|
Closed Tx Temporomandibular Dislocation 1st/Sbsq
|
Facility
|
OP
|
$180.08
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
Px09832148001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$126.96
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$120.91
|
| Rate for Payer: Aetna Workers' Compensation |
$126.96
|
| Rate for Payer: Aetna Workers' Compensation |
$120.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$118.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$132.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$138.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$135.14
|
| Rate for Payer: Cash Price |
$180.08
|
| Rate for Payer: Cash Price |
$180.08
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$110.21
|
| Rate for Payer: Cigna Commercial |
$104.96
|
| Rate for Payer: Cigna Medicare Advantage |
$97.75
|
| Rate for Payer: Cigna Medicare Advantage |
$102.65
|
| Rate for Payer: Family Health Partners Medicaid |
$311.30
|
| Rate for Payer: Family Health Partners Medicaid |
$311.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$113.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$108.05
|
| Rate for Payer: Healthy Blue Medicaid |
$336.21
|
| Rate for Payer: Healthy Blue Medicaid |
$336.21
|
| Rate for Payer: Home State Health Plan Exchange |
$102.65
|
| Rate for Payer: Home State Health Plan Exchange |
$97.75
|
| Rate for Payer: Home State Health Plan Medicaid |
$311.30
|
| Rate for Payer: Home State Health Plan Medicaid |
$311.30
|
| Rate for Payer: Humana Medicare |
$128.62
|
| Rate for Payer: Humana Medicare |
$135.06
|
| Rate for Payer: Mercy CarePlus Medicaid |
$311.30
|
| Rate for Payer: Mercy CarePlus Medicaid |
$311.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$128.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$135.06
|
| Rate for Payer: Provider Network of America Commercial |
$137.20
|
| Rate for Payer: Provider Network of America Commercial |
$144.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$113.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$118.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$171.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$180.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.37
|
|
|
clotrimazole-betamethasone 1-0.05 % cream 15 g Tube
|
Facility
|
IP
|
$67.44
|
|
|
Service Code
|
NDC 00168025815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.58 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| 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 |
$50.58
|
| Rate for Payer: Provider Network of America Commercial |
$53.95
|
|
|
clotrimazole-betamethasone 1-0.05 % cream 15 g Tube
|
Facility
|
OP
|
$67.44
|
|
|
Service Code
|
NDC 00168025815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$47.55
|
| Rate for Payer: Aetna Workers' Compensation |
$47.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$46.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$51.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.14
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cigna Commercial |
$41.27
|
| Rate for Payer: Cigna Medicare Advantage |
$38.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$42.49
|
| Rate for Payer: Home State Health Plan Exchange |
$38.44
|
| Rate for Payer: Humana Medicare |
$50.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$50.58
|
| Rate for Payer: Provider Network of America Commercial |
$53.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$67.44
|
|
|
cloZAPine 200 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 60687042611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7.49
|
| Rate for Payer: Aetna Workers' Compensation |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$8.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$8.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$8.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$8.37
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6.69
|
| Rate for Payer: Home State Health Plan Exchange |
$6.05
|
| Rate for Payer: Humana Medicare |
$7.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7.96
|
| Rate for Payer: Provider Network of America Commercial |
$8.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10.62
|
|
|
cloZAPine 200 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 60687042611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| 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 |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| 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 |
$7.96
|
| Rate for Payer: Provider Network of America Commercial |
$8.50
|
|
|
Cltx Fx W8 Brg Artclr Prtn Dstl Tib W/Skel Tracj
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
Px00000027825
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$559.96 |
| Max. Negotiated Rate |
$559.96 |
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$559.96
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$28,538.98
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$28,538.98 |
| 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 |
$28,538.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$28,538.98
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$28,538.98
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$28,538.98
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$11,447.39
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,447.39 |
| 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 |
$11,447.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,447.39
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,447.39
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,447.39
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$16,944.58
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,944.58 |
| Rate for Payer: Healthy Blue Medicaid |
$16,944.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$16,944.58
|
| 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 Medicaid |
$16,944.58
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,944.58
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$8,189.39
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,189.39 |
| 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 |
$8,189.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,189.39
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,189.39
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,189.39
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$7,168.91
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,168.91 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$7,168.91
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$21,377.65
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,377.65 |
| 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: Family Health Partners Medicaid |
$21,377.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,377.65
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,377.65
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,377.65
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$3,826.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$3,826.58
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,826.58
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,826.58
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$8,549.95
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,549.95 |
| 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 |
$8,549.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,549.95
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,549.95
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,549.95
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7742
|
| 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 |
$4,853.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,853.72
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,853.72
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,853.72
|
|
|
codeine-guaifenesin 10-100 mg/5 mL liquid 5 mL Cup
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00121177505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$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: 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: Provider Network of America Commercial |
$36.00
|
|
|
codeine-guaifenesin 10-100 mg/5 mL liquid 5 mL Cup
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00121177505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
Co Diffusing Capacity
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
Px09839472901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$87.42
|
| Rate for Payer: Aetna Workers' Compensation |
$87.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$85.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$97.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$97.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$97.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$95.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$97.71
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$75.89
|
| Rate for Payer: Cigna Medicare Advantage |
$70.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$78.12
|
| Rate for Payer: Home State Health Plan Exchange |
$70.68
|
| Rate for Payer: Humana Medicare |
$93.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Provider Network of America Commercial |
$99.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$81.84
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$124.00
|
|
|
Co Diffusing Capacity
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
Px09839472901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.00 |
| 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 |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| 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 |
$93.00
|
| Rate for Payer: Provider Network of America Commercial |
$99.20
|
|
|
colchicine 0.6 mg tablet 30 Each BLIST PACK
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
NDC 00904712004
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$13.53
|
| Rate for Payer: Aetna Workers' Compensation |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$13.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$15.12
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cigna Commercial |
$11.74
|
| Rate for Payer: Cigna Medicare Advantage |
$10.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$12.09
|
| Rate for Payer: Home State Health Plan Exchange |
$10.94
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$14.39
|
| Rate for Payer: Provider Network of America Commercial |
$15.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$19.19
|
|
|
colchicine 0.6 mg tablet 30 Each BLIST PACK
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
NDC 00904712004
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.39 |
| 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 |
$19.19
|
| Rate for Payer: Cash Price |
$19.19
|
| 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 |
$14.39
|
| Rate for Payer: Provider Network of America Commercial |
$15.35
|
|
|
Cold Agglutinin Screen
|
Facility
|
OP
|
$120.75
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
Px03028615601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$85.13
|
| Rate for Payer: Aetna Workers' Compensation |
$85.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$83.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$95.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$95.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$95.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$92.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$95.15
|
| Rate for Payer: Cash Price |
$120.75
|
| Rate for Payer: Cash Price |
$120.75
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: Cigna Medicare Advantage |
$68.83
|
| Rate for Payer: Family Health Partners Medicaid |
$10.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$76.07
|
| Rate for Payer: Healthy Blue Medicaid |
$10.98
|
| Rate for Payer: Home State Health Plan Exchange |
$68.83
|
| Rate for Payer: Home State Health Plan Medicaid |
$10.16
|
| Rate for Payer: Humana Medicare |
$90.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10.16
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$90.56
|
| Rate for Payer: Provider Network of America Commercial |
$96.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$79.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.65
|
|
|
Cold Agglutinin Screen
|
Facility
|
IP
|
$120.75
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
Px03028615601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.56 |
| 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 |
$120.75
|
| Rate for Payer: Cash Price |
$120.75
|
| 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 |
$90.56
|
| Rate for Payer: Provider Network of America Commercial |
$96.60
|
|
|
Colectomy Partial W/Anastomosis
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
Px03614414001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.20 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$835.38
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
|
|
Colectomy Partial W/Anastomosis
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
Px03614414001
|
|
Hospital Revenue Code
|
361
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
