|
Betamethasone Acet&Sod Phosp
|
Facility
|
IP
|
$171.39
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
Px0636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.54 |
| 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 |
$171.39
|
| Rate for Payer: Cash Price |
$171.39
|
| 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 |
$128.54
|
| Rate for Payer: Provider Network of America Commercial |
$137.11
|
|
|
betamethasone valerate 0.1 % cream 15 g Tube
|
Facility
|
IP
|
$71.60
|
|
|
Service Code
|
NDC 00713032615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.70
|
| Rate for Payer: Provider Network of America Commercial |
$57.28
|
|
|
betamethasone valerate 0.1 % cream 15 g Tube
|
Facility
|
OP
|
$71.60
|
|
|
Service Code
|
NDC 00713032615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$50.48
|
| Rate for Payer: Aetna Workers' Compensation |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$49.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$55.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$56.42
|
| Rate for Payer: Cash Price |
$71.60
|
| Rate for Payer: Cigna Commercial |
$43.82
|
| Rate for Payer: Cigna Medicare Advantage |
$40.81
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$45.11
|
| Rate for Payer: Home State Health Plan Exchange |
$40.81
|
| Rate for Payer: Humana Medicare |
$53.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$53.70
|
| Rate for Payer: Provider Network of America Commercial |
$57.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$71.60
|
|
|
bevacizumab-bvzr 25 mg/mL solution 4 mL Vial
|
Facility
|
OP
|
$2,453.60
|
|
|
Service Code
|
NDC 00069031501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,398.55 |
| Max. Negotiated Rate |
$2,453.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,729.79
|
| Rate for Payer: Aetna Workers' Compensation |
$1,729.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,700.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,700.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,889.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,933.44
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cigna Commercial |
$1,501.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,398.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,545.77
|
| Rate for Payer: Home State Health Plan Exchange |
$1,398.55
|
| Rate for Payer: Humana Medicare |
$1,840.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,840.20
|
| Rate for Payer: Provider Network of America Commercial |
$1,962.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,619.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,453.60
|
|
|
bevacizumab-bvzr 25 mg/mL solution 4 mL Vial
|
Facility
|
IP
|
$2,453.60
|
|
|
Service Code
|
NDC 00069031501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,840.20
|
| Rate for Payer: Provider Network of America Commercial |
$1,962.88
|
|
|
bevacizumab-bvzr 25 mg/mL solution 4 mL Vial
|
Facility
|
OP
|
$2,453.60
|
|
|
Service Code
|
HCPCS Q5118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,398.55 |
| Max. Negotiated Rate |
$2,453.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,729.79
|
| Rate for Payer: Aetna Workers' Compensation |
$1,729.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,700.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,700.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,933.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,889.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,933.44
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cigna Commercial |
$1,501.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,398.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,545.77
|
| Rate for Payer: Home State Health Plan Exchange |
$1,398.55
|
| Rate for Payer: Humana Medicare |
$1,840.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,840.20
|
| Rate for Payer: Provider Network of America Commercial |
$1,962.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,619.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,453.60
|
|
|
bevacizumab-bvzr 25 mg/mL solution 4 mL Vial
|
Facility
|
IP
|
$2,453.60
|
|
|
Service Code
|
HCPCS Q5118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cash Price |
$2,453.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,840.20
|
| Rate for Payer: Provider Network of America Commercial |
$1,962.88
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$25,194.82
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$25,194.82 |
| 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 |
$25,194.82
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$12,502.00
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,502.00 |
| Rate for Payer: Humana Medicare |
$12,502.00
|
| 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
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$10,233.31
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,233.31 |
| 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 |
$10,233.31
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$16,758.32
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,758.32 |
| 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 |
$16,758.32
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$7,462.19
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,462.19 |
| 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 |
$7,462.19
|
|
|
Binocular Microscopy Separate Dx Procedure
|
Facility
|
IP
|
$67.57
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
Px09839250401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$50.68 |
| 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 |
$67.57
|
| Rate for Payer: Cash Price |
$67.57
|
| 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 |
$50.68
|
| Rate for Payer: Provider Network of America Commercial |
$54.06
|
|
|
Binocular Microscopy Separate Dx Procedure
|
Facility
|
OP
|
$67.57
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
Px09839250401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$67.57 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$47.64
|
| Rate for Payer: Aetna Workers' Compensation |
$47.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$46.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$46.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$52.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.25
|
| Rate for Payer: Cash Price |
$67.57
|
| Rate for Payer: Cigna Medicare Advantage |
$38.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$42.57
|
| Rate for Payer: Home State Health Plan Exchange |
$38.51
|
| Rate for Payer: Humana Medicare |
$50.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$50.68
|
| Rate for Payer: Provider Network of America Commercial |
$54.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$67.57
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$11,558.24
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,558.24 |
| 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 |
$11,558.24
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$16,236.62
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,236.62 |
| 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 |
$16,236.62
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$8,736.83
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,736.83 |
| 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 |
$8,736.83
|
|
|
Biopsy Cervix Single/Mult/Excision of Lesion Spx
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
Px05105750001
|
|
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 |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| 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 |
$1,260.00
|
|
|
Biopsy Cervix Single/Mult/Excision of Lesion Spx
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
Px05105750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$875.12 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,110.38
|
| Rate for Payer: Aetna Workers' Compensation |
$1,110.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,091.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,091.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,241.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,241.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,241.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,212.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna Medicare Advantage |
$897.75
|
| Rate for Payer: Family Health Partners Medicaid |
$1,162.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$992.25
|
| Rate for Payer: Healthy Blue Medicaid |
$1,255.38
|
| Rate for Payer: Home State Health Plan Exchange |
$897.75
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,162.39
|
| Rate for Payer: Humana Medicare |
$1,181.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,162.39
|
| Rate for Payer: Provider Network of America Commercial |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,039.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,575.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$875.12
|
|
|
Biopsy Nasopharynx Visible Lesion Simple
|
Facility
|
OP
|
$113.64
|
|
|
Service Code
|
CPT 42804
|
| Hospital Charge Code |
Px03614280401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$4,518.94 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$80.12
|
| Rate for Payer: Aetna Workers' Compensation |
$80.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$87.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$89.55
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cigna Commercial |
$69.55
|
| Rate for Payer: Cigna Medicare Advantage |
$64.77
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$71.59
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$64.77
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$85.23
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$85.23
|
| Rate for Payer: Provider Network of America Commercial |
$90.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$113.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Biopsy Nasopharynx Visible Lesion Simple
|
Facility
|
IP
|
$113.64
|
|
|
Service Code
|
CPT 42804
|
| Hospital Charge Code |
Px03614280401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.23 |
| 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 |
$113.64
|
| Rate for Payer: Cash Price |
$113.64
|
| 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 |
$85.23
|
| Rate for Payer: Provider Network of America Commercial |
$90.91
|
|
|
Biopsy Nasopharynx Visible Lesion Simple
|
Facility
|
IP
|
$113.64
|
|
|
Service Code
|
CPT 42804
|
| Hospital Charge Code |
Px09834280401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$85.23 |
| 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 |
$108.23
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cash Price |
$108.23
|
| 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 |
$85.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$81.17
|
| Rate for Payer: Provider Network of America Commercial |
$90.91
|
| Rate for Payer: Provider Network of America Commercial |
$86.58
|
|
|
Biopsy Nasopharynx Visible Lesion Simple
|
Facility
|
OP
|
$113.64
|
|
|
Service Code
|
CPT 42804
|
| Hospital Charge Code |
Px09834280401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$4,518.94 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$80.12
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$76.30
|
| Rate for Payer: Aetna Workers' Compensation |
$80.12
|
| Rate for Payer: Aetna Workers' Compensation |
$76.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$85.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$85.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$85.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$83.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$87.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$89.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$85.29
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cash Price |
$113.64
|
| Rate for Payer: Cash Price |
$108.23
|
| Rate for Payer: Cash Price |
$108.23
|
| Rate for Payer: Cigna Commercial |
$69.55
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Cigna Medicare Advantage |
$61.69
|
| Rate for Payer: Cigna Medicare Advantage |
$64.77
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$71.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$68.18
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$64.77
|
| Rate for Payer: Home State Health Plan Exchange |
$61.69
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$81.17
|
| Rate for Payer: Humana Medicare |
$85.23
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$81.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$85.23
|
| Rate for Payer: Provider Network of America Commercial |
$86.58
|
| Rate for Payer: Provider Network of America Commercial |
$90.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$71.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$75.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$108.23
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$113.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Biopsy of Lip
|
Facility
|
IP
|
$76.06
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
Px09834049001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$72.44
|
| Rate for Payer: Cash Price |
$76.06
|
| Rate for Payer: Cash Price |
$76.06
|
| Rate for Payer: Cash Price |
$72.44
|
| 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 |
$57.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$54.33
|
| Rate for Payer: Provider Network of America Commercial |
$60.85
|
| Rate for Payer: Provider Network of America Commercial |
$57.95
|
|
|
Biopsy of Lip
|
Facility
|
OP
|
$76.06
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
Px09834049001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$322.83 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.62
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$51.07
|
| Rate for Payer: Aetna Workers' Compensation |
$53.62
|
| Rate for Payer: Aetna Workers' Compensation |
$51.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$50.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$50.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$57.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$55.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$57.08
|
| Rate for Payer: Cash Price |
$76.06
|
| Rate for Payer: Cash Price |
$76.06
|
| Rate for Payer: Cash Price |
$72.44
|
| Rate for Payer: Cash Price |
$72.44
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cigna Commercial |
$44.33
|
| Rate for Payer: Cigna Medicare Advantage |
$41.29
|
| Rate for Payer: Cigna Medicare Advantage |
$43.35
|
| Rate for Payer: Family Health Partners Medicaid |
$298.91
|
| Rate for Payer: Family Health Partners Medicaid |
$298.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$45.64
|
| Rate for Payer: Healthy Blue Medicaid |
$322.83
|
| Rate for Payer: Healthy Blue Medicaid |
$322.83
|
| Rate for Payer: Home State Health Plan Exchange |
$43.35
|
| Rate for Payer: Home State Health Plan Exchange |
$41.29
|
| Rate for Payer: Home State Health Plan Medicaid |
$298.91
|
| Rate for Payer: Home State Health Plan Medicaid |
$298.91
|
| Rate for Payer: Humana Medicare |
$54.33
|
| Rate for Payer: Humana Medicare |
$57.05
|
| Rate for Payer: Mercy CarePlus Medicaid |
$298.91
|
| Rate for Payer: Mercy CarePlus Medicaid |
$298.91
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$54.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.05
|
| Rate for Payer: Provider Network of America Commercial |
$57.95
|
| Rate for Payer: Provider Network of America Commercial |
$60.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$72.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.04
|
|
