|
Critical Care First Patient Init 30-74 Min
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
Px06819929101
|
|
Hospital Revenue Code
|
681
|
| 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 |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| 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 |
$2,100.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,240.00
|
|
|
Critical Care First Patient Init 30-74 Min
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
Px06819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$784.84 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,974.00
|
| Rate for Payer: Aetna Workers' Compensation |
$1,974.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,940.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,940.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,156.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,206.40
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$1,713.60
|
| Rate for Payer: Cigna Medicare Advantage |
$1,596.00
|
| Rate for Payer: Family Health Partners Medicaid |
$1,042.48
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,764.00
|
| Rate for Payer: Healthy Blue Medicaid |
$1,125.88
|
| Rate for Payer: Home State Health Plan Exchange |
$1,596.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,042.48
|
| Rate for Payer: Humana Medicare |
$2,100.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,042.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,100.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,240.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,848.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,800.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$784.84
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
Px06819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Cigna Medicare Advantage |
$359.10
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$444.15
|
| Rate for Payer: Aetna Workers' Compensation |
$444.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$436.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$436.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$496.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$496.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$496.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$496.44
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$385.56
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$396.90
|
| Rate for Payer: Home State Health Plan Exchange |
$359.10
|
| Rate for Payer: Humana Medicare |
$472.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$472.50
|
| Rate for Payer: Provider Network of America Commercial |
$504.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$415.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$630.00
|
|
|
Critical Care Ill/Injured Patient Addl 30 Min
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
Px06819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$472.50 |
| 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 |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| 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 |
$472.50
|
| Rate for Payer: Provider Network of America Commercial |
$504.00
|
|
|
Critical Care Ill/Injured Patient Init 30-74 Min
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
Px00000099291
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$242.57 |
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$242.57
|
|
|
crotalidae polyvalent immune fab 1 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
NDC 50633011012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,291.44 |
| Max. Negotiated Rate |
$12,792.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,018.36
|
| Rate for Payer: Aetna Workers' Compensation |
$9,018.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8,864.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8,864.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9,849.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,080.10
|
| Rate for Payer: Cash Price |
$12,792.00
|
| Rate for Payer: Cigna Commercial |
$7,828.70
|
| Rate for Payer: Cigna Medicare Advantage |
$7,291.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,058.96
|
| Rate for Payer: Home State Health Plan Exchange |
$7,291.44
|
| Rate for Payer: Humana Medicare |
$9,594.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,594.00
|
| Rate for Payer: Provider Network of America Commercial |
$10,233.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,442.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12,792.00
|
|
|
crotalidae polyvalent immune fab 1 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
HCPCS J0840
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,291.44 |
| Max. Negotiated Rate |
$12,792.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,018.36
|
| Rate for Payer: Aetna Workers' Compensation |
$9,018.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8,864.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8,864.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,080.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9,849.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,080.10
|
| Rate for Payer: Cash Price |
$12,792.00
|
| Rate for Payer: Cigna Commercial |
$7,828.70
|
| Rate for Payer: Cigna Medicare Advantage |
$7,291.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,058.96
|
| Rate for Payer: Home State Health Plan Exchange |
$7,291.44
|
| Rate for Payer: Humana Medicare |
$9,594.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,594.00
|
| Rate for Payer: Provider Network of America Commercial |
$10,233.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,442.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12,792.00
|
|
|
crotalidae polyvalent immune fab 1 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
NDC 50633011012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,233.60 |
| 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 |
$12,792.00
|
| Rate for Payer: Cash Price |
$12,792.00
|
| 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 |
$9,594.00
|
| Rate for Payer: Provider Network of America Commercial |
$10,233.60
|
|
|
crotalidae polyvalent immune fab 1 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
HCPCS J0840
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,233.60 |
| 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 |
$12,792.00
|
| Rate for Payer: Cash Price |
$12,792.00
|
| 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 |
$9,594.00
|
| Rate for Payer: Provider Network of America Commercial |
$10,233.60
|
|
|
Cstm Ambulatory Surgical Boot Each
|
Facility
|
IP
|
$21.78
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
Px0274L326002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.34 |
| 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 |
$21.78
|
| Rate for Payer: Cash Price |
$21.78
|
| 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 |
$16.34
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
|
|
Cstm Ambulatory Surgical Boot Each
|
Facility
|
OP
|
$21.78
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
Px0274L326002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.35
|
| Rate for Payer: Aetna Workers' Compensation |
$15.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$21.78
|
| Rate for Payer: Cigna Commercial |
$13.33
|
| Rate for Payer: Cigna Medicare Advantage |
$12.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.72
|
| Rate for Payer: Home State Health Plan Exchange |
$12.41
|
| Rate for Payer: Humana Medicare |
$16.34
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.34
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.78
|
|
|
Cta Head&Neck C+ W/Noncontrast Img&Post-Pxessing
|
Professional
|
Both
|
$2,907.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
Px00000070471
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$421.21 |
| Max. Negotiated Rate |
$421.21 |
| Rate for Payer: Cash Price |
$2,907.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$421.21
|
|
|
CT Angiography Abdomen W/Contrast/Noncontrast
|
Facility
|
OP
|
$207.48
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
Px09727417501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$118.26 |
| Max. Negotiated Rate |
$239.08 |
| 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 |
$221.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$130.71
|
| Rate for Payer: Healthy Blue Medicaid |
$239.08
|
| Rate for Payer: Home State Health Plan Exchange |
$118.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$221.37
|
| Rate for Payer: Humana Medicare |
$155.61
|
| Rate for Payer: Mercy CarePlus Medicaid |
$221.37
|
| 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 |
$166.66
|
|
|
CT Angiography Abdomen W/Contrast/Noncontrast
|
Facility
|
IP
|
$207.48
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
Px09727417501
|
|
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
|
|
|
CT Angiography Upper Extremity
|
Facility
|
IP
|
$207.48
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
Px09727320601
|
|
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
|
|
|
CT Angiography Upper Extremity
|
Facility
|
OP
|
$207.48
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
Px09727320601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$118.26 |
| Max. Negotiated Rate |
$239.08 |
| 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 |
$221.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$130.71
|
| Rate for Payer: Healthy Blue Medicaid |
$239.08
|
| Rate for Payer: Home State Health Plan Exchange |
$118.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$221.37
|
| Rate for Payer: Humana Medicare |
$155.61
|
| Rate for Payer: Mercy CarePlus Medicaid |
$221.37
|
| 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 |
$166.66
|
|
|
CT Head/Brain W/O Contrast Material
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
Px00000070450
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$119.88 |
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$119.88
|
|
|
CT Orbit Sella/Post Fossa/Ear W/O Contrast Matrl
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
Px00000070480
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$178.21 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$178.21
|
|
|
Culture Bacterial Quantitative Colony Count Urine
|
Facility
|
IP
|
$162.75
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
Px03068708601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.06 |
| 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 |
$162.75
|
| Rate for Payer: Cash Price |
$162.75
|
| 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 |
$122.06
|
| Rate for Payer: Provider Network of America Commercial |
$130.20
|
|
|
Culture Bacterial Quantitative Colony Count Urine
|
Facility
|
OP
|
$162.75
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
Px03068708601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$114.74
|
| Rate for Payer: Aetna Workers' Compensation |
$114.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$112.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$112.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$125.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$128.25
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Cigna Commercial |
$85.28
|
| Rate for Payer: Cigna Medicare Advantage |
$92.77
|
| Rate for Payer: Family Health Partners Medicaid |
$10.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$102.53
|
| Rate for Payer: Healthy Blue Medicaid |
$10.98
|
| Rate for Payer: Home State Health Plan Exchange |
$92.77
|
| Rate for Payer: Home State Health Plan Medicaid |
$10.16
|
| Rate for Payer: Humana Medicare |
$122.06
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10.16
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$122.06
|
| Rate for Payer: Provider Network of America Commercial |
$130.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$107.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.65
|
|
|
Culture Bct Isol&Prsmptv ID Isolate Ea Urine
|
Facility
|
OP
|
$110.25
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
Px03068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$77.73
|
| Rate for Payer: Aetna Workers' Compensation |
$77.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$76.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$76.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$84.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$86.88
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna Commercial |
$57.77
|
| Rate for Payer: Cigna Medicare Advantage |
$62.84
|
| Rate for Payer: Family Health Partners Medicaid |
$10.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$69.46
|
| Rate for Payer: Healthy Blue Medicaid |
$11.01
|
| Rate for Payer: Home State Health Plan Exchange |
$62.84
|
| Rate for Payer: Home State Health Plan Medicaid |
$10.19
|
| Rate for Payer: Humana Medicare |
$82.69
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$82.69
|
| Rate for Payer: Provider Network of America Commercial |
$88.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.67
|
|
|
Culture Bct Isol&Prsmptv ID Isolate Ea Urine
|
Facility
|
IP
|
$110.25
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
Px03068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.69 |
| 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 |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| 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 |
$82.69
|
| Rate for Payer: Provider Network of America Commercial |
$88.20
|
|
|
Curad Pad 3" X 4" Non-Adherent
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
Px0272A622201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| 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 |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
Curad Pad 3" X 4" Non-Adherent
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
Px0272A622201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$9,793.43
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,793.43 |
| 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 |
$9,793.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,793.43
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,793.43
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,793.43
|
|
