|
12-Lead Ecg Rhythm Strip
|
Facility
|
OP
|
$288.75
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
Px07309304105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$56.05 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$203.57
|
| Rate for Payer: Aetna Workers' Compensation |
$203.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$222.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$227.53
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna Commercial |
$176.72
|
| Rate for Payer: Cigna Medicare Advantage |
$164.59
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$181.91
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Home State Health Plan Exchange |
$164.59
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Humana Medicare |
$216.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$216.56
|
| Rate for Payer: Provider Network of America Commercial |
$231.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$288.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
|
|
12-Lead Ecg Rhythm Strip
|
Facility
|
IP
|
$288.75
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
Px07309304105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$216.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$216.56
|
| Rate for Payer: Provider Network of America Commercial |
$231.00
|
|
|
25 Hydroxy Includes Fractions if Performed
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
Px03018230607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$259.35
|
| Rate for Payer: Cash Price |
$259.35
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$194.51
|
| Rate for Payer: Provider Network of America Commercial |
$207.48
|
|
|
25 Hydroxy Includes Fractions if Performed
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
Px03018230607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$182.84
|
| Rate for Payer: Aetna Workers' Compensation |
$182.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$179.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$179.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$204.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$204.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$204.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$199.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$204.37
|
| Rate for Payer: Cash Price |
$259.35
|
| Rate for Payer: Cash Price |
$259.35
|
| Rate for Payer: Cigna Commercial |
$135.90
|
| Rate for Payer: Cigna Medicare Advantage |
$147.83
|
| Rate for Payer: Family Health Partners Medicaid |
$37.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$163.39
|
| Rate for Payer: Healthy Blue Medicaid |
$40.28
|
| Rate for Payer: Home State Health Plan Exchange |
$147.83
|
| Rate for Payer: Home State Health Plan Medicaid |
$37.30
|
| Rate for Payer: Humana Medicare |
$194.51
|
| Rate for Payer: Mercy CarePlus Medicaid |
$37.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$194.51
|
| Rate for Payer: Provider Network of America Commercial |
$207.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$171.17
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$29.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.08
|
|
|
3615810001
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
Px03615810001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.09 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$315.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$315.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$315.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$308.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$315.20
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: Cigna Medicare Advantage |
$228.00
|
| Rate for Payer: Family Health Partners Medicaid |
$255.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$252.00
|
| Rate for Payer: Healthy Blue Medicaid |
$275.56
|
| Rate for Payer: Home State Health Plan Exchange |
$228.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$255.15
|
| Rate for Payer: Humana Medicare |
$300.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$255.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$300.00
|
| Rate for Payer: Provider Network of America Commercial |
$320.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$264.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$400.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$192.09
|
|
|
3615810001
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
Px03615810001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$300.00
|
| Rate for Payer: Provider Network of America Commercial |
$320.00
|
|
|
9vhpv Vacc 2/3 Dose Sched Im Use
|
Facility
|
OP
|
$841.40
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
Px06369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$841.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$593.19
|
| Rate for Payer: Aetna Workers' Compensation |
$593.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$583.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$583.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$663.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$663.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$663.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$647.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$663.02
|
| Rate for Payer: Cash Price |
$841.40
|
| Rate for Payer: Cash Price |
$841.40
|
| Rate for Payer: Cigna Commercial |
$514.94
|
| Rate for Payer: Cigna Medicare Advantage |
$479.60
|
| Rate for Payer: Family Health Partners Medicaid |
$11.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$530.08
|
| Rate for Payer: Healthy Blue Medicaid |
$12.20
|
| Rate for Payer: Home State Health Plan Exchange |
$479.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$11.30
|
| Rate for Payer: Humana Medicare |
$631.05
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$631.05
|
| Rate for Payer: Provider Network of America Commercial |
$673.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$555.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$841.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.51
|
|
|
9vhpv Vacc 2/3 Dose Sched Im Use
|
Facility
|
IP
|
$841.40
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
Px06369065101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$631.05 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$841.40
|
| Rate for Payer: Cash Price |
$841.40
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$631.05
|
| Rate for Payer: Provider Network of America Commercial |
$673.12
|
|
|
AA 4.25 % no.1-D5W-lytes no.39 4.25 % parenteral solution 2,000 mL Bag
|
Facility
|
IP
|
$319.60
|
|
|
Service Code
|
NDC 00338111304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$239.70 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$239.70
|
| Rate for Payer: Provider Network of America Commercial |
$255.68
|
|
|
AA 4.25 % no.1-D5W-lytes no.39 4.25 % parenteral solution 2,000 mL Bag
|
Facility
|
OP
|
$319.60
|
|
|
Service Code
|
NDC 00338111304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$182.17 |
| Max. Negotiated Rate |
$319.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$225.32
|
| Rate for Payer: Aetna Workers' Compensation |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$221.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$251.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$251.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$251.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$246.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$251.84
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cigna Commercial |
$195.60
|
| Rate for Payer: Cigna Medicare Advantage |
$182.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$201.35
|
| Rate for Payer: Home State Health Plan Exchange |
$182.17
|
| Rate for Payer: Humana Medicare |
$239.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$239.70
|
| Rate for Payer: Provider Network of America Commercial |
$255.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$210.94
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$319.60
|
|
|
Abatacept injection
|
Facility
|
OP
|
$4,238.01
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
Px0636J012901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,415.67 |
| Max. Negotiated Rate |
$4,238.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,987.80
|
| Rate for Payer: Aetna Workers' Compensation |
$2,987.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,936.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,936.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,339.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,339.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,339.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,263.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,339.55
|
| Rate for Payer: Cash Price |
$4,238.01
|
| Rate for Payer: Cigna Commercial |
$2,593.66
|
| Rate for Payer: Cigna Medicare Advantage |
$2,415.67
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,669.95
|
| Rate for Payer: Home State Health Plan Exchange |
$2,415.67
|
| Rate for Payer: Humana Medicare |
$3,178.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,178.51
|
| Rate for Payer: Provider Network of America Commercial |
$3,390.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,797.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,238.01
|
|
|
Abatacept injection
|
Facility
|
IP
|
$4,238.01
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
Px0636J012901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4,238.01
|
| Rate for Payer: Cash Price |
$4,238.01
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,178.51
|
| Rate for Payer: Provider Network of America Commercial |
$3,390.41
|
|
|
abatacept per 10 mg
|
Facility
|
OP
|
$6,417.00
|
|
|
Service Code
|
NDC 00003218713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,657.69 |
| Max. Negotiated Rate |
$6,417.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,523.98
|
| Rate for Payer: Aetna Workers' Compensation |
$4,523.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,446.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,446.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,941.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,056.60
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cigna Commercial |
$3,927.20
|
| Rate for Payer: Cigna Medicare Advantage |
$3,657.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,042.71
|
| Rate for Payer: Home State Health Plan Exchange |
$3,657.69
|
| Rate for Payer: Humana Medicare |
$4,812.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.75
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,235.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,417.00
|
|
|
abatacept per 10 mg
|
Facility
|
OP
|
$6,417.00
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,657.69 |
| Max. Negotiated Rate |
$6,417.00 |
| Rate for Payer: Aetna Workers' Compensation |
$4,523.98
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,523.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,446.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,446.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,056.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,941.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,056.60
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cigna Commercial |
$3,927.20
|
| Rate for Payer: Cigna Medicare Advantage |
$3,657.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,042.71
|
| Rate for Payer: Home State Health Plan Exchange |
$3,657.69
|
| Rate for Payer: Humana Medicare |
$4,812.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.75
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,235.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,417.00
|
|
|
abatacept per 10 mg
|
Facility
|
IP
|
$6,417.00
|
|
|
Service Code
|
NDC 00003218713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.75
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.60
|
|
|
abatacept per 10 mg
|
Facility
|
IP
|
$6,417.00
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cash Price |
$6,417.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.75
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.60
|
|
|
Abdom,B-Scan &/or Real Time,Complete - US Abdomen
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
Px09727670001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Abdom,B-Scan &/or Real Time,Complete - US Abdomen
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
Px09727670001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$16,146.72
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,146.72 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$16,146.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$16,146.72
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,146.72
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,146.72
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$7,560.72
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,560.72 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$7,560.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,560.72
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,560.72
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,560.72
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$10,091.12
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,091.12 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$10,091.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,091.12
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,091.12
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,091.12
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$6,038.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,038.03
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,038.03
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,038.03
|
|
|
Abdom Paracentesis Dx/Ther W/Imaging Guidance
|
Facility
|
OP
|
$98.80
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
Px09834908301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$1,236.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.65
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$69.65
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Cigna Medicare Advantage |
$56.32
|
| Rate for Payer: Family Health Partners Medicaid |
$1,144.64
|
| Rate for Payer: Family Health Partners Medicaid |
$1,144.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$1,236.21
|
| Rate for Payer: Healthy Blue Medicaid |
$1,236.21
|
| Rate for Payer: Home State Health Plan Exchange |
$56.32
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,144.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,144.64
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Humana Medicare |
$74.10
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,144.64
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,144.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.10
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$861.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$861.75
|
|
|
Abdom Paracentesis Dx/Ther W/Imaging Guidance
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
Px09724908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Abdom Paracentesis Dx/Ther W/Imaging Guidance
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
Px09724908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$1,236.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$1,144.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$1,236.21
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,144.64
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,144.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$861.75
|
|
