|
CONNECTOR, TUBING 5-IN-1
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
283301
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$13.02
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$15.71
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.92
|
|
|
CONNECTOR, TUBING 5-IN-1
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
283301
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$19.80
|
|
|
CONSCIOUS SEDATION<5YRO
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 99143
|
| Hospital Charge Code |
1212123
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$459.90
|
|
|
CONSCIOUS SEDATION<5YRO
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 99143
|
| Hospital Charge Code |
1212123
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$364.85 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$302.51
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$364.85
|
| Rate for Payer: Cash Price |
$459.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$340.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$183.96
|
|
|
CONSCIOUS SEDATION>5YRO
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 99144
|
| Hospital Charge Code |
1212124
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$503.10
|
|
|
CONSCIOUS SEDATION>5YRO
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 99144
|
| Hospital Charge Code |
1212124
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$201.24 |
| Max. Negotiated Rate |
$399.13 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$330.93
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$399.13
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$372.85
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$201.24
|
|
|
CONSCIOUS SEDATION ADD ON 15 MIN
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 99145
|
| Hospital Charge Code |
1212125
|
|
Hospital Revenue Code
|
370
|
| Rate for Payer: Cash Price |
$152.10
|
|
|
CONSCIOUS SEDATION ADD ON 15 MIN
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 99145
|
| Hospital Charge Code |
1212125
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$120.67 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$100.05
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$120.67
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$60.84
|
|
|
CONSULTATION COMPLEX
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9699245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$266.40
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$321.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$300.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION COMPLEX
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9699245
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$405.00
|
|
|
CONSULTATION COMPREHENSIVE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9699244
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$207.20
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$249.90
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$233.45
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION COMPREHENSIVE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9699244
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$315.00
|
|
|
CONSULTATION COMPREHENSIVE 40 MINUTES
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
5499243
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$236.70
|
|
|
CONSULTATION COMPREHENSIVE 40 MINUTES
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
5499243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$187.78 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$155.70
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$187.78
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$175.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION COMPREHENSIVE 80 MINUTES
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
5499245
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$425.70
|
|
|
CONSULTATION COMPREHENSIVE 80 MINUTES
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
5499245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$337.72 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$280.02
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$337.72
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$315.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION EXTENDED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
9699243
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$225.00
|
|
|
CONSULTATION EXTENDED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
9699243
|
|
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
|
|
|
CONSULTATION INITIAL COMPLEX
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9799245
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$296.00
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$357.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$333.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION INITIAL COMPLEX
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
9799245
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$450.00
|
|
|
CONSULTATION INITIAL COMPREHENSIVE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9799244
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$236.80
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$285.60
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$266.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION INITIAL COMPREHENSIVE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
9799244
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$360.00
|
|
|
CONSULTATION INITIAL EXTENDED
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
9799243
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$270.00
|
|
|
CONSULTATION INITIAL EXTENDED
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
9799243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$177.60
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$214.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
CONSULTATION INITIAL INTERMEDIATE
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
9799242
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$133.20
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$160.65
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
