|
STURE, SILK 2-0 BLK BR FSL 30 INCH
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
2819060
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$7.70
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$9.28
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.67
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.68
|
|
|
STURE, SILK 2-0 BLK BR FSL 30 INCH
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
2819060
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$11.70
|
|
|
SUBCLAVIAN JUGULAR
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2819806
|
|
Hospital Revenue Code
|
271
|
| Rate for Payer: Cash Price |
$77.40
|
|
|
SUBCLAVIAN JUGULAR
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2819806
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$50.91
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$61.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$30.96
|
|
|
SUBESQUENT HOSPITAL CARE
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
4199232
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$68.53
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care |
$58.46
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$68.53
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$58.46
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$64.31
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$68.53
|
| Rate for Payer: Optum Medicare Advantage |
$68.25
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$58.46
|
|
|
SUBMANDIBULAR GLAND
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
CPT 42440
|
| Hospital Charge Code |
4142440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$710.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$350.24
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care |
$313.40
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$350.24
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$313.40
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$344.74
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$350.24
|
| Rate for Payer: Optum Medicare Advantage |
$710.50
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$313.40
|
|
|
SUBMUCOUS RESEC INFERIOR TURBANATE
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
9330140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$147.27
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care |
$246.55
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial HMO & PPO |
$147.27
|
| Rate for Payer: Healthy Blue CHP/Medicaid Managed Care |
$246.55
|
| Rate for Payer: Home State Health Plan Medicaid Managed Care |
$271.20
|
| Rate for Payer: Home State Health Plan Medicare Advantage |
$147.27
|
| Rate for Payer: Optum Medicare Advantage |
$505.75
|
| Rate for Payer: UnitedHealthcare Medicaid Managed Care |
$246.55
|
|
|
SUB NH VISIT
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
9799310
|
|
Hospital Revenue Code
|
521
|
| Rate for Payer: Cash Price |
$234.00
|
|
|
SUB NH VISIT
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
9799310
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$153.92
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$185.64
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB NH VISIT MODERATE
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
5499309
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$166.50
|
|
|
SUB NH VISIT MODERATE
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4499309
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$112.48
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$135.66
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$126.73
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB NH VISIT MODERATE
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4499309
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$171.00
|
|
|
SUB NH VISIT MODERATE
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
5499309
|
|
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
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4499307
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$90.00
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4499311
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$51.30
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
5499308
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$82.88
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$99.96
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.38
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
4499308
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$135.00
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
5499308
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$126.00
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4499311
|
|
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
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
4499307
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$59.20
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$71.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB. NURSING FAC. CARE (BRIEF)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
4499308
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$173.53 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$88.80
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$107.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB. NURSING FAC. CARE COMPREHENSIVE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
4499310
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$234.00
|
|
|
SUB. NURSING FAC. CARE COMPREHENSIVE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
4499310
|
|
Hospital Revenue Code
|
525
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X |
$153.92
|
| Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional |
$185.64
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$173.53
|
|
|
SUB. NURSING FAC. CARE (INTER)
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4499313
|
|
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
|
|
|
SUB. NURSING FAC. CARE (INTER)
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
4499313
|
|
Hospital Revenue Code
|
525
|
| Rate for Payer: Cash Price |
$102.60
|
|
