|
Recmpl Wnd Head,Fac,Hand 1.1-2.5 Cm
|
Facility
|
IP
|
$584.85
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
Px03601313101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$438.64 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cash Price |
$584.85
|
| Rate for Payer: Cigna Medicare Advantage |
$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 |
$584.85
|
| 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 |
$438.64
|
| Rate for Payer: Provider Network of America Commercial |
$467.88
|
|
|
Recmpl Wnd Head,Fac,Hand 1.1-2.5 Cm
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
Px07611313101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.75 |
| 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 |
$557.00
|
| Rate for Payer: Cash Price |
$557.00
|
| 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 |
$417.75
|
| Rate for Payer: Provider Network of America Commercial |
$445.60
|
|
|
Recmpl Wnd Head,Fac,Hand 1.1-2.5 Cm
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
Px07611313101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.49 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$392.69
|
| Rate for Payer: Aetna Workers' Compensation |
$392.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$386.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$438.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$438.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$438.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$428.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$438.92
|
| Rate for Payer: Cash Price |
$557.00
|
| Rate for Payer: Cash Price |
$557.00
|
| Rate for Payer: Cigna Commercial |
$340.88
|
| Rate for Payer: Cigna Medicare Advantage |
$317.49
|
| Rate for Payer: Family Health Partners Medicaid |
$513.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$350.91
|
| Rate for Payer: Healthy Blue Medicaid |
$554.07
|
| Rate for Payer: Home State Health Plan Exchange |
$317.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$513.03
|
| Rate for Payer: Humana Medicare |
$417.75
|
| Rate for Payer: Mercy CarePlus Medicaid |
$513.03
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$417.75
|
| Rate for Payer: Provider Network of America Commercial |
$445.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$367.62
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$557.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.24
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$11,008.34
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,008.34 |
| 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 |
$11,008.34
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$17,017.29
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$17,017.29 |
| 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 |
$17,017.29
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$7,698.13
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,698.13 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$7,698.13
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$6,600.21
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,600.21 |
| 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 |
$6,600.21
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 812
|
| 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 |
$4,315.54
|
|
|
regadenoson 0.4 mg/5 mL syringe 5 mL Syringe
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J2785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.00 |
| 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 |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$75.00
|
| Rate for Payer: Provider Network of America Commercial |
$80.00
|
|
|
regadenoson 0.4 mg/5 mL syringe 5 mL Syringe
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
NDC 60505611600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.00 |
| 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 |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$75.00
|
| Rate for Payer: Provider Network of America Commercial |
$80.00
|
|
|
regadenoson 0.4 mg/5 mL syringe 5 mL Syringe
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
NDC 60505611600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$70.50
|
| Rate for Payer: Aetna Workers' Compensation |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$77.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$78.80
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: Cigna Medicare Advantage |
$57.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$63.00
|
| Rate for Payer: Home State Health Plan Exchange |
$57.00
|
| Rate for Payer: Humana Medicare |
$75.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$75.00
|
| Rate for Payer: Provider Network of America Commercial |
$80.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$100.00
|
|
|
regadenoson 0.4 mg/5 mL syringe 5 mL Syringe
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J2785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$70.50
|
| Rate for Payer: Aetna Workers' Compensation |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$78.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$77.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$78.80
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: Cigna Medicare Advantage |
$57.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$63.00
|
| Rate for Payer: Home State Health Plan Exchange |
$57.00
|
| Rate for Payer: Humana Medicare |
$75.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$75.00
|
| Rate for Payer: Provider Network of America Commercial |
$80.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$100.00
|
|
|
Regadenoson injection
|
Facility
|
OP
|
$34.46
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
Px0636J278501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$34.46 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.29
|
| Rate for Payer: Aetna Workers' Compensation |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.15
|
| Rate for Payer: Cash Price |
$34.46
|
| Rate for Payer: Cigna Commercial |
$21.09
|
| Rate for Payer: Cigna Medicare Advantage |
$19.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21.71
|
| Rate for Payer: Home State Health Plan Exchange |
$19.64
|
| Rate for Payer: Humana Medicare |
$25.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25.84
|
| Rate for Payer: Provider Network of America Commercial |
$27.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34.46
|
|
|
Regadenoson injection
|
Facility
|
IP
|
$34.46
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
Px0636J278501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.84 |
| 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 |
$34.46
|
| Rate for Payer: Cash Price |
$34.46
|
| 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 |
$25.84
|
| Rate for Payer: Provider Network of America Commercial |
$27.57
|
|
|
REHABILITATION
|
Facility
|
IP
|
$11,614.73
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,614.73 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$11,614.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,614.73
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,614.73
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,614.73
|
|
|
REHABILITATION
|
Facility
|
IP
|
$19,477.77
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,477.77 |
| 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 |
$19,477.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,477.77
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,477.77
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,477.77
|
|
|
REHABILITATION
|
Facility
|
IP
|
$14,762.72
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,762.72 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$14,762.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,762.72
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,762.72
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,762.72
|
|
|
REHABILITATION
|
Facility
|
IP
|
$24,155.83
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,155.83 |
| 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 |
$24,155.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$24,155.83
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$24,155.83
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$24,155.83
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$7,278.42
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,278.42 |
| 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 |
$7,278.42
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 946
|
| 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 |
$5,389.96
|
|
|
remdesivir 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$2,834.52
|
|
|
Service Code
|
HCPCS J0248
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2,834.52
|
| Rate for Payer: Cash Price |
$2,834.52
|
| 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 |
$2,125.89
|
| Rate for Payer: Provider Network of America Commercial |
$2,267.62
|
|
|
remdesivir 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$2,834.52
|
|
|
Service Code
|
HCPCS J0248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,615.68 |
| Max. Negotiated Rate |
$2,834.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,998.34
|
| Rate for Payer: Aetna Workers' Compensation |
$1,998.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,964.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,964.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,182.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,233.60
|
| Rate for Payer: Cash Price |
$2,834.52
|
| Rate for Payer: Cigna Commercial |
$1,734.73
|
| Rate for Payer: Cigna Medicare Advantage |
$1,615.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,785.75
|
| Rate for Payer: Home State Health Plan Exchange |
$1,615.68
|
| Rate for Payer: Humana Medicare |
$2,125.89
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,125.89
|
| Rate for Payer: Provider Network of America Commercial |
$2,267.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,870.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,834.52
|
|
|
remdesivir 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$2,834.52
|
|
|
Service Code
|
NDC 61958290102
|
|
Hospital Revenue Code
|
250
|
| 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 |
$2,834.52
|
| Rate for Payer: Cash Price |
$2,834.52
|
| 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 |
$2,125.89
|
| Rate for Payer: Provider Network of America Commercial |
$2,267.62
|
|
|
remdesivir 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$2,834.52
|
|
|
Service Code
|
NDC 61958290102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,615.68 |
| Max. Negotiated Rate |
$2,834.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,998.34
|
| Rate for Payer: Aetna Workers' Compensation |
$1,998.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,964.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,964.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,182.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,233.60
|
| Rate for Payer: Cash Price |
$2,834.52
|
| Rate for Payer: Cigna Commercial |
$1,734.73
|
| Rate for Payer: Cigna Medicare Advantage |
$1,615.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,785.75
|
| Rate for Payer: Home State Health Plan Exchange |
$1,615.68
|
| Rate for Payer: Humana Medicare |
$2,125.89
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,125.89
|
| Rate for Payer: Provider Network of America Commercial |
$2,267.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,870.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,834.52
|
|
|
Removal Foreign Body Foot Subcutaneous
|
Facility
|
OP
|
$197.93
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
Px09832819001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$112.82 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$139.54
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$132.89
|
| Rate for Payer: Aetna Workers' Compensation |
$139.54
|
| Rate for Payer: Aetna Workers' Compensation |
$132.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$137.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$137.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$155.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$155.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$155.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$145.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$152.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$155.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$148.54
|
| Rate for Payer: Cash Price |
$197.93
|
| Rate for Payer: Cash Price |
$197.93
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$121.13
|
| Rate for Payer: Cigna Commercial |
$115.36
|
| Rate for Payer: Cigna Medicare Advantage |
$107.44
|
| Rate for Payer: Cigna Medicare Advantage |
$112.82
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$124.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$118.75
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$112.82
|
| Rate for Payer: Home State Health Plan Exchange |
$107.44
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$141.38
|
| Rate for Payer: Humana Medicare |
$148.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$141.38
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$148.45
|
| Rate for Payer: Provider Network of America Commercial |
$150.80
|
| Rate for Payer: Provider Network of America Commercial |
$158.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$188.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$197.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
