payer: Humana Medicare Advantage |
$106.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.00
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$94.24
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.36
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$7,927.79
|
|
|
Service Code
|
APR-DRG 5431
|
| Min. Negotiated Rate |
$7,927.79 |
| Max. Negotiated Rate |
$7,927.79 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$7,927.79
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$7,927.79
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$7,927.79
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$7,927.79
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$9,253.39
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$9,253.39 |
| Max. Negotiated Rate |
$9,253.39 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$9,253.39
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$9,253.39
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$9,253.39
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$9,253.39
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$26,999.33
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$26,999.33 |
| Max. Negotiated Rate |
$26,999.33 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$26,999.33
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$26,999.33
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$26,999.33
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$26,999.33
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$15,450.50
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$15,450.50 |
| Max. Negotiated Rate |
$15,450.50 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$15,450.50
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$15,450.50
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$15,450.50
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$15,450.50
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$19,336.12
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$9,668.06 |
| Max. Negotiated Rate |
$19,336.12 |
| Rate for Payer: Aetna Medicare Advantage |
$9,668.06
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$9,668.06
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$9,668.06
|
| Rate for Payer: Humana Commercial |
$19,336.12
|
| Rate for Payer: Humana Medicare Advantage |
$9,668.06
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$16,810.32
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$8,405.16 |
| Max. Negotiated Rate |
$16,810.32 |
| Rate for Payer: Aetna Medicare Advantage |
$8,405.16
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$8,405.16
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$8,405.16
|
| Rate for Payer: Humana Commercial |
$16,810.32
|
| Rate for Payer: Humana Medicare Advantage |
$8,405.16
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$5,413.96
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$5,413.96 |
| Max. Negotiated Rate |
$5,413.96 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$5,413.96
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$5,413.96
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$5,413.96
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$5,413.96
|
|
