|
dextrose 5 % parenteral solution 500 mL Flex Cont
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J7060
|
|
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
|
|
|
DIABETES
|
Facility
|
IP
|
$10,745.68
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,745.68 |
| 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 |
$10,745.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,745.68
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,745.68
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,745.68
|
|
|
DIABETES
|
Facility
|
IP
|
$7,033.74
|
|
|
Service Code
|
APR-DRG 4202
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,033.74 |
| 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: Family Health Partners Medicaid |
$7,033.74
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,033.74
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,033.74
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,033.74
|
|
|
DIABETES
|
Facility
|
IP
|
$19,769.91
|
|
|
Service Code
|
APR-DRG 4204
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,769.91 |
| 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 |
$19,769.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,769.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,769.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,769.91
|
|
|
DIABETES
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 4201
|
| 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: Family Health Partners Medicaid |
$5,350.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,350.19
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,350.19
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,350.19
|
|
|
Diabetes Mellitus Type 1 Ev
|
Facility
|
OP
|
$220.50
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
Px03028634103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$155.45
|
| Rate for Payer: Aetna Workers' Compensation |
$155.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$169.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$173.75
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$115.54
|
| Rate for Payer: Cigna Medicare Advantage |
$125.69
|
| Rate for Payer: Family Health Partners Medicaid |
$29.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$138.91
|
| Rate for Payer: Healthy Blue Medicaid |
$32.07
|
| Rate for Payer: Home State Health Plan Exchange |
$125.69
|
| Rate for Payer: Home State Health Plan Medicaid |
$29.69
|
| Rate for Payer: Humana Medicare |
$165.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$29.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$165.38
|
| Rate for Payer: Provider Network of America Commercial |
$176.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$23.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.36
|
|
|
Diabetes Mellitus Type 1 Ev
|
Facility
|
IP
|
$220.50
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
Px03028634103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$165.38 |
| 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 |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| 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 |
$165.38
|
| Rate for Payer: Provider Network of America Commercial |
$176.40
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 638
|
| 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 |
$4,212.14
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$6,752.49
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,752.49 |
| 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 Freedom Network |
$4,369.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,369.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,369.00
|
| 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 Traditional |
$4,369.00
|
| 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 |
$6,752.49
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 639
|
| 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 |
$2,919.64
|
|
|
Diabetic O/P Self Mgmt Indiv per 30 Min, Medicaid
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px09429921103
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$30.45
|
| Rate for Payer: Cash Price |
$30.45
|
| 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 |
$22.84
|
| Rate for Payer: Provider Network of America Commercial |
$24.36
|
|
|
Diabetic O/P Self Mgmt Indiv per 30 Min, Medicaid
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
Px09429921103
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$30.45 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.47
|
| Rate for Payer: Aetna Workers' Compensation |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.99
|
| Rate for Payer: Cash Price |
$30.45
|
| Rate for Payer: Cigna Commercial |
$18.64
|
| Rate for Payer: Cigna Medicare Advantage |
$17.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$19.18
|
| Rate for Payer: Home State Health Plan Exchange |
$17.36
|
| Rate for Payer: Humana Medicare |
$22.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.84
|
| Rate for Payer: Provider Network of America Commercial |
$24.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.45
|
|
|
Diagnostic Mammography Computer-Aided Detcj Bi
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
Px04017706602
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$162.85
|
| Rate for Payer: Aetna Workers' Compensation |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$160.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$160.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$182.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$177.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$182.03
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$141.37
|
| Rate for Payer: Cigna Medicare Advantage |
$131.67
|
| Rate for Payer: Family Health Partners Medicaid |
$190.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$145.53
|
| Rate for Payer: Healthy Blue Medicaid |
$205.69
|
| Rate for Payer: Home State Health Plan Exchange |
$131.67
|
| Rate for Payer: Home State Health Plan Medicaid |
$190.46
|
| Rate for Payer: Humana Medicare |
$173.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$190.46
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$173.25
|
| Rate for Payer: Provider Network of America Commercial |
$184.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$152.46
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$231.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.39
|
|
|
Diagnostic Mammography Computer-Aided Detcj Bi
|
Facility
|
IP
|
$218.40
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
Px09727706601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| 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 |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
|
|
Diagnostic Mammography Computer-Aided Detcj Bi
|
Facility
|
OP
|
$218.40
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
Px09727706601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$153.97
|
| Rate for Payer: Aetna Workers' Compensation |
$153.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$168.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$172.10
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$133.66
|
| Rate for Payer: Cigna Medicare Advantage |
$124.49
|
| Rate for Payer: Family Health Partners Medicaid |
$190.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$137.59
|
| Rate for Payer: Healthy Blue Medicaid |
$205.69
|
| Rate for Payer: Home State Health Plan Exchange |
$124.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$190.46
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Mercy CarePlus Medicaid |
$190.46
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$144.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$218.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$143.39
|
|
|
Diagnostic Mammography Computer-Aided Detcj Bi
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
Px04017706602
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$173.25 |
| 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 |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| 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 |
$173.25
|
| Rate for Payer: Provider Network of America Commercial |
$184.80
|
|
|
Diagnostic Mammography Computer-Aided Detcj Uni
|
Facility
|
OP
|
$218.40
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
Px09727706501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$153.97
|
| Rate for Payer: Aetna Workers' Compensation |
$153.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$168.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$172.10
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$133.66
|
| Rate for Payer: Cigna Medicare Advantage |
$124.49
|
| Rate for Payer: Family Health Partners Medicaid |
$150.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$137.59
|
| Rate for Payer: Healthy Blue Medicaid |
$162.40
|
| Rate for Payer: Home State Health Plan Exchange |
$124.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$150.37
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Mercy CarePlus Medicaid |
$150.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$144.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$218.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.21
|
|
|
Diagnostic Mammography Computer-Aided Detcj Uni
|
Facility
|
IP
|
$218.40
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
Px09727706501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| 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 |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
|
|
diazePAM 5 mg/mL syringe 2 mL Cartridge
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J3360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.00 |
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| 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 |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
|
|
diazePAM 5 mg/mL syringe 2 mL Cartridge
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
NDC 00409127303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.00 |
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| 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 |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
|
|
diazePAM 5 mg/mL syringe 2 mL Cartridge
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
NDC 00409127303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.20
|
| Rate for Payer: Aetna Workers' Compensation |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: Cigna Medicare Advantage |
$22.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.20
|
| Rate for Payer: Home State Health Plan Exchange |
$22.80
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.00
|
|
|
diazePAM 5 mg/mL syringe 2 mL Cartridge
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS J3360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.20
|
| Rate for Payer: Aetna Workers' Compensation |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: Cigna Medicare Advantage |
$22.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.20
|
| Rate for Payer: Home State Health Plan Exchange |
$22.80
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.00
|
|
|
diazePAM 5 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 51079028501
|
|
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
|
|
|
diazePAM 5 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 51079028501
|
|
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
|
|
|
Diazepam Injection
|
Facility
|
IP
|
$67.95
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
Px0636J336001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.96 |
| 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 |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| 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 |
$50.96
|
| Rate for Payer: Provider Network of America Commercial |
$54.36
|
|
