|
Office/Outpatient Est Pt May Not Req Phys/Qhp
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px07619921101
|
|
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
|
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
|
|
|
Office Outpatient New 15-29 Minutes
|
Facility
|
IP
|
$206.85
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
Px05109920201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.48 |
| 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 |
$206.85
|
| Rate for Payer: Cash Price |
$206.85
|
| 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 |
$165.48
|
|
|
Office Outpatient New 15-29 Minutes
|
Facility
|
OP
|
$206.85
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
Px05109920201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.90 |
| Max. Negotiated Rate |
$206.85 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$145.83
|
| Rate for Payer: Aetna Workers' Compensation |
$145.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$143.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$143.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$163.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$159.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$163.00
|
| Rate for Payer: Cash Price |
$206.85
|
| Rate for Payer: Cigna Medicare Advantage |
$117.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$130.32
|
| Rate for Payer: Home State Health Plan Exchange |
$117.90
|
| Rate for Payer: Humana Medicare |
$155.14
|
| Rate for Payer: Provider Network of America Commercial |
$165.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$136.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$206.85
|
|
|
Office Outpatient New 30 Minutes
|
Facility
|
IP
|
$322.35
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
Px05109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.88 |
| 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 |
$322.35
|
| Rate for Payer: Cash Price |
$322.35
|
| 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 |
$257.88
|
|
|
Office Outpatient New 30 Minutes
|
Facility
|
OP
|
$322.35
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
Px05109920301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$322.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$227.26
|
| Rate for Payer: Aetna Workers' Compensation |
$227.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$223.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$223.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$254.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$254.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$254.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$248.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$254.01
|
| Rate for Payer: Cash Price |
$322.35
|
| Rate for Payer: Cigna Medicare Advantage |
$183.74
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$203.08
|
| Rate for Payer: Home State Health Plan Exchange |
$183.74
|
| Rate for Payer: Humana Medicare |
$241.76
|
| Rate for Payer: Provider Network of America Commercial |
$257.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.75
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$322.35
|
|
|
Office Outpatient New 45-59 Minutes
|
Facility
|
OP
|
$485.10
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
Px07619920401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.51 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$342.00
|
| Rate for Payer: Aetna Workers' Compensation |
$342.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$336.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$336.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$382.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$382.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$382.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$373.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$382.26
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cigna Commercial |
$296.88
|
| Rate for Payer: Cigna Medicare Advantage |
$276.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$305.61
|
| Rate for Payer: Home State Health Plan Exchange |
$276.51
|
| Rate for Payer: Humana Medicare |
$363.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$363.82
|
| Rate for Payer: Provider Network of America Commercial |
$388.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$320.17
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$485.10
|
|
|
Office Outpatient New 45-59 Minutes
|
Facility
|
IP
|
$485.10
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
Px07619920401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.82 |
| 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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$363.82
|
| Rate for Payer: Provider Network of America Commercial |
$388.08
|
|
|
Office Outpatient New 60 Minutes
|
Facility
|
IP
|
$641.55
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
Px05109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$513.24 |
| 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 |
$641.55
|
| Rate for Payer: Cash Price |
$641.55
|
| 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 |
$513.24
|
|
|
Office Outpatient New 60 Minutes
|
Facility
|
OP
|
$641.55
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
Px05109920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$365.68 |
| Max. Negotiated Rate |
$641.55 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$452.29
|
| Rate for Payer: Aetna Workers' Compensation |
$452.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$444.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$444.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$505.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$505.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$505.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$493.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$505.54
|
| Rate for Payer: Cash Price |
$641.55
|
| Rate for Payer: Cigna Medicare Advantage |
$365.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$404.18
|
| Rate for Payer: Home State Health Plan Exchange |
$365.68
|
| Rate for Payer: Humana Medicare |
$481.16
|
| Rate for Payer: Provider Network of America Commercial |
$513.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$423.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$641.55
|
|
|
Office Outpatient Visit 10 Minutes
|
Facility
|
IP
|
$161.70
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
Px05109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.36 |
| 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 |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| 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: Provider Network of America Commercial |
$129.36
|
|
|
Office Outpatient Visit 10 Minutes
|
Facility
|
OP
|
$161.70
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
Px05109921201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$161.70 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$114.00
|
| Rate for Payer: Aetna Workers' Compensation |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$112.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$127.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$127.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$127.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$124.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$127.42
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Medicare Advantage |
$92.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$101.87
|
| Rate for Payer: Home State Health Plan Exchange |
$92.17
|
| Rate for Payer: Humana Medicare |
$121.28
|
| Rate for Payer: Provider Network of America Commercial |
$129.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$106.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$161.70
|
|
|
Office Outpatient Visit Est 20-29 Minutes
|
Facility
|
OP
|
$262.50
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
Px05109921301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.62 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$185.06
|
| Rate for Payer: Aetna Workers' Compensation |
$185.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$181.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$181.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$206.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$206.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$206.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$202.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$206.85
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Medicare Advantage |
$149.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$165.38
|
| Rate for Payer: Home State Health Plan Exchange |
$149.62
|
| Rate for Payer: Humana Medicare |
$196.88
|
| Rate for Payer: Provider Network of America Commercial |
$210.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$262.50
|
|
|
Office Outpatient Visit Est 20-29 Minutes
|
Facility
|
IP
|
$262.50
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
Px05109921301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.00 |
| 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 |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| 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: Provider Network of America Commercial |
$210.00
|
|
|
Office Outpatient Visit Est 30-39 Minutes
|
Facility
|
IP
|
$370.65
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
Px05109921401
|
|
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 Outpatient Visit Est 30-39 Minutes
|
Facility
|
OP
|
$370.65
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
Px05109921401
|
|
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 Outpatient Visit Est 30-39 Minutes
|
Facility
|
OP
|
$285.60
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
Px09839921401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$162.79 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$201.35
|
| Rate for Payer: Aetna Workers' Compensation |
$201.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$197.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$197.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$225.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$225.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$225.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$219.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$225.05
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$174.79
|
| Rate for Payer: Cigna Medicare Advantage |
$162.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$179.93
|
| Rate for Payer: Home State Health Plan Exchange |
$162.79
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$214.20
|
| Rate for Payer: Provider Network of America Commercial |
$228.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$188.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$285.60
|
|
|
Office Outpatient Visit Est 30-39 Minutes
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
Px09839921401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$214.20 |
| 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 |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| 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 |
$214.20
|
| Rate for Payer: Provider Network of America Commercial |
$228.48
|
|
|
Office Outpatient Visit Est 40-54 Minutes
|
Facility
|
IP
|
$523.95
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
Px05109921501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$419.16 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cash Price |
$523.95
|
| 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 |
$523.95
|
| 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 |
$419.16
|
|
|
Office Outpatient Visit Est 40-54 Minutes
|
Facility
|
OP
|
$523.95
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
Px05109921501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$298.65 |
| Max. Negotiated Rate |
$523.95 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$369.38
|
| Rate for Payer: Aetna Workers' Compensation |
$369.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$363.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$363.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$412.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$412.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$412.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$403.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$412.87
|
| Rate for Payer: Cash Price |
$523.95
|
| Rate for Payer: Cigna Medicare Advantage |
$298.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$330.09
|
| Rate for Payer: Home State Health Plan Exchange |
$298.65
|
| Rate for Payer: Humana Medicare |
$392.96
|
| Rate for Payer: Provider Network of America Commercial |
$419.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$345.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$523.95
|
|
|
OLANZapine 10 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$201.04
|
|
|
Service Code
|
NDC 00002759701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.78 |
| 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 |
$201.04
|
| Rate for Payer: Cash Price |
$201.04
|
| 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 |
$150.78
|
| Rate for Payer: Provider Network of America Commercial |
$160.83
|
|
|
OLANZapine 10 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
NDC 31722030801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.00 |
| 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 |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| 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 |
$60.00
|
| Rate for Payer: Provider Network of America Commercial |
$64.00
|
|
|
OLANZapine 10 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
NDC 31722030801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.40
|
| Rate for Payer: Aetna Workers' Compensation |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$63.04
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$48.96
|
| Rate for Payer: Cigna Medicare Advantage |
$45.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.40
|
| Rate for Payer: Home State Health Plan Exchange |
$45.60
|
| Rate for Payer: Humana Medicare |
$60.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Provider Network of America Commercial |
$64.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$80.00
|
|
|
OLANZapine 10 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$201.04
|
|
|
Service Code
|
NDC 00002759701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$201.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$141.73
|
| Rate for Payer: Aetna Workers' Compensation |
$141.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$158.42
|
| Rate for Payer: Cash Price |
$201.04
|
| Rate for Payer: Cigna Commercial |
$123.04
|
| Rate for Payer: Cigna Medicare Advantage |
$114.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$126.66
|
| Rate for Payer: Home State Health Plan Exchange |
$114.59
|
| Rate for Payer: Humana Medicare |
$150.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$150.78
|
| Rate for Payer: Provider Network of America Commercial |
$160.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$132.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$201.04
|
|
|
OLANZapine 10 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$201.04
|
|
|
Service Code
|
HCPCS J2359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$201.04 |
| Rate for Payer: Aetna Workers' Compensation |
$56.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$141.73
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.40
|
| Rate for Payer: Aetna Workers' Compensation |
$141.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$158.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$158.42
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$201.04
|
| Rate for Payer: Cigna Commercial |
$123.04
|
| Rate for Payer: Cigna Commercial |
$48.96
|
| Rate for Payer: Cigna Medicare Advantage |
$114.59
|
| Rate for Payer: Cigna Medicare Advantage |
$45.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$126.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.40
|
| Rate for Payer: Home State Health Plan Exchange |
$114.59
|
| Rate for Payer: Home State Health Plan Exchange |
$45.60
|
| Rate for Payer: Humana Medicare |
$150.78
|
| Rate for Payer: Humana Medicare |
$60.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$150.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Provider Network of America Commercial |
$160.83
|
| Rate for Payer: Provider Network of America Commercial |
$64.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$132.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$201.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$80.00
|
|
