|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 918
|
| 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 Freedom Network |
$1,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,028.37
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 8121
|
| 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 |
$4,165.88
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,165.88
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,165.88
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,165.88
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$6,510.46
|
|
|
Service Code
|
APR-DRG 8122
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,510.46 |
| 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 |
$6,510.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,510.46
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,510.46
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,510.46
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$10,048.60
|
|
|
Service Code
|
APR-DRG 8123
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,048.60 |
| 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 |
$10,048.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,048.60
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,048.60
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,048.60
|
|
|
POISONING OF MEDICINAL AGENTS
|
Facility
|
IP
|
$20,038.95
|
|
|
Service Code
|
APR-DRG 8124
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,038.95 |
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$20,038.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,038.95
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,038.95
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,038.95
|
|
|
polyethylene glycol 236-22.74-6.74 -5.86 gram recon soln 4,000 mL Bottle
|
Facility
|
IP
|
$99.52
|
|
|
Service Code
|
NDC 52268010001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.64 |
| 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 |
$99.52
|
| Rate for Payer: Cash Price |
$99.52
|
| 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 |
$74.64
|
| Rate for Payer: Provider Network of America Commercial |
$79.62
|
|
|
polyethylene glycol 236-22.74-6.74 -5.86 gram recon soln 4,000 mL Bottle
|
Facility
|
OP
|
$99.52
|
|
|
Service Code
|
NDC 52268010001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$70.16
|
| Rate for Payer: Aetna Workers' Compensation |
$70.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$78.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$78.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$78.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$78.42
|
| Rate for Payer: Cash Price |
$99.52
|
| Rate for Payer: Cigna Commercial |
$60.91
|
| Rate for Payer: Cigna Medicare Advantage |
$56.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.70
|
| Rate for Payer: Home State Health Plan Exchange |
$56.73
|
| Rate for Payer: Humana Medicare |
$74.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.64
|
| Rate for Payer: Provider Network of America Commercial |
$79.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$99.52
|
|
|
polyethylene glycol (PEG) 3350 17 gram/dose powder 238 g Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00536105224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| 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 |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
polyethylene glycol (PEG) 3350 17 gram/dose powder 238 g Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00536105224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
polyethylene glycol (PEG) 3350 17 gram powder in packet 1 Each Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00904693186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| 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 |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
polyethylene glycol (PEG) 3350 17 gram powder in packet 1 Each Packet
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00904693186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd
|
Facility
|
OP
|
$5,565.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
Px09209581101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$815.91 |
| Max. Negotiated Rate |
$5,565.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3,923.32
|
| Rate for Payer: Aetna Workers' Compensation |
$3,923.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,856.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,856.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,385.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,385.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,385.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,285.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,385.22
|
| Rate for Payer: Cash Price |
$5,565.00
|
| Rate for Payer: Cash Price |
$5,565.00
|
| Rate for Payer: Cigna Commercial |
$3,405.78
|
| Rate for Payer: Cigna Medicare Advantage |
$3,172.05
|
| Rate for Payer: Family Health Partners Medicaid |
$1,083.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,505.95
|
| Rate for Payer: Healthy Blue Medicaid |
$1,170.45
|
| Rate for Payer: Home State Health Plan Exchange |
$3,172.05
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,083.75
|
| Rate for Payer: Humana Medicare |
$4,173.75
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,083.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,173.75
|
| Rate for Payer: Provider Network of America Commercial |
$4,452.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,672.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,565.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$815.91
|
|
|
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd
|
Facility
|
IP
|
$5,565.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
Px09209581101
|
|
Hospital Revenue Code
|
920
|
| 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: Cash Price |
$5,565.00
|
| Rate for Payer: Cash Price |
$5,565.00
|
| 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 |
$4,173.75
|
| Rate for Payer: Provider Network of America Commercial |
$4,452.00
|
|
|
POS Airway Pressure Cpap/Bipap
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
Px04109466012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$740.25
|
| Rate for Payer: Aetna Workers' Compensation |
$740.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$727.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$727.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$808.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$827.40
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: Cigna Medicare Advantage |
$598.50
|
| Rate for Payer: Family Health Partners Medicaid |
$276.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$661.50
|
| Rate for Payer: Healthy Blue Medicaid |
$298.47
|
| Rate for Payer: Home State Health Plan Exchange |
$598.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$276.36
|
| Rate for Payer: Humana Medicare |
$95.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$276.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$787.50
|
| Rate for Payer: Provider Network of America Commercial |
$840.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$693.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.06
|
|
|
POS Airway Pressure Cpap/Bipap
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
Px04109466012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$787.50 |
| 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 |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| 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 |
$787.50
|
| Rate for Payer: Provider Network of America Commercial |
$840.00
|
|
|
POS Airway Pressure Cpap/Bipap Subseq Day
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
Px04109466013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$740.25
|
| Rate for Payer: Aetna Workers' Compensation |
$740.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$727.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$727.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$827.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$808.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$827.40
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$642.60
|
| Rate for Payer: Cigna Medicare Advantage |
$598.50
|
| Rate for Payer: Family Health Partners Medicaid |
$276.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$661.50
|
| Rate for Payer: Healthy Blue Medicaid |
$298.47
|
| Rate for Payer: Home State Health Plan Exchange |
$598.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$276.36
|
| Rate for Payer: Humana Medicare |
$95.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$276.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$787.50
|
| Rate for Payer: Provider Network of America Commercial |
$840.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$693.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.06
|
|
|
POS Airway Pressure Cpap/Bipap Subseq Day
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
Px04109466013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$787.50 |
| 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 |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| 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 |
$787.50
|
| Rate for Payer: Provider Network of America Commercial |
$840.00
|
|
|
Positional Nystagmus Test
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
Px09839254201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cash Price |
$78.00
|
| 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 |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$78.00
|
| 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 |
$61.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Provider Network of America Commercial |
$65.52
|
| Rate for Payer: Provider Network of America Commercial |
$62.40
|
|
|
Positional Nystagmus Test
|
Facility
|
OP
|
$81.90
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
Px05109254201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$57.74
|
| Rate for Payer: Aetna Workers' Compensation |
$57.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$63.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$64.54
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna Commercial |
$50.12
|
| Rate for Payer: Cigna Medicare Advantage |
$46.68
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$51.60
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$46.68
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$61.42
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$61.42
|
| Rate for Payer: Provider Network of America Commercial |
$65.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
Positional Nystagmus Test
|
Facility
|
OP
|
$81.90
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
Px09839254201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$57.74
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$54.99
|
| Rate for Payer: Aetna Workers' Compensation |
$57.74
|
| Rate for Payer: Aetna Workers' Compensation |
$54.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$61.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$63.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$64.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$61.46
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$50.12
|
| Rate for Payer: Cigna Commercial |
$47.74
|
| Rate for Payer: Cigna Medicare Advantage |
$44.46
|
| Rate for Payer: Cigna Medicare Advantage |
$46.68
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$51.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.14
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$46.68
|
| Rate for Payer: Home State Health Plan Exchange |
$44.46
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$58.50
|
| Rate for Payer: Humana Medicare |
$61.42
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$61.42
|
| Rate for Payer: Provider Network of America Commercial |
$62.40
|
| Rate for Payer: Provider Network of America Commercial |
$65.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$51.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
Positional Nystagmus Test
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
CPT 92542
|
| Hospital Charge Code |
Px05109254201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.42 |
| 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 |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| 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 |
$61.42
|
| Rate for Payer: Provider Network of America Commercial |
$65.52
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$8,571.39
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,571.39 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,571.39
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,690.13
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$10,065.05
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,065.05 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$10,065.05
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$21,378.89
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,378.89 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$21,378.89
|
|
