|
ondansetron ODT 4 mg tablet,disintegrating 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68462015740
|
|
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
|
|
|
ondansetron ODT 4 mg tablet,disintegrating 30 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68462015713
|
|
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
|
|
|
ondansetron ODT 4 mg tablet,disintegrating 30 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68462015713
|
|
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
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$44,416.67
|
|
|
Service Code
|
APR-DRG 0213
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$44,416.67 |
| 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 |
$44,416.67
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$44,416.67
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$44,416.67
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$44,416.67
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$65,235.91
|
|
|
Service Code
|
APR-DRG 0214
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$65,235.91 |
| 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 |
$65,235.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$65,235.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$65,235.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$65,235.91
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$31,975.41
|
|
|
Service Code
|
APR-DRG 0212
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$31,975.41 |
| 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 |
$31,975.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$31,975.41
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$31,975.41
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$31,975.41
|
|
|
OPEN CRANIOTOMY EXCEPT TRAUMA
|
Facility
|
IP
|
$24,321.32
|
|
|
Service Code
|
APR-DRG 0211
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,321.32 |
| 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 |
$24,321.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$24,321.32
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$24,321.32
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$24,321.32
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$36,458.41
|
|
|
Service Code
|
APR-DRG 0203
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$36,458.41 |
| 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 |
$36,458.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$36,458.41
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$36,458.41
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$36,458.41
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$26,437.55
|
|
|
Service Code
|
APR-DRG 0202
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,437.55 |
| 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 |
$26,437.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,437.55
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,437.55
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,437.55
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$20,754.53
|
|
|
Service Code
|
APR-DRG 0201
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,754.53 |
| 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 |
$20,754.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,754.53
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,754.53
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,754.53
|
|
|
OPEN CRANIOTOMY FOR TRAUMA
|
Facility
|
IP
|
$54,411.64
|
|
|
Service Code
|
APR-DRG 0204
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$54,411.64 |
| 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 |
$54,411.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$54,411.64
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$54,411.64
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$54,411.64
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$39,962.33
|
|
|
Service Code
|
APR-DRG 0244
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$39,962.33 |
| 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 |
$39,962.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$39,962.33
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$39,962.33
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$39,962.33
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$24,492.36
|
|
|
Service Code
|
APR-DRG 0243
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,492.36 |
| 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 |
$24,492.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$24,492.36
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$24,492.36
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$24,492.36
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,555.30
|
|
|
Service Code
|
APR-DRG 0242
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,555.30 |
| 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 |
$13,555.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,555.30
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,555.30
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,555.30
|
|
|
OPEN EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$10,271.41
|
|
|
Service Code
|
APR-DRG 0241
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,271.41 |
| 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 |
$10,271.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,271.41
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,271.41
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,271.41
|
|
|
Open Tx Acute Shoulder Dislocation
|
Facility
|
OP
|
$2,047.50
|
|
|
Service Code
|
CPT 23660
|
| Hospital Charge Code |
Px09832366001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,167.08 |
| Max. Negotiated Rate |
$9,890.16 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,443.49
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,374.75
|
| Rate for Payer: Aetna Workers' Compensation |
$1,443.49
|
| Rate for Payer: Aetna Workers' Compensation |
$1,374.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,418.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,351.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,418.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,351.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,613.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,536.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,613.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,536.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,536.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,613.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,501.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,576.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,613.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,536.60
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$1,253.07
|
| Rate for Payer: Cigna Commercial |
$1,193.40
|
| Rate for Payer: Cigna Medicare Advantage |
$1,111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$1,167.08
|
| Rate for Payer: Family Health Partners Medicaid |
$9,157.55
|
| Rate for Payer: Family Health Partners Medicaid |
$9,157.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,289.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,228.50
|
| Rate for Payer: Healthy Blue Medicaid |
$9,890.16
|
| Rate for Payer: Healthy Blue Medicaid |
$9,890.16
|
| Rate for Payer: Home State Health Plan Exchange |
$1,167.08
|
| Rate for Payer: Home State Health Plan Exchange |
$1,111.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,157.55
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,157.55
|
| Rate for Payer: Humana Medicare |
$1,462.50
|
| Rate for Payer: Humana Medicare |
$1,535.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,157.55
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,157.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,535.62
|
| Rate for Payer: Provider Network of America Commercial |
$1,560.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,638.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,287.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,351.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,950.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,047.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,894.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,894.33
|
|
|
Open Tx Acute Shoulder Dislocation
|
Facility
|
IP
|
$2,047.50
|
|
|
Service Code
|
CPT 23660
|
| Hospital Charge Code |
Px09832366001
|
|
Hospital Revenue Code
|
983
|
| 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 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 |
$1,950.00
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$2,047.50
|
| Rate for Payer: Cash Price |
$1,950.00
|
| 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 |
$1,535.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Provider Network of America Commercial |
$1,638.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,560.00
|
|
|
Open Tx Distal Phalangeal Fracture Each
|
Facility
|
OP
|
$495.60
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
Px09832675601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$282.49 |
| Max. Negotiated Rate |
$4,459.70 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$349.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$332.76
|
| Rate for Payer: Aetna Workers' Compensation |
$349.40
|
| Rate for Payer: Aetna Workers' Compensation |
$332.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$327.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$327.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$390.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$371.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$390.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$371.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$371.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$390.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$363.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$381.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$390.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$371.94
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Cigna Commercial |
$288.86
|
| Rate for Payer: Cigna Medicare Advantage |
$269.04
|
| Rate for Payer: Cigna Medicare Advantage |
$282.49
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$312.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$297.36
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Home State Health Plan Exchange |
$282.49
|
| Rate for Payer: Home State Health Plan Exchange |
$269.04
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Humana Medicare |
$371.70
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$371.70
|
| Rate for Payer: Provider Network of America Commercial |
$377.60
|
| Rate for Payer: Provider Network of America Commercial |
$396.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$311.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$327.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$472.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$495.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
|
|
Open Tx Distal Phalangeal Fracture Each
|
Facility
|
IP
|
$495.60
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
Px09832675601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$371.70 |
| 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 |
$472.00
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$472.00
|
| 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 |
$371.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Provider Network of America Commercial |
$396.48
|
| Rate for Payer: Provider Network of America Commercial |
$377.60
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7731
|
| 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 |
$3,267.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$3,267.25
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,267.25
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,267.25
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$20,261.76
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,261.76 |
| 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 |
$20,261.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,261.76
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,261.76
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,261.76
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$9,080.63
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,080.63 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$9,080.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,080.63
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,080.63
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,080.63
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7732
|
| 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 |
$4,940.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,940.63
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,940.63
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,940.63
|
|
|
Oprelvekin injection
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS J2355
|
| Hospital Charge Code |
Px0636J235501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$266.49
|
| Rate for Payer: Aetna Workers' Compensation |
$266.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$261.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$261.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$297.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$297.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$297.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$291.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$297.86
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna Commercial |
$231.34
|
| Rate for Payer: Cigna Medicare Advantage |
$215.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$238.14
|
| Rate for Payer: Home State Health Plan Exchange |
$215.46
|
| Rate for Payer: Humana Medicare |
$283.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$283.50
|
| Rate for Payer: Provider Network of America Commercial |
$302.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$249.48
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$378.00
|
|
|
Oprelvekin injection
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS J2355
|
| Hospital Charge Code |
Px0636J235501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.50 |
| 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 |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| 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 |
$283.50
|
| Rate for Payer: Provider Network of America Commercial |
$302.40
|
|
