|
Tx Open Tendon Flexor Toe 1 Tendon Spx
|
Facility
|
OP
|
$237.89
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
Px09832823201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$167.71
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$159.72
|
| Rate for Payer: Aetna Workers' Compensation |
$167.71
|
| Rate for Payer: Aetna Workers' Compensation |
$159.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$164.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$157.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$164.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$157.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$187.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$178.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$187.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$178.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$178.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$187.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$174.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$187.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$178.53
|
| Rate for Payer: Cash Price |
$237.89
|
| Rate for Payer: Cash Price |
$237.89
|
| Rate for Payer: Cash Price |
$226.56
|
| Rate for Payer: Cash Price |
$226.56
|
| Rate for Payer: Cigna Commercial |
$145.59
|
| Rate for Payer: Cigna Commercial |
$138.65
|
| Rate for Payer: Cigna Medicare Advantage |
$129.14
|
| Rate for Payer: Cigna Medicare Advantage |
$135.60
|
| 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 |
$149.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$142.73
|
| 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 |
$135.60
|
| Rate for Payer: Home State Health Plan Exchange |
$129.14
|
| 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 |
$169.92
|
| Rate for Payer: Humana Medicare |
$178.42
|
| 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 |
$169.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$178.42
|
| Rate for Payer: Provider Network of America Commercial |
$181.25
|
| Rate for Payer: Provider Network of America Commercial |
$190.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$149.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$157.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$226.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$237.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
|
|
Tx Open Tendon Flexor Toe 1 Tendon Spx
|
Facility
|
IP
|
$237.89
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
Px09832823201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$178.42 |
| 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 |
$226.56
|
| Rate for Payer: Cash Price |
$237.89
|
| Rate for Payer: Cash Price |
$237.89
|
| Rate for Payer: Cash Price |
$226.56
|
| 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 |
$178.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$169.92
|
| Rate for Payer: Provider Network of America Commercial |
$190.31
|
| Rate for Payer: Provider Network of America Commercial |
$181.25
|
|
|
Tx Swallowing Dysfunction&/Oral Funcj Feeding
|
Facility
|
OP
|
$288.75
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
Px04409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$78.07 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$203.57
|
| Rate for Payer: Aetna Workers' Compensation |
$203.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$227.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$222.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$227.53
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna Commercial |
$176.72
|
| Rate for Payer: Cigna Medicare Advantage |
$164.59
|
| Rate for Payer: Family Health Partners Medicaid |
$103.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$181.91
|
| Rate for Payer: Healthy Blue Medicaid |
$111.99
|
| Rate for Payer: Home State Health Plan Exchange |
$164.59
|
| Rate for Payer: Home State Health Plan Medicaid |
$103.70
|
| Rate for Payer: Humana Medicare |
$216.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$103.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$216.56
|
| Rate for Payer: Provider Network of America Commercial |
$231.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$288.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.07
|
|
|
Tx Swallowing Dysfunction&/Oral Funcj Feeding
|
Facility
|
IP
|
$288.75
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
Px04409252601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$216.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$216.56
|
| Rate for Payer: Provider Network of America Commercial |
$231.00
|
|
|
Tympanostomy Local/Topical Anesthesia
|
Facility
|
IP
|
$143.23
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
Px09836943301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$107.42 |
| 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 |
$136.41
|
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Cash Price |
$136.41
|
| 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 |
$107.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$102.31
|
| Rate for Payer: Provider Network of America Commercial |
$114.58
|
| Rate for Payer: Provider Network of America Commercial |
$109.13
|
|
|
Tympanostomy Local/Topical Anesthesia
|
Facility
|
OP
|
$143.23
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
Px09836943301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$735.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.98
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$96.17
|
| Rate for Payer: Aetna Workers' Compensation |
$100.98
|
| Rate for Payer: Aetna Workers' Compensation |
$96.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$99.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$94.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$99.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$94.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$107.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$107.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$107.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$105.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$110.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$112.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$107.49
|
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Cash Price |
$136.41
|
| Rate for Payer: Cash Price |
$136.41
|
| Rate for Payer: Cigna Commercial |
$87.66
|
| Rate for Payer: Cigna Commercial |
$83.48
|
| Rate for Payer: Cigna Medicare Advantage |
$77.75
|
| Rate for Payer: Cigna Medicare Advantage |
$81.64
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$90.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$85.94
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Home State Health Plan Exchange |
$81.64
|
| Rate for Payer: Home State Health Plan Exchange |
$77.75
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Humana Medicare |
$102.31
|
| Rate for Payer: Humana Medicare |
$107.42
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$102.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$107.42
|
| Rate for Payer: Provider Network of America Commercial |
$109.13
|
| Rate for Payer: Provider Network of America Commercial |
$114.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$94.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$136.41
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$143.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$26,161.14
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,161.14 |
| 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 |
$26,161.14
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$16,950.08
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,950.08 |
| 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 |
$16,950.08
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$13,989.08
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,989.08 |
| 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 |
$13,989.08
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$6,489.29
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,489.29 |
| 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 |
$6,489.29
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 384
|
| 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 |
$4,017.56
|
|
|
UNGROUPABLE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 999
|
| 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 |
$1,185.00
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$8,239.99
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,744.02 |
| Max. Negotiated Rate |
$8,239.99 |
| Rate for Payer: Family Health Partners Medicaid |
$7,629.62
|
| Rate for Payer: Healthy Blue Medicaid |
$8,239.99
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,629.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,629.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,744.02
|
|
|
Unlisted Laps Px Hrnap Herniorrhaphy Herniotomy
|
Facility
|
OP
|
$11,800.95
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
Px03614965901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,744.02 |
| Max. Negotiated Rate |
$11,800.95 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8,178.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8,178.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$9,299.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$9,299.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$9,299.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9,086.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$9,299.15
|
| Rate for Payer: Cash Price |
$11,800.95
|
| Rate for Payer: Cash Price |
$11,800.95
|
| Rate for Payer: Cigna Commercial |
$7,824.03
|
| Rate for Payer: Cigna Medicare Advantage |
$6,726.54
|
| Rate for Payer: Family Health Partners Medicaid |
$7,629.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$7,434.60
|
| Rate for Payer: Healthy Blue Medicaid |
$8,239.99
|
| Rate for Payer: Home State Health Plan Exchange |
$6,726.54
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,629.62
|
| Rate for Payer: Humana Medicare |
$8,850.71
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,629.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$8,850.71
|
| Rate for Payer: Provider Network of America Commercial |
$9,440.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,788.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11,800.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,744.02
|
|
|
Unlisted Laps Px Hrnap Herniorrhaphy Herniotomy
|
Facility
|
IP
|
$11,800.95
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
Px03614965901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,440.76 |
| 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: Cash Price |
$11,800.95
|
| Rate for Payer: Cash Price |
$11,800.95
|
| 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 |
$8,850.71
|
| Rate for Payer: Provider Network of America Commercial |
$9,440.76
|
|
|
Unlisted Procedure Urinary System
|
Facility
|
IP
|
$174.83
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
Px09835389901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$131.12 |
| 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 |
$166.50
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$166.50
|
| 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 |
$131.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$124.88
|
| Rate for Payer: Provider Network of America Commercial |
$139.86
|
| Rate for Payer: Provider Network of America Commercial |
$133.20
|
|
|
Unlisted Procedure Urinary System
|
Facility
|
OP
|
$174.83
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
Px09835389901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$340.53 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$123.26
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$117.38
|
| Rate for Payer: Aetna Workers' Compensation |
$123.26
|
| Rate for Payer: Aetna Workers' Compensation |
$117.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$121.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$121.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$137.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$131.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$137.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$131.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$131.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$137.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$134.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$137.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$131.20
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$174.83
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$107.00
|
| Rate for Payer: Cigna Commercial |
$101.90
|
| Rate for Payer: Cigna Medicare Advantage |
$94.91
|
| Rate for Payer: Cigna Medicare Advantage |
$99.65
|
| Rate for Payer: Family Health Partners Medicaid |
$315.31
|
| Rate for Payer: Family Health Partners Medicaid |
$315.31
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$110.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$104.89
|
| Rate for Payer: Healthy Blue Medicaid |
$340.53
|
| Rate for Payer: Healthy Blue Medicaid |
$340.53
|
| Rate for Payer: Home State Health Plan Exchange |
$99.65
|
| Rate for Payer: Home State Health Plan Exchange |
$94.91
|
| Rate for Payer: Home State Health Plan Medicaid |
$315.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$315.31
|
| Rate for Payer: Humana Medicare |
$124.88
|
| Rate for Payer: Humana Medicare |
$131.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$315.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$315.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$124.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$131.12
|
| Rate for Payer: Provider Network of America Commercial |
$133.20
|
| Rate for Payer: Provider Network of America Commercial |
$139.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$109.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.39
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$166.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$174.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$237.38
|
|
|
Unlisted Pulmonary Service/Procedure
|
Facility
|
IP
|
$211.58
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
Px04109479905
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$158.69 |
| 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 |
$211.58
|
| Rate for Payer: Cash Price |
$211.58
|
| 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 |
$158.69
|
| Rate for Payer: Provider Network of America Commercial |
$169.26
|
|
|
Unlisted Pulmonary Service/Procedure
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
Px00000094799
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.00
|
|
|
Unlisted Pulmonary Service/Procedure
|
Facility
|
OP
|
$211.58
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
Px04109479905
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$211.58 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.16
|
| Rate for Payer: Aetna Workers' Compensation |
$149.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$162.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$166.73
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cash Price |
$211.58
|
| Rate for Payer: Cigna Commercial |
$129.49
|
| Rate for Payer: Cigna Medicare Advantage |
$120.60
|
| Rate for Payer: Family Health Partners Medicaid |
$162.40
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.30
|
| Rate for Payer: Healthy Blue Medicaid |
$175.39
|
| Rate for Payer: Home State Health Plan Exchange |
$120.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$162.40
|
| Rate for Payer: Humana Medicare |
$95.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$162.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$158.69
|
| Rate for Payer: Provider Network of America Commercial |
$169.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$211.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.26
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$7,980.13
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,980.13 |
| 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 |
$7,980.13
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$12,677.78
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,677.78 |
| 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 |
$12,677.78
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 257
|
| 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 |
$5,133.34
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$9,847.98
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,847.98 |
| 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 |
$9,847.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,847.98
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,847.98
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,847.98
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$19,406.58
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,406.58 |
| 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 |
$19,406.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,406.58
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,406.58
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,406.58
|
|
