|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
NDC 71288003020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$48.00 |
| 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 |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| 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 |
$48.00
|
| Rate for Payer: Provider Network of America Commercial |
$51.20
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$96.64
|
|
|
Service Code
|
NDC 68382091001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$96.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$68.13
|
| Rate for Payer: Aetna Workers' Compensation |
$68.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$76.15
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cigna Commercial |
$59.14
|
| Rate for Payer: Cigna Medicare Advantage |
$55.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$60.88
|
| Rate for Payer: Home State Health Plan Exchange |
$55.08
|
| Rate for Payer: Humana Medicare |
$72.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$72.48
|
| Rate for Payer: Provider Network of America Commercial |
$77.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$63.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$96.64
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$69.30
|
|
|
Service Code
|
NDC 63323013003
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$48.86
|
| Rate for Payer: Aetna Workers' Compensation |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$54.61
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$42.41
|
| Rate for Payer: Cigna Medicare Advantage |
$39.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$43.66
|
| Rate for Payer: Home State Health Plan Exchange |
$39.50
|
| Rate for Payer: Humana Medicare |
$51.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.98
|
| Rate for Payer: Provider Network of America Commercial |
$55.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$69.30
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$69.30
|
|
|
Service Code
|
NDC 63323013003
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$51.98 |
| 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 |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| 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 |
$51.98
|
| Rate for Payer: Provider Network of America Commercial |
$55.44
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$105.32
|
|
|
Service Code
|
HCPCS J1271
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$74.25
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$48.86
|
| Rate for Payer: Humana Medicare |
$72.48
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$68.13
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$35.25
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.12
|
| Rate for Payer: Aetna Workers' Compensation |
$35.25
|
| Rate for Payer: Aetna Workers' Compensation |
$45.12
|
| Rate for Payer: Aetna Workers' Compensation |
$74.25
|
| Rate for Payer: Aetna Workers' Compensation |
$68.13
|
| Rate for Payer: Aetna Workers' Compensation |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$82.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$82.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$82.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$81.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$82.99
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cash Price |
$105.32
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$39.17
|
| Rate for Payer: Cigna Commercial |
$42.41
|
| Rate for Payer: Cigna Commercial |
$59.14
|
| Rate for Payer: Cigna Commercial |
$64.46
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: Cigna Medicare Advantage |
$39.50
|
| Rate for Payer: Cigna Medicare Advantage |
$36.48
|
| Rate for Payer: Cigna Medicare Advantage |
$28.50
|
| Rate for Payer: Cigna Medicare Advantage |
$60.03
|
| Rate for Payer: Cigna Medicare Advantage |
$55.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$60.88
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$31.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$43.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$66.35
|
| Rate for Payer: Home State Health Plan Exchange |
$28.50
|
| Rate for Payer: Home State Health Plan Exchange |
$36.48
|
| Rate for Payer: Home State Health Plan Exchange |
$60.03
|
| Rate for Payer: Home State Health Plan Exchange |
$39.50
|
| Rate for Payer: Home State Health Plan Exchange |
$55.08
|
| Rate for Payer: Humana Medicare |
$51.98
|
| Rate for Payer: Humana Medicare |
$48.00
|
| Rate for Payer: Humana Medicare |
$78.99
|
| Rate for Payer: Humana Medicare |
$37.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$72.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$78.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$37.50
|
| Rate for Payer: Provider Network of America Commercial |
$40.00
|
| Rate for Payer: Provider Network of America Commercial |
$84.26
|
| Rate for Payer: Provider Network of America Commercial |
$51.20
|
| Rate for Payer: Provider Network of America Commercial |
$55.44
|
| Rate for Payer: Provider Network of America Commercial |
$77.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$63.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$96.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$50.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$69.30
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$105.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$64.00
|
|
|
Drainage External Auditory Canal Abscess
|
Facility
|
IP
|
$148.97
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
Px09836902001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$111.73 |
| 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 |
$141.88
|
| Rate for Payer: Cash Price |
$148.97
|
| Rate for Payer: Cash Price |
$148.97
|
| Rate for Payer: Cash Price |
$141.88
|
| 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 |
$111.73
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.41
|
| Rate for Payer: Provider Network of America Commercial |
$119.18
|
| Rate for Payer: Provider Network of America Commercial |
$113.50
|
|
|
Drainage External Auditory Canal Abscess
|
Facility
|
OP
|
$148.97
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
Px09836902001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$84.91 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$105.02
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.03
|
| Rate for Payer: Aetna Workers' Compensation |
$105.02
|
| Rate for Payer: Aetna Workers' Compensation |
$100.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$103.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$103.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$114.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$117.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.80
|
| Rate for Payer: Cash Price |
$148.97
|
| Rate for Payer: Cash Price |
$148.97
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cigna Commercial |
$91.17
|
| Rate for Payer: Cigna Commercial |
$86.83
|
| Rate for Payer: Cigna Medicare Advantage |
$80.87
|
| Rate for Payer: Cigna Medicare Advantage |
$84.91
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$93.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.38
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$84.91
|
| Rate for Payer: Home State Health Plan Exchange |
$80.87
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$106.41
|
| Rate for Payer: Humana Medicare |
$111.73
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$111.73
|
| Rate for Payer: Provider Network of America Commercial |
$113.50
|
| Rate for Payer: Provider Network of America Commercial |
$119.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$98.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$141.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$148.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
Drainage External Auditory Canal Abscess
|
Facility
|
IP
|
$1,921.50
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
Px07616902001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,921.50
|
| 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 |
$1,441.12
|
| Rate for Payer: Provider Network of America Commercial |
$1,537.20
|
|
|
Drainage External Auditory Canal Abscess
|
Facility
|
OP
|
$1,921.50
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
Px07616902001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.81 |
| Max. Negotiated Rate |
$1,921.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,354.66
|
| Rate for Payer: Aetna Workers' Compensation |
$1,354.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,331.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,331.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,514.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,514.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,514.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,479.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,514.14
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cigna Commercial |
$1,175.96
|
| Rate for Payer: Cigna Medicare Advantage |
$1,095.26
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,210.55
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$1,095.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$1,441.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,441.12
|
| Rate for Payer: Provider Network of America Commercial |
$1,537.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,268.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,921.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
Dress/Debrid Small Burn No Anes
|
Facility
|
IP
|
$719.25
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
Px07611602001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.44 |
| 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 |
$719.25
|
| Rate for Payer: Cash Price |
$719.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$539.44
|
| Rate for Payer: Provider Network of America Commercial |
$575.40
|
|
|
Dress/Debrid Small Burn No Anes
|
Facility
|
OP
|
$719.25
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
Px07611602001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.63 |
| Max. Negotiated Rate |
$719.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$507.07
|
| Rate for Payer: Aetna Workers' Compensation |
$507.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$498.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$498.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$566.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$566.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$566.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$553.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$566.77
|
| Rate for Payer: Cash Price |
$719.25
|
| Rate for Payer: Cash Price |
$719.25
|
| Rate for Payer: Cigna Commercial |
$440.18
|
| Rate for Payer: Cigna Medicare Advantage |
$409.97
|
| Rate for Payer: Family Health Partners Medicaid |
$253.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$453.13
|
| Rate for Payer: Healthy Blue Medicaid |
$273.46
|
| Rate for Payer: Home State Health Plan Exchange |
$409.97
|
| Rate for Payer: Home State Health Plan Medicaid |
$253.20
|
| Rate for Payer: Humana Medicare |
$539.44
|
| Rate for Payer: Mercy CarePlus Medicaid |
$253.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$539.44
|
| Rate for Payer: Provider Network of America Commercial |
$575.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$474.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$719.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.63
|
|
|
Dress-Hydrocolloid 3x3
|
Facility
|
OP
|
$16.73
|
|
|
Service Code
|
HCPCS A6234
|
| Hospital Charge Code |
Px0272A623401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.79
|
| Rate for Payer: Aetna Workers' Compensation |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$13.18
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$10.24
|
| Rate for Payer: Cigna Medicare Advantage |
$9.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.54
|
| Rate for Payer: Home State Health Plan Exchange |
$9.54
|
| Rate for Payer: Humana Medicare |
$12.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.73
|
|
|
Dress-Hydrocolloid 3x3
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
HCPCS A6234
|
| Hospital Charge Code |
Px0272A623401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.55 |
| 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 |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| 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 |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
|
|
Dressing Allevyn Life 6x6
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
Px0272A621201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.86 |
| 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 |
$7.81
|
| Rate for Payer: Cash Price |
$7.81
|
| 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 |
$5.86
|
| Rate for Payer: Provider Network of America Commercial |
$6.25
|
|
|
Dressing Allevyn Life 6x6
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
Px0272A621201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.51
|
| Rate for Payer: Aetna Workers' Compensation |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.15
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Cigna Medicare Advantage |
$4.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4.92
|
| Rate for Payer: Home State Health Plan Exchange |
$4.45
|
| Rate for Payer: Humana Medicare |
$5.86
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5.86
|
| Rate for Payer: Provider Network of America Commercial |
$6.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7.81
|
|
|
Dressing Aquacel Ag 3.5x10"
|
Facility
|
IP
|
$81.08
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
Px0270A619702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.81 |
| 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 |
$81.08
|
| Rate for Payer: Cash Price |
$81.08
|
| 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 |
$60.81
|
| Rate for Payer: Provider Network of America Commercial |
$64.86
|
|
|
Dressing Aquacel Ag 3.5x10"
|
Facility
|
OP
|
$81.08
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
Px0270A619702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$81.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$57.16
|
| Rate for Payer: Aetna Workers' Compensation |
$57.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$56.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$56.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$63.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$62.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$63.89
|
| Rate for Payer: Cash Price |
$81.08
|
| Rate for Payer: Cigna Commercial |
$49.62
|
| Rate for Payer: Cigna Medicare Advantage |
$46.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$51.08
|
| Rate for Payer: Home State Health Plan Exchange |
$46.22
|
| Rate for Payer: Humana Medicare |
$60.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$60.81
|
| Rate for Payer: Provider Network of America Commercial |
$64.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$53.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$81.08
|
|
|
Dressing Emulsion 3x3
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
Px0272A622302
|
|
Hospital Revenue Code
|
272
|
| 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 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| 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 |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
Dressing Emulsion 3x3
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
Px0272A622302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| 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) |
$2.36
|
| 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 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 Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Dressing Hydrofera Blue
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
Px0272A620901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$8.58
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9.16
|
| Rate for Payer: Aetna Workers' Compensation |
$9.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10.24
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$7.96
|
| Rate for Payer: Cigna Medicare Advantage |
$7.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8.19
|
| Rate for Payer: Home State Health Plan Exchange |
$7.41
|
| Rate for Payer: Humana Medicare |
$9.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9.75
|
| Rate for Payer: Provider Network of America Commercial |
$10.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.00
|
|
|
Dressing Hydrofera Blue
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
Px0272A620901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.75 |
| 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 |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| 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 |
$9.75
|
| Rate for Payer: Provider Network of America Commercial |
$10.40
|
|
|
Dressing Hydrofera Blue
|
Facility
|
OP
|
$22.56
|
|
| Hospital Charge Code |
Px02720000093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$22.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.90
|
| Rate for Payer: Aetna Workers' Compensation |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$17.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.78
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cigna Commercial |
$13.81
|
| Rate for Payer: Cigna Medicare Advantage |
$12.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$14.21
|
| Rate for Payer: Home State Health Plan Exchange |
$12.86
|
| Rate for Payer: Humana Medicare |
$16.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.92
|
| Rate for Payer: Provider Network of America Commercial |
$18.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$22.56
|
|
|
Dressing Hydrofera Blue
|
Facility
|
IP
|
$22.56
|
|
| Hospital Charge Code |
Px02720000093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.92 |
| 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 |
$22.56
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.92
|
| Rate for Payer: Provider Network of America Commercial |
$18.05
|
|
|
Dressing Maxorb 4x4
|
Facility
|
IP
|
$17.46
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
Px0270A619601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.10 |
| 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 |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| 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 |
$13.10
|
| Rate for Payer: Provider Network of America Commercial |
$13.97
|
|
|
Dressing Maxorb 4x4
|
Facility
|
OP
|
$17.46
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
Px0270A619601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$12.31
|
| Rate for Payer: Aetna Workers' Compensation |
$12.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$12.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$12.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$13.76
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cigna Commercial |
$10.69
|
| Rate for Payer: Cigna Medicare Advantage |
$9.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$11.00
|
| Rate for Payer: Home State Health Plan Exchange |
$9.95
|
| Rate for Payer: Humana Medicare |
$13.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$13.10
|
| Rate for Payer: Provider Network of America Commercial |
$13.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$17.46
|
|
