|
Bone &/Joint Imaging Limited Area
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
Px09727830001
|
|
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
|
|
|
Bone &/Joint Imaging Limited Area
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
Px09727830001
|
|
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 Whole Body
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
Px09727830601
|
|
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
|
|
|
Bone &/Joint Imaging Whole Body
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
Px09727830601
|
|
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 Length Studies
|
Facility
|
OP
|
$207.48
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
Px09727707301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$207.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$146.27
|
| Rate for Payer: Aetna Workers' Compensation |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$143.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$143.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$163.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$163.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$163.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$159.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$163.49
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cigna Commercial |
$126.98
|
| Rate for Payer: Cigna Medicare Advantage |
$118.26
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$130.71
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$118.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$155.61
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$155.61
|
| Rate for Payer: Provider Network of America Commercial |
$165.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.94
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$207.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
Bone Length Studies
|
Facility
|
IP
|
$207.48
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
Px09727707301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$155.61 |
| 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 |
$207.48
|
| Rate for Payer: Cash Price |
$207.48
|
| 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 |
$155.61
|
| Rate for Payer: Provider Network of America Commercial |
$165.98
|
|
|
bortezomib per 0.1 mg
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.00 |
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| 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 |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$134.40
|
|
|
bortezomib per 0.1 mg
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS J9041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$118.44
|
| Rate for Payer: Aetna Workers' Compensation |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$132.38
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$102.82
|
| Rate for Payer: Cigna Medicare Advantage |
$95.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$105.84
|
| Rate for Payer: Home State Health Plan Exchange |
$95.76
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$134.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$168.00
|
|
|
bortezomib per 0.1 mg
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
NDC 55150033701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.00 |
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| 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 |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$134.40
|
|
|
bortezomib per 0.1 mg
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 55150033701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$118.44
|
| Rate for Payer: Aetna Workers' Compensation |
$118.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$116.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$132.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$129.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$132.38
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$102.82
|
| Rate for Payer: Cigna Medicare Advantage |
$95.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$105.84
|
| Rate for Payer: Home State Health Plan Exchange |
$95.76
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$134.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$168.00
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$11,893.01
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,893.01 |
| 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 |
$11,893.01
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,893.01
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,893.01
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,893.01
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$19,901.20
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,901.20 |
| 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 |
$19,901.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,901.20
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,901.20
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,901.20
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$7,067.02
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,067.02 |
| 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 |
$7,067.02
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,067.02
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,067.02
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,067.02
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 1321
|
| 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 |
$4,776.99
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,776.99
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,776.99
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,776.99
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$10,061.29
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,061.29 |
| 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 |
$10,061.29
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$9,066.77
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,066.77 |
| 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 |
$9,066.77
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$13,966.71
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,966.71 |
| 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 |
$13,966.71
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,966.71
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,966.71
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,966.71
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$22,180.14
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,180.14 |
| 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 |
$22,180.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,180.14
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,180.14
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,180.14
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$30,100.49
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$30,100.49 |
| 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 |
$30,100.49
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$30,100.49
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$30,100.49
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$30,100.49
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$31,708.23
|
|
|
Service Code
|
APR-DRG 3634
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$31,708.23 |
| 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 |
$31,708.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$31,708.23
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$31,708.23
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$31,708.23
|
|
|
Breast Tomosynthesis Bi
|
Facility
|
IP
|
$218.40
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
Px09727706301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| 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 |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
|
|
Breast Tomosynthesis Bi
|
Facility
|
OP
|
$218.40
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
Px09727706301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$153.97
|
| Rate for Payer: Aetna Workers' Compensation |
$153.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$168.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$172.10
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$133.66
|
| Rate for Payer: Cigna Medicare Advantage |
$124.49
|
| Rate for Payer: Family Health Partners Medicaid |
$62.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$137.59
|
| Rate for Payer: Healthy Blue Medicaid |
$67.57
|
| Rate for Payer: Home State Health Plan Exchange |
$124.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$62.57
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Mercy CarePlus Medicaid |
$62.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$144.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$218.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.10
|
|
|
Breathing Capacity Test Interp
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 94010 26
|
| Hospital Charge Code |
Px09839401001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$294.31 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.71
|
| Rate for Payer: Aetna Workers' Compensation |
$43.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$42.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$42.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$47.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$48.86
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$37.94
|
| Rate for Payer: Cigna Medicare Advantage |
$35.34
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.06
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$35.34
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$46.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Provider Network of America Commercial |
$49.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$62.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
Breathing Capacity Test Interp
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 94010 26
|
| Hospital Charge Code |
Px09839401001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| 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 |
$46.50
|
| Rate for Payer: Provider Network of America Commercial |
$49.60
|
|
|
brimonidine 0.15 % drops 5 mL DROP BTL
|
Facility
|
IP
|
$613.40
|
|
|
Service Code
|
NDC 61314014405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.05 |
| 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 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 |
$613.40
|
| Rate for Payer: Cash Price |
$613.40
|
| 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 |
$460.05
|
| Rate for Payer: Provider Network of America Commercial |
$490.72
|
|
