|
Ropivacaine hcl injection
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
Px0636J279501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$18.51
|
| Rate for Payer: Aetna Workers' Compensation |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$20.68
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$14.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$16.54
|
| Rate for Payer: Home State Health Plan Exchange |
$14.96
|
| Rate for Payer: Humana Medicare |
$19.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$26.25
|
|
|
Ropivacaine hcl injection
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
Px0636J279501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| 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 |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| 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 |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
|
|
ropivacaine per 1 mg
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 70069006101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
ropivacaine per 1 mg
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
ropivacaine per 1 mg
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
ropivacaine per 1 mg
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 70069006101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
Rplj Dgt Excluding Thmb Sublimis Tdn Compl Amp
|
Facility
|
IP
|
$2,363.03
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
Px09832082201
|
|
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 |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,363.03
|
| Rate for Payer: Cash Price |
$2,363.03
|
| Rate for Payer: Cash Price |
$2,250.50
|
| 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 |
$1,772.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,687.88
|
| Rate for Payer: Provider Network of America Commercial |
$1,890.42
|
| Rate for Payer: Provider Network of America Commercial |
$1,800.40
|
|
|
Rplj Dgt Excluding Thmb Sublimis Tdn Compl Amp
|
Facility
|
OP
|
$2,363.03
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
Px09832082201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,346.93 |
| Max. Negotiated Rate |
$2,363.03 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,665.94
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,586.60
|
| Rate for Payer: Aetna Workers' Compensation |
$1,665.94
|
| Rate for Payer: Aetna Workers' Compensation |
$1,586.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,637.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,559.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,637.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,559.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,862.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,773.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,862.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,773.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,773.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,862.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,732.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,819.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,862.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,773.39
|
| Rate for Payer: Cash Price |
$2,363.03
|
| Rate for Payer: Cash Price |
$2,363.03
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cash Price |
$2,250.50
|
| Rate for Payer: Cigna Commercial |
$1,446.17
|
| Rate for Payer: Cigna Commercial |
$1,377.31
|
| Rate for Payer: Cigna Medicare Advantage |
$1,282.79
|
| Rate for Payer: Cigna Medicare Advantage |
$1,346.93
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,488.71
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,417.82
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Home State Health Plan Exchange |
$1,346.93
|
| Rate for Payer: Home State Health Plan Exchange |
$1,282.79
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Humana Medicare |
$1,687.88
|
| Rate for Payer: Humana Medicare |
$1,772.27
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,687.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,772.27
|
| Rate for Payer: Provider Network of America Commercial |
$1,800.40
|
| Rate for Payer: Provider Network of America Commercial |
$1,890.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,485.33
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,559.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,250.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,363.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
|
|
Rpr Aa Hernia 1st > 10 Cm Ncrc8/Strangulated
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 49596
|
| Hospital Charge Code |
Px03614959601
|
|
Hospital Revenue Code
|
361
|
| 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 |
$6,090.00
|
| Rate for Payer: Cash Price |
$6,090.00
|
| 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 |
$4,567.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,872.00
|
|
|
Rpr Aa Hernia 1st > 10 Cm Ncrc8/Strangulated
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 49596
|
| Hospital Charge Code |
Px03614959601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,471.30 |
| Max. Negotiated Rate |
$6,090.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,220.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,220.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,798.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,798.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,798.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,689.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,798.92
|
| Rate for Payer: Cash Price |
$6,090.00
|
| Rate for Payer: Cigna Commercial |
$4,037.67
|
| Rate for Payer: Cigna Medicare Advantage |
$3,471.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,836.70
|
| Rate for Payer: Home State Health Plan Exchange |
$3,471.30
|
| Rate for Payer: Humana Medicare |
$4,567.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,872.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,019.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,090.00
|
|
|
Rpr Aa Hernia 1st 3-10 Cm Ncrc8/Strangulated
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT 49594
|
| Hospital Charge Code |
Px03604959401
|
|
Hospital Revenue Code
|
360
|
| 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 |
$5,250.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| 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 |
$3,937.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,200.00
|
|
|
Rpr Aa Hernia 1st 3-10 Cm Ncrc8/Strangulated
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT 49594
|
| Hospital Charge Code |
Px03604959401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,992.50 |
| Max. Negotiated Rate |
$8,239.99 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,042.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,137.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| Rate for Payer: Cigna Commercial |
$3,480.75
|
| Rate for Payer: Cigna Medicare Advantage |
$2,992.50
|
| Rate for Payer: Family Health Partners Medicaid |
$7,629.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,307.50
|
| Rate for Payer: Healthy Blue Medicaid |
$8,239.99
|
| Rate for Payer: Home State Health Plan Exchange |
$2,992.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,629.62
|
| Rate for Payer: Humana Medicare |
$3,937.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,629.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,937.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,200.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,465.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,250.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,744.02
|
|
|
Rpr Aa Hernia 1st < 3 Cm Ncrc8/Strangulated
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
Px03604959201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,992.50 |
| Max. Negotiated Rate |
$8,239.99 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,638.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,137.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,042.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,137.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| Rate for Payer: Cigna Commercial |
$3,480.75
|
| Rate for Payer: Cigna Medicare Advantage |
$2,992.50
|
| Rate for Payer: Family Health Partners Medicaid |
$7,629.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,307.50
|
| Rate for Payer: Healthy Blue Medicaid |
$8,239.99
|
| Rate for Payer: Home State Health Plan Exchange |
$2,992.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,629.62
|
| Rate for Payer: Humana Medicare |
$3,937.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,629.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,937.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,200.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,465.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,250.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,744.02
|
|
|
Rpr Aa Hernia 1st < 3 Cm Ncrc8/Strangulated
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
Px03604959201
|
|
Hospital Revenue Code
|
360
|
| 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 |
$5,250.00
|
| Rate for Payer: Cash Price |
$5,250.00
|
| 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 |
$3,937.50
|
| Rate for Payer: Provider Network of America Commercial |
$4,200.00
|
|
|
Rt Mdi/Dpi Subsequent
|
Facility
|
OP
|
$173.25
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
Px04109464011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$298.47 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$122.14
|
| Rate for Payer: Aetna Workers' Compensation |
$122.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$120.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$120.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$136.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$136.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$136.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$133.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$136.52
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna Commercial |
$106.03
|
| Rate for Payer: Cigna Medicare Advantage |
$98.75
|
| Rate for Payer: Family Health Partners Medicaid |
$276.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$109.15
|
| Rate for Payer: Healthy Blue Medicaid |
$298.47
|
| Rate for Payer: Home State Health Plan Exchange |
$98.75
|
| 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 |
$129.94
|
| Rate for Payer: Provider Network of America Commercial |
$138.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$173.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.06
|
|
|
Rt Mdi/Dpi Subsequent
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
Px04109464011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$129.94 |
| 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 |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| 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 |
$129.94
|
| Rate for Payer: Provider Network of America Commercial |
$138.60
|
|
|
sacubitril-valsartan 49-51 mg tablet 60 Each Bottle
|
Facility
|
IP
|
$48.42
|
|
|
Service Code
|
NDC 00078077720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.31 |
| 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 |
$48.42
|
| Rate for Payer: Cash Price |
$48.42
|
| 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 |
$36.31
|
| Rate for Payer: Provider Network of America Commercial |
$38.74
|
|
|
sacubitril-valsartan 49-51 mg tablet 60 Each Bottle
|
Facility
|
OP
|
$48.42
|
|
|
Service Code
|
NDC 00078077720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$48.42 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$34.14
|
| Rate for Payer: Aetna Workers' Compensation |
$34.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$37.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$38.15
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cigna Commercial |
$29.63
|
| Rate for Payer: Cigna Medicare Advantage |
$27.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$30.50
|
| Rate for Payer: Home State Health Plan Exchange |
$27.60
|
| Rate for Payer: Humana Medicare |
$36.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.31
|
| Rate for Payer: Provider Network of America Commercial |
$38.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$48.42
|
|
|
Saline Wound Wash
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
Px0272A626001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7.48
|
| Rate for Payer: Aetna Workers' Compensation |
$7.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$8.36
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: Cigna Commercial |
$6.49
|
| Rate for Payer: Cigna Medicare Advantage |
$6.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6.68
|
| Rate for Payer: Home State Health Plan Exchange |
$6.05
|
| Rate for Payer: Humana Medicare |
$7.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7.96
|
| Rate for Payer: Provider Network of America Commercial |
$8.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10.61
|
|
|
Saline Wound Wash
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
Px0272A626001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.96 |
| 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 |
$10.61
|
| Rate for Payer: Cash Price |
$10.61
|
| 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 |
$7.96
|
| Rate for Payer: Provider Network of America Commercial |
$8.49
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 139
|
| 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 |
$5,680.42
|
|
|
Sandal-Cast
|
Facility
|
IP
|
$21.78
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
Px0274L326001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.34 |
| 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 |
$21.78
|
| Rate for Payer: Cash Price |
$21.78
|
| 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 |
$16.34
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
|
|
Sandal-Cast
|
Facility
|
OP
|
$21.78
|
|
|
Service Code
|
CPT L3260
|
| Hospital Charge Code |
Px0274L326001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.35
|
| Rate for Payer: Aetna Workers' Compensation |
$15.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.16
|
| Rate for Payer: Cash Price |
$21.78
|
| Rate for Payer: Cigna Commercial |
$13.33
|
| Rate for Payer: Cigna Medicare Advantage |
$12.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.72
|
| Rate for Payer: Home State Health Plan Exchange |
$12.41
|
| Rate for Payer: Humana Medicare |
$16.34
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.34
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.78
|
|
|
Sargramostim injection
|
Facility
|
OP
|
$936.47
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
Px0636J282001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$533.79 |
| Max. Negotiated Rate |
$936.47 |
| Rate for Payer: UnitedHealthcare Commercial |
$618.07
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$660.21
|
| Rate for Payer: Aetna Workers' Compensation |
$660.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$648.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$648.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$737.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$737.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$737.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$721.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$737.94
|
| Rate for Payer: Cash Price |
$936.47
|
| Rate for Payer: Cigna Commercial |
$573.12
|
| Rate for Payer: Cigna Medicare Advantage |
$533.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$589.98
|
| Rate for Payer: Home State Health Plan Exchange |
$533.79
|
| Rate for Payer: Humana Medicare |
$702.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$702.35
|
| Rate for Payer: Provider Network of America Commercial |
$749.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$936.47
|
|
|
Sargramostim injection
|
Facility
|
IP
|
$936.47
|
|
|
Service Code
|
HCPCS J2820
|
| Hospital Charge Code |
Px0636J282001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.35 |
| 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 |
$936.47
|
| Rate for Payer: Cash Price |
$936.47
|
| 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 |
$702.35
|
| Rate for Payer: Provider Network of America Commercial |
$749.18
|
|
