|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$7,752.65
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,752.65 |
| 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 |
$7,752.65
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,506.36
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 5391
|
| 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 |
$5,936.34
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,936.34
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,936.34
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,936.34
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$7,741.00
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,741.00 |
| 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 |
$7,741.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,741.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,741.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,741.00
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$32,010.55
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$32,010.55 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$32,010.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$32,010.55
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$32,010.55
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32,010.55
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$14,931.91
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,931.91 |
| 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 |
$14,931.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,931.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,931.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,931.91
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,982.47
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$11,538.97
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,538.97 |
| 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 |
$11,538.97
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,501.66
|
|
|
Cetuximab injection
|
Facility
|
OP
|
$1,534.68
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
Px0636J905501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$874.77 |
| Max. Negotiated Rate |
$1,534.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,081.95
|
| Rate for Payer: Aetna Workers' Compensation |
$1,081.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,063.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,063.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,209.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,209.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,209.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,181.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,209.33
|
| Rate for Payer: Cash Price |
$1,534.68
|
| Rate for Payer: Cigna Commercial |
$939.22
|
| Rate for Payer: Cigna Medicare Advantage |
$874.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$966.85
|
| Rate for Payer: Home State Health Plan Exchange |
$874.77
|
| Rate for Payer: Humana Medicare |
$1,151.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,151.01
|
| Rate for Payer: Provider Network of America Commercial |
$1,227.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,012.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,534.68
|
|
|
Cetuximab injection
|
Facility
|
IP
|
$1,534.68
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
Px0636J905501
|
|
Hospital Revenue Code
|
636
|
| 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 |
$1,534.68
|
| Rate for Payer: Cash Price |
$1,534.68
|
| 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 |
$1,151.01
|
| Rate for Payer: Provider Network of America Commercial |
$1,227.74
|
|
|
Change Cystostomy Tube Complicated
|
Facility
|
OP
|
$93.45
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
Px09835171001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.27 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$65.88
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$62.74
|
| Rate for Payer: Aetna Workers' Compensation |
$65.88
|
| Rate for Payer: Aetna Workers' Compensation |
$62.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$64.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$61.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$64.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$61.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$70.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$70.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$70.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$68.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$71.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$73.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$70.13
|
| Rate for Payer: Cash Price |
$93.45
|
| Rate for Payer: Cash Price |
$93.45
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$57.19
|
| Rate for Payer: Cigna Commercial |
$54.47
|
| Rate for Payer: Cigna Medicare Advantage |
$50.73
|
| Rate for Payer: Cigna Medicare Advantage |
$53.27
|
| Rate for Payer: Family Health Partners Medicaid |
$880.00
|
| Rate for Payer: Family Health Partners Medicaid |
$880.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$58.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$56.07
|
| Rate for Payer: Healthy Blue Medicaid |
$950.40
|
| Rate for Payer: Healthy Blue Medicaid |
$950.40
|
| Rate for Payer: Home State Health Plan Exchange |
$53.27
|
| Rate for Payer: Home State Health Plan Exchange |
$50.73
|
| Rate for Payer: Home State Health Plan Medicaid |
$880.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$880.00
|
| Rate for Payer: Humana Medicare |
$66.75
|
| Rate for Payer: Humana Medicare |
$70.09
|
| Rate for Payer: Mercy CarePlus Medicaid |
$880.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$880.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$70.09
|
| Rate for Payer: Provider Network of America Commercial |
$71.20
|
| Rate for Payer: Provider Network of America Commercial |
$74.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$61.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$89.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$93.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$662.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$662.51
|
|
|
Change Cystostomy Tube Complicated
|
Facility
|
IP
|
$93.45
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
Px09835171001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$70.09 |
| 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 |
$89.00
|
| Rate for Payer: Cash Price |
$93.45
|
| Rate for Payer: Cash Price |
$93.45
|
| Rate for Payer: Cash Price |
$89.00
|
| 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 |
$70.09
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Provider Network of America Commercial |
$74.76
|
| Rate for Payer: Provider Network of America Commercial |
$71.20
|
|
|
charcoal activated 25 gram/120 mL suspension 120 mL Tube
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 00574052174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$53.44
|
| Rate for Payer: Cash Price |
$53.44
|
| 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 |
$40.08
|
| Rate for Payer: Provider Network of America Commercial |
$42.75
|
|
|
charcoal activated 25 gram/120 mL suspension 120 mL Tube
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 00574052174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$53.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$37.68
|
| Rate for Payer: Aetna Workers' Compensation |
$37.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$37.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$37.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$41.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$42.11
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Cigna Commercial |
$32.71
|
| Rate for Payer: Cigna Medicare Advantage |
$30.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$33.67
|
| Rate for Payer: Home State Health Plan Exchange |
$30.46
|
| Rate for Payer: Humana Medicare |
$40.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$40.08
|
| Rate for Payer: Provider Network of America Commercial |
$42.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$53.44
|
|
|
charcoal activated 25 gram/120 mL suspension 240 mL Tube
|
Facility
|
OP
|
$75.68
|
|
|
Service Code
|
NDC 00574052176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.14 |
| Max. Negotiated Rate |
$75.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.35
|
| Rate for Payer: Aetna Workers' Compensation |
$53.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.64
|
| Rate for Payer: Cash Price |
$75.68
|
| Rate for Payer: Cigna Commercial |
$46.32
|
| Rate for Payer: Cigna Medicare Advantage |
$43.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.68
|
| Rate for Payer: Home State Health Plan Exchange |
$43.14
|
| Rate for Payer: Humana Medicare |
$56.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$56.76
|
| Rate for Payer: Provider Network of America Commercial |
$60.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.95
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$75.68
|
|
|
charcoal activated 25 gram/120 mL suspension 240 mL Tube
|
Facility
|
IP
|
$75.68
|
|
|
Service Code
|
NDC 00574052176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.76 |
| 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 |
$75.68
|
| Rate for Payer: Cash Price |
$75.68
|
| 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 |
$56.76
|
| Rate for Payer: Provider Network of America Commercial |
$60.54
|
|
|
Chem Cautery Granulatn Tissue
|
Facility
|
IP
|
$583.80
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
Px07611725001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.85 |
| 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 |
$460.00
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$460.00
|
| 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 |
$437.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$345.00
|
| Rate for Payer: Provider Network of America Commercial |
$467.04
|
| Rate for Payer: Provider Network of America Commercial |
$368.00
|
|
|
Chem Cautery Granulatn Tissue
|
Facility
|
OP
|
$583.80
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
Px07611725001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.63 |
| Max. Negotiated Rate |
$583.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$411.58
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$324.30
|
| Rate for Payer: Aetna Workers' Compensation |
$411.58
|
| Rate for Payer: Aetna Workers' Compensation |
$324.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$404.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$318.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$404.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$318.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$460.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$362.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$460.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$362.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$362.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$460.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$354.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$449.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$460.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$362.48
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$357.29
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cigna Medicare Advantage |
$262.20
|
| Rate for Payer: Cigna Medicare Advantage |
$332.77
|
| Rate for Payer: Family Health Partners Medicaid |
$253.20
|
| Rate for Payer: Family Health Partners Medicaid |
$253.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$367.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$289.80
|
| Rate for Payer: Healthy Blue Medicaid |
$273.46
|
| Rate for Payer: Healthy Blue Medicaid |
$273.46
|
| Rate for Payer: Home State Health Plan Exchange |
$332.77
|
| Rate for Payer: Home State Health Plan Exchange |
$262.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$253.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$253.20
|
| Rate for Payer: Humana Medicare |
$345.00
|
| Rate for Payer: Humana Medicare |
$437.85
|
| Rate for Payer: Mercy CarePlus Medicaid |
$253.20
|
| Rate for Payer: Mercy CarePlus Medicaid |
$253.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$345.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$437.85
|
| Rate for Payer: Provider Network of America Commercial |
$368.00
|
| Rate for Payer: Provider Network of America Commercial |
$467.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$303.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$385.31
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$460.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$583.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.63
|
|
|
Chemotherapy drug
|
Facility
|
IP
|
$483.50
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
Px0636J999901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$362.62 |
| 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 |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.62
|
| Rate for Payer: Provider Network of America Commercial |
$386.80
|
|
|
Chemotherapy drug
|
Facility
|
OP
|
$483.50
|
|
|
Service Code
|
HCPCS J9999
|
| Hospital Charge Code |
Px0636J999901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$340.87
|
| Rate for Payer: Aetna Workers' Compensation |
$340.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$335.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$381.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$381.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$381.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$372.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$381.00
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$295.90
|
| Rate for Payer: Cigna Medicare Advantage |
$275.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$304.61
|
| Rate for Payer: Home State Health Plan Exchange |
$275.60
|
| Rate for Payer: Humana Medicare |
$362.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.62
|
| Rate for Payer: Provider Network of America Commercial |
$386.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$319.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$483.50
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$57,694.61
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$57,694.61 |
| 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: Family Health Partners Medicaid |
$57,694.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$57,694.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$57,694.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$57,694.61
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$8,528.69
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,528.69 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$8,528.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,528.69
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,528.69
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,528.69
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$13,739.28
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,739.28 |
| 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 |
$13,739.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,739.28
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,739.28
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,739.28
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$26,298.87
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,298.87 |
| 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 |
$26,298.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,298.87
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,298.87
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,298.87
|
|
