|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 4211
|
| 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 |
$5,209.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,209.66
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,209.66
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,209.66
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$22,064.57
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,064.57 |
| Rate for Payer: Humana Medicare |
$1,185.00
|
| 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 |
$22,064.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,064.57
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,064.57
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,064.57
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$12,895.19
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,895.19 |
| 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 |
$12,895.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,895.19
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,895.19
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,895.19
|
|
|
Mammo Screening Uni
|
Facility
|
OP
|
$367.50
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
Px04037706709
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$115.22 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$259.09
|
| Rate for Payer: Aetna Workers' Compensation |
$259.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$254.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$254.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$289.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$289.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$289.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$282.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$289.59
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$224.91
|
| Rate for Payer: Cigna Medicare Advantage |
$209.47
|
| Rate for Payer: Family Health Partners Medicaid |
$153.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$231.53
|
| Rate for Payer: Healthy Blue Medicaid |
$165.29
|
| Rate for Payer: Home State Health Plan Exchange |
$209.47
|
| Rate for Payer: Home State Health Plan Medicaid |
$153.05
|
| Rate for Payer: Humana Medicare |
$275.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$153.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$275.62
|
| Rate for Payer: Provider Network of America Commercial |
$294.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$242.55
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$367.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.22
|
|
|
Mammo Screening Uni
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
Px04037706709
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$275.62 |
| 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 |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| 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 |
$275.62
|
| Rate for Payer: Provider Network of America Commercial |
$294.00
|
|
|
Manj Chest Wall Facilitate Lung Function Subsq
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
Px00000094668
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$42.20
|
|
|
Manj Ch Wall Facilitate Lng Funcj 1 Demo&/Eval
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
Px00000094667
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$29.60
|
|
|
Mannitol injection
|
Facility
|
OP
|
$185.14
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
Px0636J215001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.53 |
| Max. Negotiated Rate |
$185.14 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$130.52
|
| Rate for Payer: Aetna Workers' Compensation |
$130.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$128.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$128.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$145.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$145.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$145.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$145.89
|
| Rate for Payer: Cash Price |
$185.14
|
| Rate for Payer: Cigna Commercial |
$113.31
|
| Rate for Payer: Cigna Medicare Advantage |
$105.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$116.64
|
| Rate for Payer: Home State Health Plan Exchange |
$105.53
|
| Rate for Payer: Humana Medicare |
$138.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$138.85
|
| Rate for Payer: Provider Network of America Commercial |
$148.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$122.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$185.14
|
|
|
Mannitol injection
|
Facility
|
IP
|
$185.14
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
Px0636J215001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.85 |
| 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 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 |
$185.14
|
| Rate for Payer: Cash Price |
$185.14
|
| 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 |
$138.85
|
| Rate for Payer: Provider Network of America Commercial |
$148.11
|
|
|
Marathon Liquid Skin Protectant
|
Facility
|
IP
|
$22.14
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
Px0272A625002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.61 |
| 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 |
$22.14
|
| Rate for Payer: Cash Price |
$22.14
|
| 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 |
$16.61
|
| Rate for Payer: Provider Network of America Commercial |
$17.71
|
|
|
Marathon Liquid Skin Protectant
|
Facility
|
OP
|
$22.14
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
Px0272A625002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.61
|
| Rate for Payer: Aetna Workers' Compensation |
$15.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.45
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cigna Commercial |
$13.55
|
| Rate for Payer: Cigna Medicare Advantage |
$12.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.95
|
| Rate for Payer: Home State Health Plan Exchange |
$12.62
|
| Rate for Payer: Humana Medicare |
$16.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.61
|
| Rate for Payer: Provider Network of America Commercial |
$17.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$22.14
|
|
|
Marathon Skin Xl
|
Facility
|
OP
|
$16.73
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
Px0272A625003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.79
|
| Rate for Payer: Aetna Workers' Compensation |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$13.18
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$10.24
|
| Rate for Payer: Cigna Medicare Advantage |
$9.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.54
|
| Rate for Payer: Home State Health Plan Exchange |
$9.54
|
| Rate for Payer: Humana Medicare |
$12.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.73
|
|
|
Marathon Skin Xl
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
Px0272A625003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| 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 |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| 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 |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$9,055.02
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,055.02 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$9,055.02
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$8,104.68
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,104.68 |
| 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 |
$8,104.68
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$26,584.54
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,584.54 |
| 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 |
$26,584.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,584.54
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,584.54
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,584.54
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$24,473.87
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,473.87 |
| 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 |
$24,473.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$24,473.87
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$24,473.87
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$24,473.87
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$29,366.42
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$29,366.42 |
| 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 |
$29,366.42
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$29,366.42
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$29,366.42
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$29,366.42
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$16,300.19
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,300.19 |
| 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 |
$16,300.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$16,300.19
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,300.19
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,300.19
|
|
|
Mastotomy W/Exploration/Drainage Abscess Deep
|
Facility
|
IP
|
$293.88
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
Px09831902001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$220.41 |
| 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 |
$279.89
|
| Rate for Payer: Cash Price |
$293.88
|
| Rate for Payer: Cash Price |
$293.88
|
| Rate for Payer: Cash Price |
$279.89
|
| 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 |
$220.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$209.92
|
| Rate for Payer: Provider Network of America Commercial |
$235.10
|
| Rate for Payer: Provider Network of America Commercial |
$223.91
|
|
|
Mastotomy W/Exploration/Drainage Abscess Deep
|
Facility
|
OP
|
$293.88
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
Px09831902001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$2,251.11 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$207.19
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$197.32
|
| Rate for Payer: Aetna Workers' Compensation |
$207.19
|
| Rate for Payer: Aetna Workers' Compensation |
$197.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$203.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$193.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$203.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$193.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$231.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$220.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$231.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$220.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$220.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$231.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$226.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$231.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$220.55
|
| Rate for Payer: Cash Price |
$293.88
|
| Rate for Payer: Cash Price |
$293.88
|
| Rate for Payer: Cash Price |
$279.89
|
| Rate for Payer: Cash Price |
$279.89
|
| Rate for Payer: Cigna Commercial |
$179.85
|
| Rate for Payer: Cigna Commercial |
$171.29
|
| Rate for Payer: Cigna Medicare Advantage |
$159.54
|
| Rate for Payer: Cigna Medicare Advantage |
$167.51
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$185.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$176.33
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Home State Health Plan Exchange |
$167.51
|
| Rate for Payer: Home State Health Plan Exchange |
$159.54
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Humana Medicare |
$209.92
|
| Rate for Payer: Humana Medicare |
$220.41
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$209.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$220.41
|
| Rate for Payer: Provider Network of America Commercial |
$223.91
|
| Rate for Payer: Provider Network of America Commercial |
$235.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$279.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$293.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
|
|
Maternal Cell Contamination
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
Px03108126502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$311.25 |
| 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 |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| 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 |
$311.25
|
| Rate for Payer: Provider Network of America Commercial |
$332.00
|
|
|
Maternal Cell Contamination
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
Px03108126502
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$217.46 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$292.57
|
| Rate for Payer: Aetna Workers' Compensation |
$292.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$287.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$287.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$327.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$327.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$327.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$319.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$327.02
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: Cigna Medicare Advantage |
$236.55
|
| Rate for Payer: Family Health Partners Medicaid |
$293.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$261.45
|
| Rate for Payer: Healthy Blue Medicaid |
$317.16
|
| Rate for Payer: Home State Health Plan Exchange |
$236.55
|
| Rate for Payer: Home State Health Plan Medicaid |
$293.66
|
| Rate for Payer: Humana Medicare |
$311.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$293.66
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$311.25
|
| Rate for Payer: Provider Network of America Commercial |
$332.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$273.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$233.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$221.09
|
|
|
Materni T21 Pluse Core
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
Px03008142002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$521.38 |
| Max. Negotiated Rate |
$1,032.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$701.48
|
| Rate for Payer: Aetna Workers' Compensation |
$701.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$689.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$689.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$784.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$784.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$784.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$766.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$784.06
|
| Rate for Payer: Cash Price |
$995.00
|
| Rate for Payer: Cash Price |
$995.00
|
| Rate for Payer: Cigna Commercial |
$521.38
|
| Rate for Payer: Cigna Medicare Advantage |
$567.15
|
| Rate for Payer: Family Health Partners Medicaid |
$956.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$626.85
|
| Rate for Payer: Healthy Blue Medicaid |
$1,032.92
|
| Rate for Payer: Home State Health Plan Exchange |
$567.15
|
| Rate for Payer: Home State Health Plan Medicaid |
$956.41
|
| Rate for Payer: Humana Medicare |
$746.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$956.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$746.25
|
| Rate for Payer: Provider Network of America Commercial |
$796.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$656.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$759.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$720.04
|
|
|
Materni T21 Pluse Core
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 81420
|
| Hospital Charge Code |
Px03008142002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$746.25 |
| 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 |
$995.00
|
| Rate for Payer: Cash Price |
$995.00
|
| 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 |
$746.25
|
| Rate for Payer: Provider Network of America Commercial |
$796.00
|
|
