|
colestipol 1 gram tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$16.68
|
|
|
Service Code
|
NDC 60687071511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.51 |
| 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 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 |
$16.68
|
| Rate for Payer: Cash Price |
$16.68
|
| 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 |
$12.51
|
| Rate for Payer: Provider Network of America Commercial |
$13.34
|
|
|
colestipol 1 gram tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$16.68
|
|
|
Service Code
|
NDC 60687071511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.76
|
| Rate for Payer: Aetna Workers' Compensation |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$13.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$13.14
|
| Rate for Payer: Cash Price |
$16.68
|
| Rate for Payer: Cigna Commercial |
$10.21
|
| Rate for Payer: Cigna Medicare Advantage |
$9.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.51
|
| Rate for Payer: Home State Health Plan Exchange |
$9.51
|
| Rate for Payer: Humana Medicare |
$12.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.51
|
| Rate for Payer: Provider Network of America Commercial |
$13.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.68
|
|
|
collagenase 250 unit/gram ointment 30 g Tube
|
Facility
|
OP
|
$1,333.36
|
|
|
Service Code
|
NDC 50484001030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$760.02 |
| Max. Negotiated Rate |
$1,333.36 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$940.02
|
| Rate for Payer: Aetna Workers' Compensation |
$940.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$924.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$924.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,050.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,050.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,050.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,026.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,050.69
|
| Rate for Payer: Cash Price |
$1,333.36
|
| Rate for Payer: Cigna Commercial |
$816.02
|
| Rate for Payer: Cigna Medicare Advantage |
$760.02
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$840.02
|
| Rate for Payer: Home State Health Plan Exchange |
$760.02
|
| Rate for Payer: Humana Medicare |
$1,000.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,000.02
|
| Rate for Payer: Provider Network of America Commercial |
$1,066.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$880.02
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,333.36
|
|
|
collagenase 250 unit/gram ointment 30 g Tube
|
Facility
|
IP
|
$1,333.36
|
|
|
Service Code
|
NDC 50484001030
|
|
Hospital Revenue Code
|
637
|
| 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 |
$1,333.36
|
| Rate for Payer: Cash Price |
$1,333.36
|
| 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 |
$1,000.02
|
| Rate for Payer: Provider Network of America Commercial |
$1,066.69
|
|
|
Collar-Cervical Soft
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
Px0274L012001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.13 |
| 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 |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| 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 |
$12.13
|
| Rate for Payer: Provider Network of America Commercial |
$12.94
|
|
|
Collar-Cervical Soft
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
Px0274L012001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.41
|
| Rate for Payer: Aetna Workers' Compensation |
$11.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12.75
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cigna Commercial |
$9.90
|
| Rate for Payer: Cigna Medicare Advantage |
$9.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.19
|
| Rate for Payer: Home State Health Plan Exchange |
$9.22
|
| Rate for Payer: Humana Medicare |
$12.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.13
|
| Rate for Payer: Provider Network of America Commercial |
$12.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.18
|
|
|
Collect Blood From Implant Venous Access Device
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
Px03003659101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$77.55
|
| Rate for Payer: Aetna Workers' Compensation |
$77.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$76.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$86.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$86.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$86.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$84.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$86.68
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$57.64
|
| Rate for Payer: Cigna Medicare Advantage |
$62.70
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$69.30
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$62.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$82.50
|
| Rate for Payer: Provider Network of America Commercial |
$88.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$133.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
Collect Blood From Implant Venous Access Device
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
Px03003659101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.50 |
| 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 |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| 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 |
$82.50
|
| Rate for Payer: Provider Network of America Commercial |
$88.00
|
|
|
Colposcopy Cervix Upper/Adjacent Vagina
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
Px09825745201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$176.56 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$218.37
|
| Rate for Payer: Aetna Workers' Compensation |
$218.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$238.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$244.08
|
| Rate for Payer: Cash Price |
$309.75
|
| Rate for Payer: Cash Price |
$309.75
|
| Rate for Payer: Cigna Commercial |
$189.57
|
| Rate for Payer: Cigna Medicare Advantage |
$176.56
|
| Rate for Payer: Family Health Partners Medicaid |
$255.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$195.14
|
| Rate for Payer: Healthy Blue Medicaid |
$275.56
|
| Rate for Payer: Home State Health Plan Exchange |
$176.56
|
| Rate for Payer: Home State Health Plan Medicaid |
$255.15
|
| Rate for Payer: Humana Medicare |
$232.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$255.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$232.31
|
| Rate for Payer: Provider Network of America Commercial |
$247.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$309.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$192.09
|
|
|
Colposcopy Cervix Upper/Adjacent Vagina
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
Px09825745201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$232.31 |
| 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 |
$309.75
|
| Rate for Payer: Cash Price |
$309.75
|
| 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 |
$232.31
|
| Rate for Payer: Provider Network of America Commercial |
$247.80
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$42,345.12
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$42,345.12 |
| 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 |
$42,345.12
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$27,105.37
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,105.37 |
| 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 |
$27,105.37
|
|
|
Complete Cbc & Auto Diff Wbc
|
Facility
|
OP
|
$120.75
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
Px03058502504
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.37 |
| 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 |
$9.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$76.07
|
| Rate for Payer: Healthy Blue Medicaid |
$10.57
|
| Rate for Payer: Home State Health Plan Exchange |
$68.83
|
| Rate for Payer: Home State Health Plan Medicaid |
$9.79
|
| Rate for Payer: Humana Medicare |
$90.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9.79
|
| 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 |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.37
|
|
|
Complete Cbc & Auto Diff Wbc
|
Facility
|
IP
|
$120.75
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
Px03058502504
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
COMPLEX AORTIC ARCH PROCEDURES
|
Facility
|
IP
|
$53,198.36
|
|
|
Service Code
|
MSDRG 209
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$53,198.36 |
| 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 |
$53,198.36
|
|
|
Complex e/m visit add on
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
Px0983G221101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.20
|
| Rate for Payer: Aetna Workers' Compensation |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: Cigna Medicare Advantage |
$22.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.20
|
| Rate for Payer: Home State Health Plan Exchange |
$22.80
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.00
|
|
|
Complex e/m visit add on
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
Px0983G221101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$30.00 |
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| 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 |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 381
|
| 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 |
$5,092.45
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$9,222.34
|
|
|
Service Code
|
MSDRG 380
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,222.34 |
| 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 |
$9,222.34
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 382
|
| 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 |
$3,762.82
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 920
|
| 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 |
$4,710.81
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$8,604.76
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,604.76 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,604.76
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 921
|
| 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 |
$3,235.48
|
|
|
Comprehensive Metabolic Panel
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
Px03018005307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$232.31 |
| 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 |
$309.75
|
| Rate for Payer: Cash Price |
$309.75
|
| 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 |
$232.31
|
| Rate for Payer: Provider Network of America Commercial |
$247.80
|
|
|
Comprehensive Metabolic Panel
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
Px03018005307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$247.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$218.37
|
| Rate for Payer: Aetna Workers' Compensation |
$218.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$244.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$238.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$244.08
|
| Rate for Payer: Cash Price |
$309.75
|
| Rate for Payer: Cash Price |
$309.75
|
| Rate for Payer: Cigna Commercial |
$162.31
|
| Rate for Payer: Cigna Medicare Advantage |
$176.56
|
| Rate for Payer: Family Health Partners Medicaid |
$13.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$195.14
|
| Rate for Payer: Healthy Blue Medicaid |
$14.36
|
| Rate for Payer: Home State Health Plan Exchange |
$176.56
|
| Rate for Payer: Home State Health Plan Medicaid |
$13.30
|
| Rate for Payer: Humana Medicare |
$232.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$232.31
|
| Rate for Payer: Provider Network of America Commercial |
$247.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.01
|
|
