|
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
|
|
|
Abltj Sof Tiss Inf Turbs Uni/Bi Supfc Intramural
|
Facility
|
IP
|
$186.44
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
Px09833080201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.83 |
| 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 |
$177.56
|
| Rate for Payer: Cash Price |
$186.44
|
| Rate for Payer: Cash Price |
$186.44
|
| Rate for Payer: Cash Price |
$177.56
|
| 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 |
$139.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$133.17
|
| Rate for Payer: Provider Network of America Commercial |
$149.15
|
| Rate for Payer: Provider Network of America Commercial |
$142.05
|
|
|
Abltj Sof Tiss Inf Turbs Uni/Bi Supfc Intramural
|
Facility
|
OP
|
$186.44
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
Px09833080201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$2,114.79 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$131.44
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$125.18
|
| Rate for Payer: Aetna Workers' Compensation |
$131.44
|
| Rate for Payer: Aetna Workers' Compensation |
$125.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$129.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$146.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$146.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$146.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$136.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$143.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$146.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$139.92
|
| Rate for Payer: Cash Price |
$186.44
|
| Rate for Payer: Cash Price |
$186.44
|
| Rate for Payer: Cash Price |
$177.56
|
| Rate for Payer: Cash Price |
$177.56
|
| Rate for Payer: Cigna Commercial |
$114.10
|
| Rate for Payer: Cigna Commercial |
$108.67
|
| Rate for Payer: Cigna Medicare Advantage |
$101.21
|
| Rate for Payer: Cigna Medicare Advantage |
$106.27
|
| Rate for Payer: Family Health Partners Medicaid |
$1,958.14
|
| Rate for Payer: Family Health Partners Medicaid |
$1,958.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$117.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$111.86
|
| Rate for Payer: Healthy Blue Medicaid |
$2,114.79
|
| Rate for Payer: Healthy Blue Medicaid |
$2,114.79
|
| Rate for Payer: Home State Health Plan Exchange |
$106.27
|
| Rate for Payer: Home State Health Plan Exchange |
$101.21
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,958.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,958.14
|
| Rate for Payer: Humana Medicare |
$133.17
|
| Rate for Payer: Humana Medicare |
$139.83
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,958.14
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,958.14
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$133.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$139.83
|
| Rate for Payer: Provider Network of America Commercial |
$142.05
|
| Rate for Payer: Provider Network of America Commercial |
$149.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$117.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$123.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$177.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$186.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,474.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,474.20
|
|
|
Abltj Soft Tis Inferior Turbinates Uni/Bi Supfc
|
Facility
|
IP
|
$132.10
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
Px09833080101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$99.08 |
| 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 |
$125.81
|
| Rate for Payer: Cash Price |
$132.10
|
| Rate for Payer: Cash Price |
$132.10
|
| Rate for Payer: Cash Price |
$125.81
|
| 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 |
$99.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.36
|
| Rate for Payer: Provider Network of America Commercial |
$105.68
|
| Rate for Payer: Provider Network of America Commercial |
$100.65
|
|
|
Abltj Soft Tis Inferior Turbinates Uni/Bi Supfc
|
Facility
|
OP
|
$132.10
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
Px09833080101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$2,114.79 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$93.13
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.70
|
| Rate for Payer: Aetna Workers' Compensation |
$93.13
|
| Rate for Payer: Aetna Workers' Compensation |
$88.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$96.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$101.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$104.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.14
|
| Rate for Payer: Cash Price |
$132.10
|
| Rate for Payer: Cash Price |
$132.10
|
| Rate for Payer: Cash Price |
$125.81
|
| Rate for Payer: Cash Price |
$125.81
|
| Rate for Payer: Cigna Commercial |
$80.85
|
| Rate for Payer: Cigna Commercial |
$77.00
|
| Rate for Payer: Cigna Medicare Advantage |
$71.71
|
| Rate for Payer: Cigna Medicare Advantage |
$75.30
|
| Rate for Payer: Family Health Partners Medicaid |
$1,958.14
|
| Rate for Payer: Family Health Partners Medicaid |
$1,958.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$83.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.26
|
| Rate for Payer: Healthy Blue Medicaid |
$2,114.79
|
| Rate for Payer: Healthy Blue Medicaid |
$2,114.79
|
| Rate for Payer: Home State Health Plan Exchange |
$75.30
|
| Rate for Payer: Home State Health Plan Exchange |
$71.71
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,958.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,958.14
|
| Rate for Payer: Humana Medicare |
$94.36
|
| Rate for Payer: Humana Medicare |
$99.08
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,958.14
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,958.14
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$99.08
|
| Rate for Payer: Provider Network of America Commercial |
$100.65
|
| Rate for Payer: Provider Network of America Commercial |
$105.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$125.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$132.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,474.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,474.20
|
|
|
Abo 8x10
|
Facility
|
IP
|
$3.25
|
|
| Hospital Charge Code |
Px02720000046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.25
|
| 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 |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
Abo 8x10
|
Facility
|
OP
|
$3.25
|
|
| Hospital Charge Code |
Px02720000046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$27,908.46
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,908.46 |
| 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 |
$27,908.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$27,908.46
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$27,908.46
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$27,908.46
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 770
|
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,712.69
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$11,660.96
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,660.96 |
| 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 |
$11,660.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,660.96
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,660.96
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,660.96
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 5431
|
| 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 |
$5,977.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,977.94
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,977.94
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,977.94
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$7,501.55
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,501.55 |
| 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 |
$7,501.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,501.55
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,501.55
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,501.55
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 779
|
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$3,351.57
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$8,412.20
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,412.20 |
| 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 |
$8,412.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,412.20
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,412.20
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,412.20
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$16,570.15
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,570.15 |
| 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 |
$16,570.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$16,570.15
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,570.15
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,570.15
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 5641
|
| 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 |
$3,621.34
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$3,621.34
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,621.34
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,621.34
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 5642
|
| 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 |
$4,936.93
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,936.93
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,936.93
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,936.93
|
|
|
acetaminophen 1,000 mg/100 mL (10 mg/mL) solution 100 mL Bag
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
NDC 63323043441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.80 |
| 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 |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| 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 |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
|
|
acetaminophen 1,000 mg/100 mL (10 mg/mL) solution 100 mL Bag
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
NDC 63323043441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$27.07
|
| Rate for Payer: Aetna Workers' Compensation |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$29.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$30.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$24.19
|
| Rate for Payer: Home State Health Plan Exchange |
$21.89
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$38.40
|
|
|
acetaminophen 1,000 mg/100 mL (10 mg/mL) solution 100 mL Bag
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
HCPCS J0134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.80 |
| 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 |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| 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 |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
|
|
acetaminophen 1,000 mg/100 mL (10 mg/mL) solution 100 mL Bag
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
HCPCS J0134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$27.07
|
| Rate for Payer: Aetna Workers' Compensation |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$29.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$30.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$23.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$24.19
|
| Rate for Payer: Home State Health Plan Exchange |
$21.89
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$38.40
|
|
|
acetic acid (bulk) 5 % liquid 50 mL Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 51552005503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
acetic acid (bulk) 5 % liquid 50 mL Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 51552005503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| 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 |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
Acetylcholine Receptor Binding Antibody
|
Facility
|
IP
|
$789.25
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
Px03028604101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$591.94 |
| 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 |
$789.25
|
| Rate for Payer: Cash Price |
$789.25
|
| 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 |
$591.94
|
| Rate for Payer: Provider Network of America Commercial |
$631.40
|
|
|
Acetylcholine Receptor Binding Antibody
|
Facility
|
OP
|
$789.25
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
Px03028604101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$631.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$556.42
|
| Rate for Payer: Aetna Workers' Compensation |
$556.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$546.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$546.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$621.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$621.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$621.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$607.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$621.93
|
| Rate for Payer: Cash Price |
$789.25
|
| Rate for Payer: Cash Price |
$789.25
|
| Rate for Payer: Cigna Commercial |
$413.57
|
| Rate for Payer: Cigna Medicare Advantage |
$449.87
|
| Rate for Payer: Family Health Partners Medicaid |
$23.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$497.23
|
| Rate for Payer: Healthy Blue Medicaid |
$25.04
|
| Rate for Payer: Home State Health Plan Exchange |
$449.87
|
| Rate for Payer: Home State Health Plan Medicaid |
$23.18
|
| Rate for Payer: Humana Medicare |
$591.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$23.18
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$591.94
|
| Rate for Payer: Provider Network of America Commercial |
$631.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$520.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.45
|
|
