|
protamine 10 mg/mL solution 25 mL Vial
|
Facility
|
IP
|
$241.24
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.93 |
| 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 |
$241.24
|
| Rate for Payer: Cash Price |
$241.24
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$180.93
|
| Rate for Payer: Provider Network of America Commercial |
$192.99
|
|
|
protamine 10 mg/mL solution 25 mL Vial
|
Facility
|
IP
|
$241.24
|
|
|
Service Code
|
NDC 63323022930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.93 |
| Max. Negotiated Rate |
$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: 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 |
$241.24
|
| Rate for Payer: Cash Price |
$241.24
|
| 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 |
$180.93
|
| Rate for Payer: Provider Network of America Commercial |
$192.99
|
|
|
Proteinase 3 Antibodies, Igg Serum
|
Facility
|
IP
|
$202.65
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
Px03018351640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$151.99 |
| 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 |
$202.65
|
| Rate for Payer: Cash Price |
$202.65
|
| 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: Oscar Health EPO/HMO/POS/PPO |
$151.99
|
| Rate for Payer: Provider Network of America Commercial |
$162.12
|
|
|
Proteinase 3 Antibodies, Igg Serum
|
Facility
|
OP
|
$202.65
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
Px03018351640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$162.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$142.87
|
| Rate for Payer: Aetna Workers' Compensation |
$142.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$159.69
|
| Rate for Payer: Cash Price |
$202.65
|
| Rate for Payer: Cash Price |
$202.65
|
| Rate for Payer: Cigna Commercial |
$106.19
|
| Rate for Payer: Cigna Medicare Advantage |
$115.51
|
| Rate for Payer: Family Health Partners Medicaid |
$14.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.67
|
| Rate for Payer: Healthy Blue Medicaid |
$15.69
|
| Rate for Payer: Home State Health Plan Exchange |
$115.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$14.53
|
| Rate for Payer: Humana Medicare |
$151.99
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$151.99
|
| Rate for Payer: Provider Network of America Commercial |
$162.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.75
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.94
|
|
|
Pro Unlisted Procedure Hands/Fingers
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
Px09832698901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.51
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$71.91
|
| Rate for Payer: Aetna Workers' Compensation |
$75.51
|
| Rate for Payer: Aetna Workers' Compensation |
$71.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$70.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$70.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$80.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$80.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$80.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$78.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$80.38
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cigna Commercial |
$62.42
|
| Rate for Payer: Cigna Medicare Advantage |
$58.14
|
| Rate for Payer: Cigna Medicare Advantage |
$61.05
|
| Rate for Payer: Family Health Partners Medicaid |
$311.30
|
| Rate for Payer: Family Health Partners Medicaid |
$311.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$64.26
|
| Rate for Payer: Healthy Blue Medicaid |
$336.21
|
| Rate for Payer: Healthy Blue Medicaid |
$336.21
|
| Rate for Payer: Home State Health Plan Exchange |
$61.05
|
| Rate for Payer: Home State Health Plan Exchange |
$58.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$311.30
|
| Rate for Payer: Home State Health Plan Medicaid |
$311.30
|
| Rate for Payer: Humana Medicare |
$76.50
|
| Rate for Payer: Humana Medicare |
$80.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$311.30
|
| Rate for Payer: Mercy CarePlus Medicaid |
$311.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.33
|
| Rate for Payer: Provider Network of America Commercial |
$81.60
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$67.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$102.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$107.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.37
|
|
|
Pro Unlisted Procedure Hands/Fingers
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
Px09832698901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$80.33 |
| 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 |
$102.00
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$102.00
|
| 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 |
$80.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
| Rate for Payer: Provider Network of America Commercial |
$81.60
|
|
|
PR Pelvic Examination
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
Px05109945901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.32 |
| 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 |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| 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 |
$40.32
|
|
|
PR Pelvic Examination
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
Px07619945901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.80 |
| 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 |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| 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 |
$37.80
|
| Rate for Payer: Provider Network of America Commercial |
$40.32
|
|
|
PR Pelvic Examination
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
Px05109945901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$35.53
|
| Rate for Payer: Aetna Workers' Compensation |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$38.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$39.72
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Medicare Advantage |
$28.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$31.75
|
| Rate for Payer: Home State Health Plan Exchange |
$28.73
|
| Rate for Payer: Humana Medicare |
$37.80
|
| Rate for Payer: Provider Network of America Commercial |
$40.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$50.40
|
|
|
PR Pelvic Examination
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
Px07619945901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$35.53
|
| Rate for Payer: Aetna Workers' Compensation |
$35.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$34.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$39.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$38.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$39.72
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$30.84
|
| Rate for Payer: Cigna Medicare Advantage |
$28.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$31.75
|
| Rate for Payer: Home State Health Plan Exchange |
$28.73
|
| Rate for Payer: Humana Medicare |
$37.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$37.80
|
| Rate for Payer: Provider Network of America Commercial |
$40.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$50.40
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$6,564.96
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,564.96 |
| 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 |
$6,564.96
|
|
|
Psychotherapy Patient &/ Family 45 Minutes
|
Facility
|
IP
|
$792.75
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
Px09149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$594.56 |
| 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 |
$792.75
|
| Rate for Payer: Cash Price |
$792.75
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$594.56
|
| Rate for Payer: Provider Network of America Commercial |
$634.20
|
|
|
Psychotherapy Patient &/ Family 45 Minutes
|
Facility
|
OP
|
$792.75
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
Px09149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$558.89
|
| Rate for Payer: Aetna Workers' Compensation |
$558.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$549.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$549.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$624.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$624.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$624.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$610.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$624.69
|
| Rate for Payer: Cash Price |
$792.75
|
| Rate for Payer: Cash Price |
$792.75
|
| Rate for Payer: Cigna Commercial |
$485.16
|
| Rate for Payer: Cigna Medicare Advantage |
$451.87
|
| Rate for Payer: Family Health Partners Medicaid |
$224.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$499.43
|
| Rate for Payer: Healthy Blue Medicaid |
$241.92
|
| Rate for Payer: Home State Health Plan Exchange |
$451.87
|
| Rate for Payer: Home State Health Plan Medicaid |
$224.00
|
| Rate for Payer: Humana Medicare |
$594.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$224.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$594.56
|
| Rate for Payer: Provider Network of America Commercial |
$634.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$523.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$792.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.64
|
|
|
Psychotherapy Patient &/ Family 60 Minutes
|
Facility
|
OP
|
$808.50
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
Px09149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$808.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$569.99
|
| Rate for Payer: Aetna Workers' Compensation |
$569.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$560.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$560.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$637.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$637.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$637.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$622.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$637.10
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cash Price |
$808.50
|
| Rate for Payer: Cigna Commercial |
$494.80
|
| Rate for Payer: Cigna Medicare Advantage |
$460.85
|
| Rate for Payer: Family Health Partners Medicaid |
$224.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$509.36
|
| Rate for Payer: Healthy Blue Medicaid |
$241.92
|
| Rate for Payer: Home State Health Plan Exchange |
$460.85
|
| Rate for Payer: Home State Health Plan Medicaid |
$224.00
|
| Rate for Payer: Humana Medicare |
$606.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$224.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$606.38
|
| Rate for Payer: Provider Network of America Commercial |
$646.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$533.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$808.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.64
|
|
|
Psychotherapy Patient &/ Family 60 Minutes
|
Facility
|
IP
|
$808.50
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
Px09149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$606.38 |
| 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 |
$808.50
|
| Rate for Payer: Cash Price |
$808.50
|
| 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: Oscar Health EPO/HMO/POS/PPO |
$606.38
|
| Rate for Payer: Provider Network of America Commercial |
$646.80
|
|
|
Psychotherapy W/Patient 30 Minutes
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
Px00000090832
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$86.09 |
| Max. Negotiated Rate |
$86.09 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$86.09
|
|
|
psyllium husk 3.4 gram powder in packet 1 Each Packet
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 37000002410
|
|
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
|
|
|
psyllium husk 3.4 gram powder in packet 1 Each Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 37000002410
|
|
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
|
|
|
psyllium husk 3.4 gram powder in packet 30 Each Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 37000002404
|
|
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
|
|
|
psyllium husk 3.4 gram powder in packet 30 Each Packet
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 37000002404
|
|
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
|
|
|
Pt Physical Therapy Evaluation Low Complex 20 Mins
|
Facility
|
IP
|
$262.50
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
Px04249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.88 |
| 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 |
$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: Oscar Health EPO/HMO/POS/PPO |
$196.88
|
| Rate for Payer: Provider Network of America Commercial |
$210.00
|
|
|
Pt Physical Therapy Evaluation Low Complex 20 Mins
|
Facility
|
OP
|
$262.50
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
Px04249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$65.00 |
| 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: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$160.65
|
| Rate for Payer: Cigna Medicare Advantage |
$149.62
|
| Rate for Payer: Family Health Partners Medicaid |
$120.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$165.38
|
| Rate for Payer: Healthy Blue Medicaid |
$130.17
|
| Rate for Payer: Home State Health Plan Exchange |
$149.62
|
| Rate for Payer: Home State Health Plan Medicaid |
$120.53
|
| Rate for Payer: Humana Medicare |
$196.88
|
| Rate for Payer: Mercy CarePlus Medicaid |
$120.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$196.88
|
| Rate for Payer: Provider Network of America Commercial |
$210.00
|
| Rate for Payer: TheraMatrix Physical Therapy Network |
$65.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$262.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.74
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 189
|
| 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 |
$5,806.38
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$21,493.22
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,493.22 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$21,493.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,493.22
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,493.22
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,493.22
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$12,047.41
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,047.41 |
| 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 |
$12,047.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,047.41
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,047.41
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,047.41
|
|
