|
Biopsy Thyroid Percutaneous Core Needle
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
Px09836010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$28.60
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$28.60
|
| 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 |
$22.52
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$21.45
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: Provider Network of America Commercial |
$22.88
|
|
|
Biopsy Thyroid Percutaneous Core Needle
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
Px09836010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$20.16
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$19.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$19.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$22.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$22.54
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Commercial |
$17.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.30
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.02
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Exchange |
$16.30
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$21.45
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$21.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$22.88
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$28.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
Biopsy Tongue Anterior Two-Thirds
|
Facility
|
IP
|
$164.68
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
Px09834110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$156.84
|
| Rate for Payer: Cash Price |
$164.68
|
| Rate for Payer: Cash Price |
$164.68
|
| Rate for Payer: Cash Price |
$156.84
|
| 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 |
$123.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.63
|
| Rate for Payer: Provider Network of America Commercial |
$131.74
|
| Rate for Payer: Provider Network of America Commercial |
$125.47
|
|
|
Biopsy Tongue Anterior Two-Thirds
|
Facility
|
OP
|
$164.68
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
Px09834110001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.87 |
| Max. Negotiated Rate |
$735.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$116.10
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$110.57
|
| Rate for Payer: Aetna Workers' Compensation |
$116.10
|
| Rate for Payer: Aetna Workers' Compensation |
$110.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$114.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$108.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$114.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$108.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$123.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$123.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$123.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$120.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$126.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$123.59
|
| Rate for Payer: Cash Price |
$164.68
|
| Rate for Payer: Cash Price |
$164.68
|
| Rate for Payer: Cash Price |
$156.84
|
| Rate for Payer: Cash Price |
$156.84
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cigna Commercial |
$95.99
|
| Rate for Payer: Cigna Medicare Advantage |
$89.40
|
| Rate for Payer: Cigna Medicare Advantage |
$93.87
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$103.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$98.81
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Home State Health Plan Exchange |
$93.87
|
| Rate for Payer: Home State Health Plan Exchange |
$89.40
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Humana Medicare |
$117.63
|
| Rate for Payer: Humana Medicare |
$123.51
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.63
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$123.51
|
| Rate for Payer: Provider Network of America Commercial |
$125.47
|
| Rate for Payer: Provider Network of America Commercial |
$131.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$108.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$156.84
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$164.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
|
|
Biopsy Vestibule Mouth
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
Px00000040808
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$95.42
|
|
|
Biopsy Vulva/Perineum Each Addl Lesion
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
Px05105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$596.00 |
| 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 |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| 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 |
$596.00
|
|
|
Biopsy Vulva/Perineum Each Addl Lesion
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
Px05105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$424.65 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$525.23
|
| Rate for Payer: Aetna Workers' Compensation |
$525.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$516.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$516.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$587.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$587.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$587.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$573.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$587.06
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Medicare Advantage |
$424.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$469.35
|
| Rate for Payer: Home State Health Plan Exchange |
$424.65
|
| Rate for Payer: Humana Medicare |
$558.75
|
| Rate for Payer: Provider Network of America Commercial |
$596.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$491.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$745.00
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$10,923.19
|
|
|
Service Code
|
APR-DRG 7533
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,923.19 |
| 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: Family Health Partners Medicaid |
$10,923.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,923.19
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,923.19
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,923.19
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$21,294.45
|
|
|
Service Code
|
APR-DRG 7534
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,294.45 |
| 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 |
$21,294.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,294.45
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,294.45
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,294.45
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7531
|
| 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 |
$4,477.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,477.45
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,477.45
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,477.45
|
|
|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7532
|
| 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 |
$5,996.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,996.43
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,996.43
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,996.43
|
|
|
bisacodyl 10 mg suppository 12 Each Box
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00574705012
|
|
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
|
|
|
bisacodyl 10 mg suppository 12 Each Box
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00574705012
|
|
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
|
|
|
bisacodyl 5 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904640761
|
|
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
|
|
|
bisacodyl 5 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904640761
|
|
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
|
|
|
bismuth subsalicylate 525 mg/15 mL suspension 237 mL Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00536128736
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
bismuth subsalicylate 525 mg/15 mL suspension 237 mL Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00536128736
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
Bleomycin sulfate injection
|
Facility
|
IP
|
$753.90
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
Px0636J904001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$565.42 |
| 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 |
$753.90
|
| Rate for Payer: Cash Price |
$753.90
|
| 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 |
$565.42
|
| Rate for Payer: Provider Network of America Commercial |
$603.12
|
|
|
Bleomycin sulfate injection
|
Facility
|
OP
|
$753.90
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
Px0636J904001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$429.72 |
| Max. Negotiated Rate |
$753.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$531.50
|
| Rate for Payer: Aetna Workers' Compensation |
$531.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$522.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$594.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$594.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$594.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$594.07
|
| Rate for Payer: Cash Price |
$753.90
|
| Rate for Payer: Cigna Commercial |
$461.39
|
| Rate for Payer: Cigna Medicare Advantage |
$429.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$474.96
|
| Rate for Payer: Home State Health Plan Exchange |
$429.72
|
| Rate for Payer: Humana Medicare |
$565.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$565.42
|
| Rate for Payer: Provider Network of America Commercial |
$603.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$497.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$753.90
|
|
|
Blood Count Smear Mcrscp W/Mnl Difrntl Wbc Count - Vet
|
Facility
|
OP
|
$76.65
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
Px03058500702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$54.04
|
| Rate for Payer: Aetna Workers' Compensation |
$54.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$53.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$53.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$59.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$60.40
|
| Rate for Payer: Cash Price |
$76.65
|
| Rate for Payer: Cash Price |
$76.65
|
| Rate for Payer: Cigna Commercial |
$40.16
|
| Rate for Payer: Cigna Medicare Advantage |
$43.69
|
| Rate for Payer: Family Health Partners Medicaid |
$4.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$48.29
|
| Rate for Payer: Healthy Blue Medicaid |
$5.17
|
| Rate for Payer: Home State Health Plan Exchange |
$43.69
|
| Rate for Payer: Home State Health Plan Medicaid |
$4.79
|
| Rate for Payer: Humana Medicare |
$57.49
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4.79
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.49
|
| Rate for Payer: Provider Network of America Commercial |
$61.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
|
|
Blood Count Smear Mcrscp W/Mnl Difrntl Wbc Count - Vet
|
Facility
|
IP
|
$76.65
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
Px03058500702
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.49 |
| 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 |
$76.65
|
| Rate for Payer: Cash Price |
$76.65
|
| 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 |
$57.49
|
| Rate for Payer: Provider Network of America Commercial |
$61.32
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$6,092.61
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,092.61 |
| 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 |
$6,092.61
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 554
|
| 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 |
$3,901.47
|
|
|
Bone &/Joint Imaging 3 Phase Study
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
Px09727831501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$544.89 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.08
|
| Rate for Payer: Aetna Workers' Compensation |
$100.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.86
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cigna Commercial |
$86.88
|
| Rate for Payer: Cigna Medicare Advantage |
$80.92
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.43
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$80.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$106.47
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$141.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
Bone &/Joint Imaging 3 Phase Study
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
Px09727831501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.47 |
| 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 |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| 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 |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
|
