|
Application Cast Finger
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
Px09832908601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.55 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.00
|
| Rate for Payer: Provider Network of America Commercial |
$57.12
|
| Rate for Payer: Provider Network of America Commercial |
$54.40
|
|
|
Application Cast Finger
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
Px09832908601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$221.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$50.34
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$47.94
|
| Rate for Payer: Aetna Workers' Compensation |
$50.34
|
| Rate for Payer: Aetna Workers' Compensation |
$47.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$49.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$47.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$49.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$47.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$56.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$56.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$56.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$52.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$54.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$56.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.58
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cigna Commercial |
$41.62
|
| Rate for Payer: Cigna Medicare Advantage |
$38.76
|
| Rate for Payer: Cigna Medicare Advantage |
$40.70
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$44.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$42.84
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Home State Health Plan Exchange |
$40.70
|
| Rate for Payer: Home State Health Plan Exchange |
$38.76
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Humana Medicare |
$51.00
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.55
|
| Rate for Payer: Provider Network of America Commercial |
$54.40
|
| Rate for Payer: Provider Network of America Commercial |
$57.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$68.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$71.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
|
|
Application Finger Splint Dynamic
|
Facility
|
OP
|
$70.88
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
Px09832913101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$49.97
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$47.59
|
| Rate for Payer: Aetna Workers' Compensation |
$49.97
|
| Rate for Payer: Aetna Workers' Compensation |
$47.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$46.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$49.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$46.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$55.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$55.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$55.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$51.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$54.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$55.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.19
|
| Rate for Payer: Cash Price |
$70.88
|
| Rate for Payer: Cash Price |
$70.88
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$43.38
|
| Rate for Payer: Cigna Commercial |
$41.31
|
| Rate for Payer: Cigna Medicare Advantage |
$38.48
|
| Rate for Payer: Cigna Medicare Advantage |
$40.40
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$44.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$42.52
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Home State Health Plan Exchange |
$40.40
|
| Rate for Payer: Home State Health Plan Exchange |
$38.48
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Humana Medicare |
$50.62
|
| Rate for Payer: Humana Medicare |
$53.16
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$50.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.16
|
| Rate for Payer: Provider Network of America Commercial |
$54.00
|
| Rate for Payer: Provider Network of America Commercial |
$56.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$67.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$70.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
|
|
Application Finger Splint Dynamic
|
Facility
|
IP
|
$70.88
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
Px09832913101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cash Price |
$70.88
|
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$70.88
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.16
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$50.62
|
| Rate for Payer: Provider Network of America Commercial |
$56.70
|
| Rate for Payer: Provider Network of America Commercial |
$54.00
|
|
|
Application Long Leg Cast Thigh-Toe
|
Facility
|
OP
|
$201.60
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
Px09832934501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$114.91 |
| Max. Negotiated Rate |
$381.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$142.13
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$135.36
|
| Rate for Payer: Aetna Workers' Compensation |
$142.13
|
| Rate for Payer: Aetna Workers' Compensation |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$139.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$133.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$139.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$133.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$158.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$158.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$151.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$158.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$155.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$158.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$151.30
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$123.38
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| Rate for Payer: Cigna Medicare Advantage |
$109.44
|
| Rate for Payer: Cigna Medicare Advantage |
$114.91
|
| Rate for Payer: Family Health Partners Medicaid |
$352.98
|
| Rate for Payer: Family Health Partners Medicaid |
$352.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.01
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$120.96
|
| Rate for Payer: Healthy Blue Medicaid |
$381.22
|
| Rate for Payer: Healthy Blue Medicaid |
$381.22
|
| Rate for Payer: Home State Health Plan Exchange |
$114.91
|
| Rate for Payer: Home State Health Plan Exchange |
$109.44
|
| Rate for Payer: Home State Health Plan Medicaid |
$352.98
|
| Rate for Payer: Home State Health Plan Medicaid |
$352.98
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Humana Medicare |
$151.20
|
| Rate for Payer: Mercy CarePlus Medicaid |
$352.98
|
| Rate for Payer: Mercy CarePlus Medicaid |
$352.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$144.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$151.20
|
| Rate for Payer: Provider Network of America Commercial |
$153.60
|
| Rate for Payer: Provider Network of America Commercial |
$161.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$126.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.06
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$192.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$201.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.75
|
|
|
Application Long Leg Cast Thigh-Toe
|
Facility
|
IP
|
$201.60
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
Px09832934501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.20 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$151.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$144.00
|
| Rate for Payer: Provider Network of America Commercial |
$161.28
|
| Rate for Payer: Provider Network of America Commercial |
$153.60
|
|
|
Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
Px07612958101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.25 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$462.51
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$462.51
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$346.88
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
| Rate for Payer: Provider Network of America Commercial |
$370.01
|
|
|
Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
Px07612958101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$340.51
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$326.07
|
| Rate for Payer: Aetna Workers' Compensation |
$340.51
|
| Rate for Payer: Aetna Workers' Compensation |
$326.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$320.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$320.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$364.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$364.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$364.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$356.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$371.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$364.46
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$462.51
|
| Rate for Payer: Cash Price |
$462.51
|
| Rate for Payer: Cigna Commercial |
$295.60
|
| Rate for Payer: Cigna Commercial |
$283.06
|
| Rate for Payer: Cigna Medicare Advantage |
$263.63
|
| Rate for Payer: Cigna Medicare Advantage |
$275.31
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$304.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$291.38
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Home State Health Plan Exchange |
$275.31
|
| Rate for Payer: Home State Health Plan Exchange |
$263.63
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Humana Medicare |
$346.88
|
| Rate for Payer: Humana Medicare |
$362.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$346.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Provider Network of America Commercial |
$370.01
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$305.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$318.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$462.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$483.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
|
|
App Skn Sub Grft T/a/L Area/100sq Cm /<1st 25
|
Facility
|
IP
|
$3,994.64
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
Px07611527101
|
|
Hospital Revenue Code
|
761
|
| 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 |
$3,994.64
|
| Rate for Payer: Cash Price |
$3,994.64
|
| 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 |
$2,995.98
|
| Rate for Payer: Provider Network of America Commercial |
$3,195.71
|
|
|
App Skn Sub Grft T/a/L Area/100sq Cm /<1st 25
|
Facility
|
OP
|
$3,994.64
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
Px07611527101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$702.21 |
| Max. Negotiated Rate |
$3,994.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,816.22
|
| Rate for Payer: Aetna Workers' Compensation |
$2,816.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,768.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,768.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,147.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,147.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,147.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,075.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,147.78
|
| Rate for Payer: Cash Price |
$3,994.64
|
| Rate for Payer: Cash Price |
$3,994.64
|
| Rate for Payer: Cigna Commercial |
$2,444.72
|
| Rate for Payer: Cigna Medicare Advantage |
$2,276.94
|
| Rate for Payer: Family Health Partners Medicaid |
$932.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,516.62
|
| Rate for Payer: Healthy Blue Medicaid |
$1,007.34
|
| Rate for Payer: Home State Health Plan Exchange |
$2,276.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$932.72
|
| Rate for Payer: Humana Medicare |
$2,995.98
|
| Rate for Payer: Mercy CarePlus Medicaid |
$932.72
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,995.98
|
| Rate for Payer: Provider Network of America Commercial |
$3,195.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,636.46
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,994.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$702.21
|
|
|
ARIPiprazole 10 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268008911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
ARIPiprazole 10 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268008911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
ARIPiprazole 2 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 50268008711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.93
|
| Rate for Payer: Aetna Workers' Compensation |
$2.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.27
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cigna Commercial |
$2.54
|
| Rate for Payer: Cigna Medicare Advantage |
$2.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.61
|
| Rate for Payer: Home State Health Plan Exchange |
$2.37
|
| Rate for Payer: Humana Medicare |
$3.11
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.11
|
| Rate for Payer: Provider Network of America Commercial |
$3.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.15
|
|
|
ARIPiprazole 2 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 50268008711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| 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 |
$4.15
|
| Rate for Payer: Cash Price |
$4.15
|
| 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 |
$3.11
|
| Rate for Payer: Provider Network of America Commercial |
$3.32
|
|
|
Arthrd Midtarsl/Tarsometatarsal Mult/Transvrs
|
Facility
|
OP
|
$791.18
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
Px09832873001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$450.97 |
| Max. Negotiated Rate |
$17,499.00 |
| Rate for Payer: Cash Price |
$791.18
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$557.78
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$531.22
|
| Rate for Payer: Aetna Workers' Compensation |
$557.78
|
| Rate for Payer: Aetna Workers' Compensation |
$531.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$548.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$522.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$548.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$522.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$623.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$593.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$623.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$593.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$593.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$623.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$609.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$623.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$593.76
|
| Rate for Payer: Cash Price |
$791.18
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cigna Commercial |
$484.20
|
| Rate for Payer: Cigna Commercial |
$461.14
|
| Rate for Payer: Cigna Medicare Advantage |
$429.50
|
| Rate for Payer: Cigna Medicare Advantage |
$450.97
|
| Rate for Payer: Family Health Partners Medicaid |
$16,202.77
|
| Rate for Payer: Family Health Partners Medicaid |
$16,202.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$498.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$474.70
|
| Rate for Payer: Healthy Blue Medicaid |
$17,499.00
|
| Rate for Payer: Healthy Blue Medicaid |
$17,499.00
|
| Rate for Payer: Home State Health Plan Exchange |
$450.97
|
| Rate for Payer: Home State Health Plan Exchange |
$429.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,202.77
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,202.77
|
| Rate for Payer: Humana Medicare |
$565.12
|
| Rate for Payer: Humana Medicare |
$593.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,202.77
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,202.77
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$565.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$593.38
|
| Rate for Payer: Provider Network of America Commercial |
$602.80
|
| Rate for Payer: Provider Network of America Commercial |
$632.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$497.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$522.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$753.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$791.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,198.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,198.37
|
|
|
Arthrd Midtarsl/Tarsometatarsal Mult/Transvrs
|
Facility
|
IP
|
$791.18
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
Px09832873001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$593.38 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cash Price |
$791.18
|
| Rate for Payer: Cash Price |
$791.18
|
| Rate for Payer: Cash Price |
$753.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$593.38
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$565.12
|
| Rate for Payer: Provider Network of America Commercial |
$632.94
|
| Rate for Payer: Provider Network of America Commercial |
$602.80
|
|
|
Arthrodesis Subtalar
|
Facility
|
IP
|
$352.28
|
|
|
Service Code
|
CPT 28725
|
| Hospital Charge Code |
Px09832872501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$264.21 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$352.28
|
| Rate for Payer: Cash Price |
$352.28
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$264.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$251.62
|
| Rate for Payer: Provider Network of America Commercial |
$281.82
|
| Rate for Payer: Provider Network of America Commercial |
$268.40
|
|
|
Arthrodesis Subtalar
|
Facility
|
OP
|
$352.28
|
|
|
Service Code
|
CPT 28725
|
| Hospital Charge Code |
Px09832872501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$17,499.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$248.36
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$236.53
|
| Rate for Payer: Aetna Workers' Compensation |
$248.36
|
| Rate for Payer: Aetna Workers' Compensation |
$236.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$244.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$244.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$232.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$277.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$264.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$277.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$264.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$264.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$277.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$258.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$271.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$277.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$264.37
|
| Rate for Payer: Cash Price |
$352.28
|
| Rate for Payer: Cash Price |
$352.28
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$215.60
|
| Rate for Payer: Cigna Commercial |
$205.33
|
| Rate for Payer: Cigna Medicare Advantage |
$191.24
|
| Rate for Payer: Cigna Medicare Advantage |
$200.80
|
| Rate for Payer: Family Health Partners Medicaid |
$16,202.77
|
| Rate for Payer: Family Health Partners Medicaid |
$16,202.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$221.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$211.37
|
| Rate for Payer: Healthy Blue Medicaid |
$17,499.00
|
| Rate for Payer: Healthy Blue Medicaid |
$17,499.00
|
| Rate for Payer: Home State Health Plan Exchange |
$200.80
|
| Rate for Payer: Home State Health Plan Exchange |
$191.24
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,202.77
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,202.77
|
| Rate for Payer: Humana Medicare |
$251.62
|
| Rate for Payer: Humana Medicare |
$264.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,202.77
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,202.77
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$251.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$264.21
|
| Rate for Payer: Provider Network of America Commercial |
$268.40
|
| Rate for Payer: Provider Network of America Commercial |
$281.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$232.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$335.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$352.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,198.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,198.37
|
|
|
Arthroscopy Knee Removal Loose/Foreign Body
|
Facility
|
OP
|
$6,655.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
Px05102987401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,108.82 |
| Max. Negotiated Rate |
$6,655.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,691.77
|
| Rate for Payer: Aetna Workers' Compensation |
$4,691.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,611.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,611.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,244.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,244.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,244.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,124.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,244.14
|
| Rate for Payer: Cash Price |
$6,655.00
|
| Rate for Payer: Cash Price |
$6,655.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3,793.35
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,192.65
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Home State Health Plan Exchange |
$3,793.35
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Humana Medicare |
$4,991.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Provider Network of America Commercial |
$5,324.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,392.30
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,655.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
|
|
Arthroscopy Knee Removal Loose/Foreign Body
|
Facility
|
IP
|
$6,655.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
Px05102987401
|
|
Hospital Revenue Code
|
510
|
| 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 |
$6,655.00
|
| Rate for Payer: Cash Price |
$6,655.00
|
| 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: Provider Network of America Commercial |
$5,324.00
|
|
|
Arthroscopy Knee Synovectomy 2/>Compartments
|
Facility
|
OP
|
$6,982.50
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
Px03602987601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,108.82 |
| Max. Negotiated Rate |
$6,982.50 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,838.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,838.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,502.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,502.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,502.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,376.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,502.21
|
| Rate for Payer: Cash Price |
$6,982.50
|
| Rate for Payer: Cash Price |
$6,982.50
|
| Rate for Payer: Cigna Commercial |
$4,629.40
|
| Rate for Payer: Cigna Medicare Advantage |
$3,980.03
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,398.98
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Home State Health Plan Exchange |
$3,980.03
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Humana Medicare |
$5,236.88
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,236.88
|
| Rate for Payer: Provider Network of America Commercial |
$5,586.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,608.45
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,982.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
|
|
Arthroscopy Knee Synovectomy 2/>Compartments
|
Facility
|
IP
|
$6,982.50
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
Px03602987601
|
|
Hospital Revenue Code
|
360
|
| 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 |
$6,982.50
|
| Rate for Payer: Cash Price |
$6,982.50
|
| 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 |
$5,236.88
|
| Rate for Payer: Provider Network of America Commercial |
$5,586.00
|
|
|
ascorbic acid 500 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904052361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
ascorbic acid 500 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 06894011359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
ascorbic acid 500 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904052361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
