|
morphine 4 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
morphine 4 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00641612501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
morphine 4 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00641612525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
morphine 4 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
morphine 4 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00641612525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
morphine ER 15 mg tablet extended release 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084015711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
morphine ER 15 mg tablet extended release 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084015711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
morphine pf per 10 mg
|
Facility
|
IP
|
$93.11
|
|
|
Service Code
|
HCPCS J2274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.83 |
| 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 |
$93.11
|
| Rate for Payer: Cash Price |
$93.11
|
| 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 |
$69.83
|
| Rate for Payer: Provider Network of America Commercial |
$74.49
|
|
|
morphine pf per 10 mg
|
Facility
|
OP
|
$93.11
|
|
|
Service Code
|
NDC 00409381412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.07 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$65.64
|
| Rate for Payer: Aetna Workers' Compensation |
$65.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$71.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$73.37
|
| Rate for Payer: Cash Price |
$93.11
|
| Rate for Payer: Cigna Commercial |
$56.98
|
| Rate for Payer: Cigna Medicare Advantage |
$53.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$58.66
|
| Rate for Payer: Home State Health Plan Exchange |
$53.07
|
| Rate for Payer: Humana Medicare |
$69.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$69.83
|
| Rate for Payer: Provider Network of America Commercial |
$74.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$61.45
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$93.11
|
|
|
morphine pf per 10 mg
|
Facility
|
IP
|
$93.11
|
|
|
Service Code
|
NDC 00409381412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.83 |
| 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 |
$93.11
|
| Rate for Payer: Cash Price |
$93.11
|
| 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 |
$69.83
|
| Rate for Payer: Provider Network of America Commercial |
$74.49
|
|
|
morphine pf per 10 mg
|
Facility
|
OP
|
$93.11
|
|
|
Service Code
|
HCPCS J2274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.07 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: UnitedHealthcare Commercial |
$61.45
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$65.64
|
| Rate for Payer: Aetna Workers' Compensation |
$65.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$64.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$71.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$73.37
|
| Rate for Payer: Cash Price |
$93.11
|
| Rate for Payer: Cigna Commercial |
$56.98
|
| Rate for Payer: Cigna Medicare Advantage |
$53.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$58.66
|
| Rate for Payer: Home State Health Plan Exchange |
$53.07
|
| Rate for Payer: Humana Medicare |
$69.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$69.83
|
| Rate for Payer: Provider Network of America Commercial |
$74.49
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$93.11
|
|
|
Morphine sulfate injection
|
Facility
|
OP
|
$64.06
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
Px0636J227001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.16
|
| Rate for Payer: Aetna Workers' Compensation |
$45.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$49.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.48
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cigna Commercial |
$39.20
|
| Rate for Payer: Cigna Medicare Advantage |
$36.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.36
|
| Rate for Payer: Home State Health Plan Exchange |
$36.51
|
| Rate for Payer: Humana Medicare |
$48.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.05
|
| Rate for Payer: Provider Network of America Commercial |
$51.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$64.06
|
|
|
Morphine sulfate injection
|
Facility
|
IP
|
$64.06
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
Px0636J227001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.05 |
| 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 |
$64.06
|
| Rate for Payer: Cash Price |
$64.06
|
| 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 |
$48.05
|
| Rate for Payer: Provider Network of America Commercial |
$51.25
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$7,018.04
|
|
|
Service Code
|
MSDRG 137
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,018.04 |
| 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 |
$7,018.04
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 138
|
| 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 |
$4,165.14
|
|
|
Mra Abdomen W/WO Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
Px09727418501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
Mra Abdomen W/WO Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
Px09727418501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$267.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
|
|
Mra Head W/O Contrst Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
Px09727054401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
Mra Head W/O Contrst Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
Px09727054401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
Mra Head W/O & W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
Px09727054601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
Mra Head W/O & W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
Px09727054601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
Mra Lower Extremity W/WO Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
Px09727372501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
Mra Lower Extremity W/WO Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
Px09727372501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$267.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
|
|
Mra Neck W/O &W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
Px09727054901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
Mra Neck W/O &W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
Px09727054901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
