|
nystatin-triamcinolone 100,000-0.1 unit/g-% cream 15 g Tube
|
Facility
|
IP
|
$83.80
|
|
|
Service Code
|
NDC 45802088014
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.85 |
| 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 |
$83.80
|
| Rate for Payer: Cash Price |
$83.80
|
| 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 |
$62.85
|
| Rate for Payer: Provider Network of America Commercial |
$67.04
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$7,825.13
|
|
|
Service Code
|
APR-DRG 7622
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,825.13 |
| 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 |
$7,825.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,825.13
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,825.13
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,825.13
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$14,395.69
|
|
|
Service Code
|
APR-DRG 7624
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,395.69 |
| 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 |
$14,395.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,395.69
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,395.69
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,395.69
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$11,512.11
|
|
|
Service Code
|
APR-DRG 7623
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,512.11 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$11,512.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,512.11
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,512.11
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,512.11
|
|
|
OBSESSIVE COMPULSIVE DISORDERS
|
Facility
|
IP
|
$6,256.22
|
|
|
Service Code
|
APR-DRG 7621
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,256.22 |
| 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 |
$6,256.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,256.22
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,256.22
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,256.22
|
|
|
octreotide 20 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
IP
|
$18,465.20
|
|
|
Service Code
|
NDC 00078081881
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,772.16 |
| 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 |
$18,465.20
|
| Rate for Payer: Cash Price |
$18,465.20
|
| 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 |
$13,848.90
|
| Rate for Payer: Provider Network of America Commercial |
$14,772.16
|
|
|
octreotide 20 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
OP
|
$18,465.20
|
|
|
Service Code
|
NDC 00078081881
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,525.16 |
| Max. Negotiated Rate |
$18,465.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$13,017.97
|
| Rate for Payer: Aetna Workers' Compensation |
$13,017.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$12,796.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$12,796.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14,218.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$14,550.58
|
| Rate for Payer: Cash Price |
$18,465.20
|
| Rate for Payer: Cigna Commercial |
$11,300.70
|
| Rate for Payer: Cigna Medicare Advantage |
$10,525.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$11,633.08
|
| Rate for Payer: Home State Health Plan Exchange |
$10,525.16
|
| Rate for Payer: Humana Medicare |
$13,848.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$13,848.90
|
| Rate for Payer: Provider Network of America Commercial |
$14,772.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,187.03
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18,465.20
|
|
|
octreotide 20 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
OP
|
$18,465.20
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,525.16 |
| Max. Negotiated Rate |
$18,465.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$13,017.97
|
| Rate for Payer: Aetna Workers' Compensation |
$13,017.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$12,796.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$12,796.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$14,550.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14,218.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$14,550.58
|
| Rate for Payer: Cash Price |
$18,465.20
|
| Rate for Payer: Cigna Commercial |
$11,300.70
|
| Rate for Payer: Cigna Medicare Advantage |
$10,525.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$11,633.08
|
| Rate for Payer: Home State Health Plan Exchange |
$10,525.16
|
| Rate for Payer: Humana Medicare |
$13,848.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$13,848.90
|
| Rate for Payer: Provider Network of America Commercial |
$14,772.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,187.03
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18,465.20
|
|
|
octreotide 20 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
IP
|
$18,465.20
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,772.16 |
| 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 |
$18,465.20
|
| Rate for Payer: Cash Price |
$18,465.20
|
| 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 |
$13,848.90
|
| Rate for Payer: Provider Network of America Commercial |
$14,772.16
|
|
|
octreotide 30 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
IP
|
$27,650.24
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,120.19 |
| 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: Cash Price |
$27,650.24
|
| Rate for Payer: Cash Price |
$27,650.24
|
| 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 |
$20,737.68
|
| Rate for Payer: Provider Network of America Commercial |
$22,120.19
|
|
|
octreotide 30 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
OP
|
$27,650.24
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,760.64 |
| Max. Negotiated Rate |
$27,650.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$19,493.42
|
| Rate for Payer: Aetna Workers' Compensation |
$19,493.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$19,161.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$19,161.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$21,290.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$21,788.39
|
| Rate for Payer: Cash Price |
$27,650.24
|
| Rate for Payer: Cigna Commercial |
$16,921.95
|
| Rate for Payer: Cigna Medicare Advantage |
$15,760.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$17,419.65
|
| Rate for Payer: Home State Health Plan Exchange |
$15,760.64
|
| Rate for Payer: Humana Medicare |
$20,737.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$20,737.68
|
| Rate for Payer: Provider Network of America Commercial |
$22,120.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$18,249.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$27,650.24
|
|
|
octreotide 30 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
OP
|
$27,650.24
|
|
|
Service Code
|
NDC 00078082581
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,760.64 |
| Max. Negotiated Rate |
$27,650.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$19,493.42
|
| Rate for Payer: Aetna Workers' Compensation |
$19,493.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$19,161.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$19,161.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$21,788.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$21,290.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$21,788.39
|
| Rate for Payer: Cash Price |
$27,650.24
|
| Rate for Payer: Cigna Commercial |
$16,921.95
|
| Rate for Payer: Cigna Medicare Advantage |
$15,760.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$17,419.65
|
| Rate for Payer: Home State Health Plan Exchange |
$15,760.64
|
| Rate for Payer: Humana Medicare |
$20,737.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$20,737.68
|
| Rate for Payer: Provider Network of America Commercial |
$22,120.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$18,249.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$27,650.24
|
|
|
octreotide 30 mg suspension,extended rel recon 1 Each Vial
|
Facility
|
IP
|
$27,650.24
|
|
|
Service Code
|
NDC 00078082581
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,120.19 |
| 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: Cash Price |
$27,650.24
|
| Rate for Payer: Cash Price |
$27,650.24
|
| 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 |
$20,737.68
|
| Rate for Payer: Provider Network of America Commercial |
$22,120.19
|
|
|
Octreotide injection, depot
|
Facility
|
OP
|
$19,105.70
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
Px0636J235301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,890.25 |
| Max. Negotiated Rate |
$19,105.70 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$13,469.52
|
| Rate for Payer: Aetna Workers' Compensation |
$13,469.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$13,240.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$13,240.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$15,055.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$15,055.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$15,055.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14,711.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$15,055.29
|
| Rate for Payer: Cash Price |
$19,105.70
|
| Rate for Payer: Cigna Commercial |
$11,692.69
|
| Rate for Payer: Cigna Medicare Advantage |
$10,890.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$12,036.59
|
| Rate for Payer: Home State Health Plan Exchange |
$10,890.25
|
| Rate for Payer: Humana Medicare |
$14,329.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$14,329.27
|
| Rate for Payer: Provider Network of America Commercial |
$15,284.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$12,609.76
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$19,105.70
|
|
|
Octreotide injection, depot
|
Facility
|
IP
|
$19,105.70
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
Px0636J235301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,284.56 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$19,105.70
|
| Rate for Payer: Cash Price |
$19,105.70
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$14,329.27
|
| Rate for Payer: Provider Network of America Commercial |
$15,284.56
|
|
|
Octreotide inj, non-depot
|
Facility
|
IP
|
$73.75
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
Px0636J235401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.31 |
| 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 |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| 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 |
$55.31
|
| Rate for Payer: Provider Network of America Commercial |
$59.00
|
|
|
Octreotide inj, non-depot
|
Facility
|
OP
|
$73.75
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
Px0636J235401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$51.99
|
| Rate for Payer: Aetna Workers' Compensation |
$51.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$51.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$58.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$58.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$58.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$56.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$58.12
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cigna Commercial |
$45.13
|
| Rate for Payer: Cigna Medicare Advantage |
$42.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$46.46
|
| Rate for Payer: Home State Health Plan Exchange |
$42.04
|
| Rate for Payer: Humana Medicare |
$55.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$55.31
|
| Rate for Payer: Provider Network of America Commercial |
$59.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$73.75
|
|
|
Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes
|
Facility
|
IP
|
$370.65
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
Px05109924401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$296.52 |
| 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 |
$370.65
|
| Rate for Payer: Cash Price |
$370.65
|
| 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: Provider Network of America Commercial |
$296.52
|
|
|
Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes
|
Facility
|
OP
|
$370.65
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
Px05109924401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.27 |
| Max. Negotiated Rate |
$370.65 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$261.31
|
| Rate for Payer: Aetna Workers' Compensation |
$261.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$256.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$256.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$292.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$292.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$292.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$285.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$292.07
|
| Rate for Payer: Cash Price |
$370.65
|
| Rate for Payer: Cigna Medicare Advantage |
$211.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$233.51
|
| Rate for Payer: Home State Health Plan Exchange |
$211.27
|
| Rate for Payer: Humana Medicare |
$277.99
|
| Rate for Payer: Provider Network of America Commercial |
$296.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$244.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$370.65
|
|
|
Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
Px09839924201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.83
|
| Rate for Payer: Aetna Workers' Compensation |
$88.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.29
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Cigna Medicare Advantage |
$71.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.38
|
| Rate for Payer: Home State Health Plan Exchange |
$71.82
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$126.00
|
|
|
Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
Px09839924201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| 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 |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
|
|
Office/Outpatient Est Pt May Not Req Phys/Qhp
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px07619921104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.90
|
| Rate for Payer: Aetna Workers' Compensation |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.30
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: Cigna Medicare Advantage |
$37.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.01
|
| Rate for Payer: Home State Health Plan Exchange |
$37.11
|
| Rate for Payer: Humana Medicare |
$48.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.83
|
| Rate for Payer: Provider Network of America Commercial |
$52.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.10
|
|
|
Office/Outpatient Est Pt May Not Req Phys/Qhp
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px07619921101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.83 |
| 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 |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| 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 |
$48.83
|
| Rate for Payer: Provider Network of America Commercial |
$52.08
|
|
|
Office/Outpatient Est Pt May Not Req Phys/Qhp
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px05109921101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.08 |
| 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 |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| 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: Provider Network of America Commercial |
$52.08
|
|
|
Office/Outpatient Est Pt May Not Req Phys/Qhp
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px05109921101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.90
|
| Rate for Payer: Aetna Workers' Compensation |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.30
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Medicare Advantage |
$37.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.01
|
| Rate for Payer: Home State Health Plan Exchange |
$37.11
|
| Rate for Payer: Humana Medicare |
$48.83
|
| Rate for Payer: Provider Network of America Commercial |
$52.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.10
|
|
