|
Splint-Clavicle
|
Facility
|
IP
|
$33.64
|
|
|
Service Code
|
CPT L3671
|
| Hospital Charge Code |
Px0274L367101
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.23 |
| 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 |
$35.32
|
| Rate for Payer: Cash Price |
$35.32
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Cash Price |
$33.64
|
| 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 |
$26.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25.23
|
| Rate for Payer: Provider Network of America Commercial |
$26.91
|
| Rate for Payer: Provider Network of America Commercial |
$28.26
|
|
|
Splint-Colles
|
Facility
|
IP
|
$14.95
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
Px0274L390801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.21 |
| 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 |
$85.58
|
| Rate for Payer: Cash Price |
$85.58
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$14.95
|
| 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 |
$64.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$11.21
|
| Rate for Payer: Provider Network of America Commercial |
$11.96
|
| Rate for Payer: Provider Network of America Commercial |
$68.46
|
|
|
Splint-Colles
|
Facility
|
OP
|
$14.95
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
Px0274L390801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$10.54
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$60.33
|
| Rate for Payer: Aetna Workers' Compensation |
$10.54
|
| Rate for Payer: Aetna Workers' Compensation |
$60.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$10.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$10.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$59.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$67.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$67.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$11.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$67.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$11.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$65.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$67.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$11.78
|
| Rate for Payer: Cash Price |
$85.58
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cigna Commercial |
$9.15
|
| Rate for Payer: Cigna Commercial |
$52.37
|
| Rate for Payer: Cigna Medicare Advantage |
$8.52
|
| Rate for Payer: Cigna Medicare Advantage |
$48.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$9.42
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$53.92
|
| Rate for Payer: Home State Health Plan Exchange |
$8.52
|
| Rate for Payer: Home State Health Plan Exchange |
$48.78
|
| Rate for Payer: Humana Medicare |
$11.21
|
| Rate for Payer: Humana Medicare |
$64.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$11.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$64.19
|
| Rate for Payer: Provider Network of America Commercial |
$11.96
|
| Rate for Payer: Provider Network of America Commercial |
$68.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$56.48
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14.95
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$85.58
|
|
|
Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px00000094010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$33.10 |
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.10
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 537
|
| 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 |
$4,485.21
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 538
|
| 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 |
$3,385.41
|
|
|
sterile water (PF) solution 100 mL Vial
|
Facility
|
IP
|
$40.95
|
|
|
Service Code
|
NDC 00409488725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.71 |
| 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 |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| 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 |
$30.71
|
| Rate for Payer: Provider Network of America Commercial |
$32.76
|
|
|
sterile water (PF) solution 100 mL Vial
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
NDC 00409488725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.87
|
| Rate for Payer: Aetna Workers' Compensation |
$28.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$28.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$28.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$32.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$32.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$32.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$31.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$32.27
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna Commercial |
$25.06
|
| Rate for Payer: Cigna Medicare Advantage |
$23.34
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.80
|
| Rate for Payer: Home State Health Plan Exchange |
$23.34
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.71
|
| Rate for Payer: Provider Network of America Commercial |
$32.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.03
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.95
|
|
|
sterile water (PF) solution 10 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 63323018507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
sterile water (PF) solution 10 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00409488710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
sterile water (PF) solution 10 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 63323018507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
sterile water (PF) solution 10 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00409488710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
sterile water (PF) solution 20 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00409488723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
sterile water (PF) solution 20 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00409488723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
sterile water (PF) solution 50 mL Vial
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
NDC 00409488724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.45 |
| 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 |
$35.26
|
| Rate for Payer: Cash Price |
$35.26
|
| 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 |
$26.45
|
| Rate for Payer: Provider Network of America Commercial |
$28.21
|
|
|
sterile water (PF) solution 50 mL Vial
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
NDC 00409488724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.86
|
| Rate for Payer: Aetna Workers' Compensation |
$24.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.78
|
| Rate for Payer: Cash Price |
$35.26
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: Cigna Medicare Advantage |
$20.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.21
|
| Rate for Payer: Home State Health Plan Exchange |
$20.10
|
| Rate for Payer: Humana Medicare |
$26.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.45
|
| Rate for Payer: Provider Network of America Commercial |
$28.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.26
|
|
|
sterile water solution 250 mL Flex Cont
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 00338000402
|
|
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
|
|
|
sterile water solution 250 mL Flex Cont
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 00338000402
|
|
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
|
|
|
Steri-Strips 1/2"
|
Facility
|
IP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| 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 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| 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 |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
|
|
Steri-Strips 1/2"
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$11,487.74
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,487.74 |
| 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 |
$11,487.74
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$23,440.78
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$23,440.78 |
| 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 |
$23,440.78
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$7,530.81
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,530.81 |
| 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 |
$7,530.81
|
|
|
Sub Grft F/S/N/H/F/G/M/D >= 100scm Adl 100sq Cm
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
Px07611527801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$370.12
|
| Rate for Payer: Aetna Workers' Compensation |
$370.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$363.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$363.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$413.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$413.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$413.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$404.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$413.70
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: Cigna Medicare Advantage |
$299.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$330.75
|
| Rate for Payer: Home State Health Plan Exchange |
$299.25
|
| Rate for Payer: Humana Medicare |
$393.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$393.75
|
| Rate for Payer: Provider Network of America Commercial |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$346.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$525.00
|
|
|
Sub Grft F/S/N/H/F/G/M/D >= 100scm Adl 100sq Cm
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
Px07611527801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.75 |
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| 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 |
$393.75
|
| Rate for Payer: Provider Network of America Commercial |
$420.00
|
|
