|
NURSING FAC. DISH. > 30 MIN.
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
4499316
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$207.00
|
|
|
NURSING FAC. DISH. > 30 MIN.
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
4499316
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$136.16 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$136.16
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$164.22
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$153.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME DISC OVER 30 MIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
4299316
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$198.00
|
|
|
NURSING HOME DISC OVER 30 MIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
4299316
|
|
Hospital Revenue Code
|
525
|
| 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
|
|
|
NURSING HOME DISC UNDER 30 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
4299315
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$148.50
|
|
|
NURSING HOME DISC UNDER 30 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
4299315
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$97.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$117.81
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME EST BRIEF
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4299311
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$51.30
|
|
|
NURSING HOME EST BRIEF
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4299311
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$33.74
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$40.70
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME EST COMPREHENSIVE
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
4299310
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$220.50
|
|
|
NURSING HOME EST COMPREHENSIVE
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
4299310
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$145.04
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$174.93
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$163.41
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME EST EXTENDED
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4299313
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$67.49
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$81.40
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME EST EXTENDED
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4299313
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$102.60
|
|
|
NURSING HOME EST INTERMEDIATE
|
Facility
|
OP
|
$88.50
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
4299312
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$52.39
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$63.19
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME EST INTERMEDIATE
|
Facility
|
IP
|
$88.50
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
4299312
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$79.65
|
|
|
NURSING HOME NEW 30 + MIN
|
Facility
|
IP
|
$169.50
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
4299303
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$152.55
|
|
|
NURSING HOME NEW 30 + MIN
|
Facility
|
OP
|
$169.50
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
4299303
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$100.34 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$100.34
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$121.02
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$113.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME NEW BRIEF
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
4299301
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$81.90
|
|
|
NURSING HOME NEW BRIEF
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
4499304
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$109.52 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$109.52
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$132.09
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$123.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME NEW BRIEF
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
4299301
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$53.87
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$64.97
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NURSING HOME NEW BRIEF
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
4499304
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$166.50
|
|
|
NURSING HOME NEW UNDER 30 MIN
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
4299302
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$109.35
|
|
|
NURSING HOME NEW UNDER 30 MIN
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
4299302
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$71.93 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$71.93
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$86.75
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$81.04
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
NUT. 1000CC RTH.
|
Facility
|
OP
|
$43.00
|
|
| Hospital Charge Code |
2819901
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$25.46
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$30.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.48
|
|
|
NUT. 1000CC RTH.
|
Facility
|
IP
|
$43.00
|
|
| Hospital Charge Code |
2819901
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$38.70
|
|
|
NUT 4 OZ.
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
2819907
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$14.40
|
|
