|
FECAL Na
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
2284900
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$193.50
|
|
|
FECAL Na
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
2284900
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$153.51 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$4.37
|
| Rate for Payer: Aetna Medicare Advantage |
$4.86
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$127.28
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$153.51
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$4.86
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$4.37
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$4.68
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Humana Commercial |
$9.72
|
| Rate for Payer: Humana Medicare Advantage |
$4.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$77.40
|
|
|
FECAL WBC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
305990
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$78.30
|
|
|
FECAL WBC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
305990
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$62.12 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$3.84
|
| Rate for Payer: Aetna Medicare Advantage |
$4.27
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$51.50
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$62.12
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$4.27
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$3.84
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$4.11
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Humana Commercial |
$8.54
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$3.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$31.32
|
|
|
FEEDING TUBE ENERGETIC
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
286810
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$86.39 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$71.63
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$86.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$80.71
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$43.56
|
|
|
FEEDING TUBE ENERGETIC
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
286810
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$108.90
|
|
|
FEEDING TUBE INFANT
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
286804
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$25.20
|
|
|
FEEDING TUBE INFANT
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
286804
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$16.58
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$19.99
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$10.08
|
|
|
FELODIPINE (PLENDIL) ER 5MG TAB
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 6.8462E+10
|
| Hospital Charge Code |
2626616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$11.84
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$14.28
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.20
|
|
|
FELODIPINE (PLENDIL) ER 5MG TAB
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 6.8462E+10
|
| Hospital Charge Code |
2626616
|
|
Hospital Revenue Code
|
250
|
| Rate for Payer: Cash Price |
$18.00
|
|
|
FELT, ORTHOPEDIC-1/4 ROLL
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
4070007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$75.68 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$62.75
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$75.68
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.16
|
|
|
FELT, ORTHOPEDIC-1/4 ROLL
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
4070007
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$95.40
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$21,786.29
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$21,786.29 |
| Max. Negotiated Rate |
$21,786.29 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$21,786.29
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$21,786.29
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$21,786.29
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$21,786.29
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$5,972.39
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$5,972.39 |
| Max. Negotiated Rate |
$5,972.39 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$5,972.39
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$5,972.39
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$5,972.39
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$5,972.39
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$3,512.25
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$3,512.25 |
| Max. Negotiated Rate |
$3,512.25 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$3,512.25
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$3,512.25
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$3,512.25
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$3,512.25
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$10,886.21
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$10,886.21 |
| Max. Negotiated Rate |
$10,886.21 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$10,886.21
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$10,886.21
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$10,886.21
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$10,886.21
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$7,986.00
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$7,986.00 |
| Max. Negotiated Rate |
$7,986.00 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$7,986.00
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$7,986.00
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$7,986.00
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$7,986.00
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$15,800.03
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$15,800.03 |
| Max. Negotiated Rate |
$15,800.03 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$15,800.03
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$15,800.03
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$15,800.03
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$15,800.03
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$19,962.21
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$19,962.21 |
| Max. Negotiated Rate |
$19,962.21 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$19,962.21
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$19,962.21
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$19,962.21
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$19,962.21
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$10,649.53
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$10,649.53 |
| Max. Negotiated Rate |
$10,649.53 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$10,649.53
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$10,649.53
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$10,649.53
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$10,649.53
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$25,356.30
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$12,678.15 |
| Max. Negotiated Rate |
$25,356.30 |
| Rate for Payer: Aetna Medicare Advantage |
$12,678.15
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$12,678.15
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$12,678.15
|
| Rate for Payer: Humana Commercial |
$25,356.30
|
| Rate for Payer: Humana Medicare Advantage |
$12,678.15
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$12,162.05
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$12,162.05 |
| Max. Negotiated Rate |
$12,162.05 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$12,162.05
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$12,162.05
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$12,162.05
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$12,162.05
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$21,173.33
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$21,173.33 |
| Max. Negotiated Rate |
$21,173.33 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$21,173.33
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$21,173.33
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$21,173.33
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$21,173.33
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$39,034.12
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$39,034.12 |
| Max. Negotiated Rate |
$39,034.12 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$39,034.12
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$39,034.12
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$39,034.12
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$39,034.12
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$21,173.33
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$21,173.33 |
| Max. Negotiated Rate |
$21,173.33 |
| Rate for Payer: Aetna Better Health Medicaid/QHP |
$21,173.33
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$21,173.33
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$21,173.33
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$21,173.33
|
|
