|
ascorbic acid 500 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 06894011359
|
|
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
|
|
|
Aspiration Bladder Insert Suprapubic Catheter
|
Facility
|
OP
|
$4,252.50
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
Px05105110201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,986.14 |
| Max. Negotiated Rate |
$4,252.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,998.01
|
| Rate for Payer: Aetna Workers' Compensation |
$2,998.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,946.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,946.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,350.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,350.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,350.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,274.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,350.97
|
| Rate for Payer: Cash Price |
$4,252.50
|
| Rate for Payer: Cash Price |
$4,252.50
|
| Rate for Payer: Cigna Medicare Advantage |
$2,423.93
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,679.07
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$2,423.93
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$3,189.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Provider Network of America Commercial |
$3,402.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,806.65
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,252.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Aspiration Bladder Insert Suprapubic Catheter
|
Facility
|
IP
|
$151.88
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
Px09835110201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$113.91 |
| 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 |
$144.65
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cash Price |
$144.65
|
| 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 |
$113.91
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$108.49
|
| Rate for Payer: Provider Network of America Commercial |
$121.50
|
| Rate for Payer: Provider Network of America Commercial |
$115.72
|
|
|
Aspiration Bladder Insert Suprapubic Catheter
|
Facility
|
OP
|
$151.88
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
Px09835110201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$86.57 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$107.08
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$101.98
|
| Rate for Payer: Aetna Workers' Compensation |
$107.08
|
| Rate for Payer: Aetna Workers' Compensation |
$101.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$105.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$100.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$105.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$100.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$119.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$119.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$113.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$119.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$111.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$116.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$119.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$113.98
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cigna Commercial |
$92.95
|
| Rate for Payer: Cigna Commercial |
$88.53
|
| Rate for Payer: Cigna Medicare Advantage |
$82.45
|
| Rate for Payer: Cigna Medicare Advantage |
$86.57
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$95.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$91.13
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$86.57
|
| Rate for Payer: Home State Health Plan Exchange |
$82.45
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$108.49
|
| Rate for Payer: Humana Medicare |
$113.91
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$108.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$113.91
|
| Rate for Payer: Provider Network of America Commercial |
$115.72
|
| Rate for Payer: Provider Network of America Commercial |
$121.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$95.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$144.65
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$151.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Aspiration Bladder Insert Suprapubic Catheter
|
Facility
|
IP
|
$4,252.50
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
Px05105110201
|
|
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 |
$4,252.50
|
| Rate for Payer: Cash Price |
$4,252.50
|
| 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: Provider Network of America Commercial |
$3,402.00
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$2,849.18
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,986.14 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
aspirin 300 mg suppository 12 Each Box
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 00574703412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| 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 |
$4.67
|
| Rate for Payer: Cash Price |
$4.67
|
| 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 |
$3.50
|
| Rate for Payer: Provider Network of America Commercial |
$3.74
|
|
|
aspirin 300 mg suppository 12 Each Box
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 00574703412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.29
|
| Rate for Payer: Aetna Workers' Compensation |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.68
|
| Rate for Payer: Cash Price |
$4.67
|
| Rate for Payer: Cigna Commercial |
$2.86
|
| Rate for Payer: Cigna Medicare Advantage |
$2.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.94
|
| Rate for Payer: Home State Health Plan Exchange |
$2.66
|
| Rate for Payer: Humana Medicare |
$3.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.50
|
| Rate for Payer: Provider Network of America Commercial |
$3.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.67
|
|
|
aspirin 325 mg tablet,delayed release (DR/EC) 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00536123201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$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
|
|
|
aspirin 325 mg tablet,delayed release (DR/EC) 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00536123201
|
|
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
|
|
|
aspirin 81 mg tablet,chewable 300 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904679430
|
|
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
|
|
|
aspirin 81 mg tablet,chewable 300 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904679430
|
|
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
|
|
|
aspirin-dipyridamole 25-200 mg capsule, ER multiphase 12 hr 20 Each BLIST PACK
|
Facility
|
IP
|
$42.24
|
|
|
Service Code
|
NDC 00904705699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.68 |
| 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 |
$42.24
|
| Rate for Payer: Cash Price |
$42.24
|
| 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 |
$31.68
|
| Rate for Payer: Provider Network of America Commercial |
$33.79
|
|
|
aspirin-dipyridamole 25-200 mg capsule, ER multiphase 12 hr 20 Each BLIST PACK
|
Facility
|
OP
|
$42.24
|
|
|
Service Code
|
NDC 00904705699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$29.78
|
| Rate for Payer: Aetna Workers' Compensation |
$29.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$32.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$33.29
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cigna Commercial |
$25.85
|
| Rate for Payer: Cigna Medicare Advantage |
$24.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$26.61
|
| Rate for Payer: Home State Health Plan Exchange |
$24.08
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$31.68
|
| Rate for Payer: Provider Network of America Commercial |
$33.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$42.24
|
|
|
Assay Biovlbl Testosterone Direct Measurement
|
Facility
|
IP
|
$474.08
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
Px03018441001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$355.56 |
| 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 |
$474.08
|
| Rate for Payer: Cash Price |
$474.08
|
| 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 |
$355.56
|
| Rate for Payer: Provider Network of America Commercial |
$379.26
|
|
|
Assay Biovlbl Testosterone Direct Measurement
|
Facility
|
OP
|
$474.08
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
Px03018441001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$379.26 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$334.23
|
| Rate for Payer: Aetna Workers' Compensation |
$334.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$328.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$328.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$373.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$373.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$373.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$365.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$373.58
|
| Rate for Payer: Cash Price |
$474.08
|
| Rate for Payer: Cash Price |
$474.08
|
| Rate for Payer: Cigna Commercial |
$248.42
|
| Rate for Payer: Cigna Medicare Advantage |
$270.23
|
| Rate for Payer: Family Health Partners Medicaid |
$64.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$298.67
|
| Rate for Payer: Healthy Blue Medicaid |
$69.78
|
| Rate for Payer: Home State Health Plan Exchange |
$270.23
|
| Rate for Payer: Home State Health Plan Medicaid |
$64.61
|
| Rate for Payer: Humana Medicare |
$355.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$64.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$355.56
|
| Rate for Payer: Provider Network of America Commercial |
$379.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$312.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$51.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.64
|
|
|
Assay of Calcium in Urine - Calcium 24 Hr Urine
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
Px03018234003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.25 |
| 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 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 |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| 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 |
$47.25
|
| Rate for Payer: Provider Network of America Commercial |
$50.40
|
|
|
Assay of Calcium in Urine - Calcium 24 Hr Urine
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
Px03018234003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$44.41
|
| Rate for Payer: Aetna Workers' Compensation |
$44.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$49.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$49.64
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$33.01
|
| Rate for Payer: Cigna Medicare Advantage |
$35.91
|
| Rate for Payer: Family Health Partners Medicaid |
$7.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.69
|
| Rate for Payer: Healthy Blue Medicaid |
$8.21
|
| Rate for Payer: Home State Health Plan Exchange |
$35.91
|
| Rate for Payer: Home State Health Plan Medicaid |
$7.60
|
| Rate for Payer: Humana Medicare |
$47.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7.60
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Provider Network of America Commercial |
$50.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.72
|
|
|
Assay of Prostate Specific Antigen Total
|
Facility
|
IP
|
$170.37
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
Px03018415307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.78 |
| 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 |
$170.37
|
| Rate for Payer: Cash Price |
$170.37
|
| 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 |
$127.78
|
| Rate for Payer: Provider Network of America Commercial |
$136.30
|
|
|
Assay of Prostate Specific Antigen Total
|
Facility
|
OP
|
$170.37
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
Px03018415307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$120.11
|
| Rate for Payer: Aetna Workers' Compensation |
$120.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$118.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$118.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$134.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$131.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$134.25
|
| Rate for Payer: Cash Price |
$170.37
|
| Rate for Payer: Cash Price |
$170.37
|
| Rate for Payer: Cigna Commercial |
$89.27
|
| Rate for Payer: Cigna Medicare Advantage |
$97.11
|
| Rate for Payer: Family Health Partners Medicaid |
$23.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$107.33
|
| Rate for Payer: Healthy Blue Medicaid |
$25.02
|
| Rate for Payer: Home State Health Plan Exchange |
$97.11
|
| Rate for Payer: Home State Health Plan Medicaid |
$23.17
|
| Rate for Payer: Humana Medicare |
$127.78
|
| Rate for Payer: Mercy CarePlus Medicaid |
$23.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$127.78
|
| Rate for Payer: Provider Network of America Commercial |
$136.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.44
|
|
|
Assay of Thyroid Stimulating Hormone Tsh
|
Facility
|
IP
|
$183.75
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
Px03018444307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.81 |
| 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 |
$183.75
|
| Rate for Payer: Cash Price |
$183.75
|
| 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 |
$137.81
|
| Rate for Payer: Provider Network of America Commercial |
$147.00
|
|
|
Assay of Thyroid Stimulating Hormone Tsh
|
Facility
|
OP
|
$183.75
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
Px03018444307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$129.54
|
| Rate for Payer: Aetna Workers' Compensation |
$129.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$127.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$127.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$141.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$144.79
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: Cigna Medicare Advantage |
$104.74
|
| Rate for Payer: Family Health Partners Medicaid |
$21.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.76
|
| Rate for Payer: Healthy Blue Medicaid |
$22.86
|
| Rate for Payer: Home State Health Plan Exchange |
$104.74
|
| Rate for Payer: Home State Health Plan Medicaid |
$21.17
|
| Rate for Payer: Humana Medicare |
$137.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.81
|
| Rate for Payer: Provider Network of America Commercial |
$147.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$121.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.94
|
|
|
Assay Thyroid Stim Hormone - Thyroid Stimulating Hormone
|
Facility
|
OP
|
$183.75
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
Px03018444303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Cigna Medicare Advantage |
$104.74
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$129.54
|
| Rate for Payer: Aetna Workers' Compensation |
$129.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$127.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$127.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$144.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$141.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$144.79
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Cash Price |
$183.75
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: Family Health Partners Medicaid |
$21.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.76
|
| Rate for Payer: Healthy Blue Medicaid |
$22.86
|
| Rate for Payer: Home State Health Plan Exchange |
$104.74
|
| Rate for Payer: Home State Health Plan Medicaid |
$21.17
|
| Rate for Payer: Humana Medicare |
$137.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.81
|
| Rate for Payer: Provider Network of America Commercial |
$147.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$121.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.94
|
|
|
Assay Thyroid Stim Hormone - Thyroid Stimulating Hormone
|
Facility
|
IP
|
$183.75
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
Px03018444303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.81 |
| 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 |
$183.75
|
| Rate for Payer: Cash Price |
$183.75
|
| 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 |
$137.81
|
| Rate for Payer: Provider Network of America Commercial |
$147.00
|
|
|
ASTHMA
|
Facility
|
IP
|
$9,744.43
|
|
|
Service Code
|
APR-DRG 1413
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,744.43 |
| 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 |
$9,744.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,744.43
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,744.43
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,744.43
|
|
