|
sodium hyaluronate (viscosup) 30 mg/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,912.00
|
|
|
Service Code
|
HCPCS J7324
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,089.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,347.96
|
| Rate for Payer: Aetna Workers' Compensation |
$1,347.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,325.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,325.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,472.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,506.66
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cigna Commercial |
$1,170.14
|
| Rate for Payer: Cigna Medicare Advantage |
$1,089.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,204.56
|
| Rate for Payer: Home State Health Plan Exchange |
$1,089.84
|
| Rate for Payer: Humana Medicare |
$1,434.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,434.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,529.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,261.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,912.00
|
|
|
sodium hyaluronate (viscosup) 30 mg/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,912.00
|
|
|
Service Code
|
NDC 59676036001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,089.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,347.96
|
| Rate for Payer: Aetna Workers' Compensation |
$1,347.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,325.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,325.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,506.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,472.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,506.66
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cigna Commercial |
$1,170.14
|
| Rate for Payer: Cigna Medicare Advantage |
$1,089.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,204.56
|
| Rate for Payer: Home State Health Plan Exchange |
$1,089.84
|
| Rate for Payer: Humana Medicare |
$1,434.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,434.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,529.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,261.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,912.00
|
|
|
sodium hyaluronate (viscosup) 30 mg/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,912.00
|
|
|
Service Code
|
NDC 59676036001
|
|
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 |
$1,912.00
|
| Rate for Payer: Cash Price |
$1,912.00
|
| 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 |
$1,434.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,529.60
|
|
|
sodium polystyrene 15-20 gram/60 mL suspension 60 mL Bottle
|
Facility
|
IP
|
$99.20
|
|
|
Service Code
|
NDC 46287000660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.40
|
| Rate for Payer: Provider Network of America Commercial |
$79.36
|
|
|
sodium polystyrene 15-20 gram/60 mL suspension 60 mL Bottle
|
Facility
|
OP
|
$99.20
|
|
|
Service Code
|
NDC 46287000660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.54 |
| Max. Negotiated Rate |
$99.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.94
|
| Rate for Payer: Aetna Workers' Compensation |
$69.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$78.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$78.17
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cigna Commercial |
$60.71
|
| Rate for Payer: Cigna Medicare Advantage |
$56.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.50
|
| Rate for Payer: Home State Health Plan Exchange |
$56.54
|
| Rate for Payer: Humana Medicare |
$74.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.40
|
| Rate for Payer: Provider Network of America Commercial |
$79.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$99.20
|
|
|
So Fig 8 Abd Restraint Prefab Ots Pr1
|
Facility
|
OP
|
$23.01
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
Px0274L365001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$16.22
|
| Rate for Payer: Aetna Workers' Compensation |
$16.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$18.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$18.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$18.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$17.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$18.13
|
| Rate for Payer: Cash Price |
$23.01
|
| Rate for Payer: Cigna Commercial |
$14.08
|
| Rate for Payer: Cigna Medicare Advantage |
$13.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$14.50
|
| Rate for Payer: Home State Health Plan Exchange |
$13.12
|
| Rate for Payer: Humana Medicare |
$17.26
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$17.26
|
| Rate for Payer: Provider Network of America Commercial |
$18.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$23.01
|
|
|
So Fig 8 Abd Restraint Prefab Ots Pr1
|
Facility
|
IP
|
$23.01
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
Px0274L365001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.26 |
| 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 |
$23.01
|
| Rate for Payer: Cash Price |
$23.01
|
| 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 |
$17.26
|
| Rate for Payer: Provider Network of America Commercial |
$18.41
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$8,216.07
|
|
|
Service Code
|
MSDRG 501
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,216.07 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,216.07
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$14,874.56
|
|
|
Service Code
|
MSDRG 500
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,874.56 |
| 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 |
$14,874.56
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,325.73
|
|
|
Service Code
|
MSDRG 502
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,325.73 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,325.73
|
|
|
sotalol 80 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268072411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
sotalol 80 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268072411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
sotalol 80 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268072415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
sotalol 80 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268072415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
Special Stains,Group I - Lab Special Stains,Group I
|
Facility
|
IP
|
$180.60
|
|
|
Service Code
|
CPT 88312 TC
|
| Hospital Charge Code |
Px03128831201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.45 |
| 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 |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| 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 |
$135.45
|
| Rate for Payer: Provider Network of America Commercial |
$144.48
|
|
|
Special Stains,Group I - Lab Special Stains,Group I
|
Facility
|
OP
|
$180.60
|
|
|
Service Code
|
CPT 88312 TC
|
| Hospital Charge Code |
Px03128831201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$180.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$127.32
|
| Rate for Payer: Aetna Workers' Compensation |
$127.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$125.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$125.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$139.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$142.31
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$94.63
|
| Rate for Payer: Cigna Medicare Advantage |
$102.94
|
| Rate for Payer: Family Health Partners Medicaid |
$65.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$113.78
|
| Rate for Payer: Healthy Blue Medicaid |
$71.03
|
| Rate for Payer: Home State Health Plan Exchange |
$102.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$65.77
|
| Rate for Payer: Humana Medicare |
$135.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$65.77
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$135.45
|
| Rate for Payer: Provider Network of America Commercial |
$144.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$119.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$180.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.52
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$15,446.86
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,446.86 |
| 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 |
$15,446.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,446.86
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,446.86
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,446.86
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$11,091.45
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,091.45 |
| 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 |
$11,091.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,091.45
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,091.45
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,091.45
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$29,771.36
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$29,771.36 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$29,771.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$29,771.36
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$29,771.36
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$29,771.36
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$22,010.02
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,010.02 |
| 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 |
$22,010.02
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,010.02
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,010.02
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,010.02
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$8,369.76
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,369.76 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,369.76
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 053
|
| 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 |
$4,602.24
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$37,367.21
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$37,367.21 |
| 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: Family Health Partners Medicaid |
$37,367.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$37,367.21
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$37,367.21
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$37,367.21
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$17,639.82
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$17,639.82 |
| 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 |
$17,639.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$17,639.82
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$17,639.82
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17,639.82
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$23,766.61
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$23,766.61 |
| 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 |
$23,766.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$23,766.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$23,766.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$23,766.61
|
|
