|
PACK, LAP #4 MID 88241
|
Facility
|
IP
|
$244.00
|
|
| Hospital Charge Code |
1216038
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$219.60
|
|
|
PACK, OB INSTRUMENT
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
2816045
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$148.50
|
|
|
PACK, OB INSTRUMENT
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
2816045
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$117.81 |
| 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: UnitedHealthcare Commercial |
$110.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$59.40
|
|
|
PACK, TRANSVERSE
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
2816047
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$195.30
|
|
|
PACK, TRANSVERSE
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
2816047
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$154.94 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$128.46
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$154.94
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$144.74
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$78.12
|
|
|
PACLITAXEL (TAXOL) 300MG/50ML IVPB
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
NDC 6.1703E+10
|
| Hospital Charge Code |
2697611
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$209.88 |
| Max. Negotiated Rate |
$416.26 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$345.14
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$416.26
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$388.86
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$209.88
|
|
|
PACLITAXEL (TAXOL) 300MG/50ML IVPB
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
NDC 6.1703E+10
|
| Hospital Charge Code |
2697611
|
|
Hospital Revenue Code
|
335
|
| Rate for Payer: Cash Price |
$524.70
|
|
|
PAD, GEL
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2816400
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$23.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$28.56
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.40
|
|
|
PAD, GEL
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2816400
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$36.00
|
|
|
PAD, GROUNDING ADULT
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
127800
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$68.40
|
|
|
PAD, GROUNDING ADULT
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
127797
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$54.26 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$44.99
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$54.26
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.36
|
|
|
PAD, GROUNDING ADULT
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
127800
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$54.26 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$44.99
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$54.26
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.36
|
|
|
PAD, GROUNDING ADULT
|
Facility
|
IP
|
$76.00
|
|
| Hospital Charge Code |
127797
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$68.40
|
|
|
PAD, GROUNDING PEDIATRIC
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
127792
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$79.97 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$66.30
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$79.97
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$40.32
|
|
|
PAD, GROUNDING PEDIATRIC
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
127792
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$100.80
|
|
|
PAD HEEL-ELBOW
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
2816171
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$52.20
|
|
|
PAD HEEL-ELBOW
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
2816171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$41.41 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$34.34
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$41.41
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.88
|
|
|
PAD, PREP #51301
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2816278
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$36.00
|
|
|
PAD, PREP #51301
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
2816278
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$28.56 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$23.68
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$28.56
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.40
|
|
|
PADS, K
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
2816838
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$39.27 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$32.56
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$39.27
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$19.80
|
|
|
PADS, K
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
2816838
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$49.50
|
|
|
PADS, PER O.B.
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2816680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$14.99 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$12.43
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$14.99
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$7.56
|
|
|
PADS, PER O.B.
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2816680
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$18.90
|
|
|
PADS, PER REG.
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2816679
|
|
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
|
|
|
PADS, PER REG.
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2816679
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$19.80
|
|
