|
droPERidol 2.5 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
droPERidol 2.5 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
droPERidol 2.5 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00517970201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
Drug Analysis Profile, Comprehensive, Urine
|
Facility
|
IP
|
$408.45
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
Px03018030748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$306.34 |
| 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 |
$408.45
|
| Rate for Payer: Cash Price |
$408.45
|
| 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 |
$306.34
|
| Rate for Payer: Provider Network of America Commercial |
$326.76
|
|
|
Drug Analysis Profile, Comprehensive, Urine
|
Facility
|
OP
|
$408.45
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
Px03018030748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.95 |
| Max. Negotiated Rate |
$326.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$287.96
|
| Rate for Payer: Aetna Workers' Compensation |
$287.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$283.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$283.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$321.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$321.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$321.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$314.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$321.86
|
| Rate for Payer: Cash Price |
$408.45
|
| Rate for Payer: Cash Price |
$408.45
|
| Rate for Payer: Cigna Commercial |
$214.03
|
| Rate for Payer: Cigna Medicare Advantage |
$232.82
|
| Rate for Payer: Family Health Partners Medicaid |
$78.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$257.32
|
| Rate for Payer: Healthy Blue Medicaid |
$84.57
|
| Rate for Payer: Home State Health Plan Exchange |
$232.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$78.30
|
| Rate for Payer: Humana Medicare |
$306.34
|
| Rate for Payer: Mercy CarePlus Medicaid |
$78.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$306.34
|
| Rate for Payer: Provider Network of America Commercial |
$326.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$269.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$62.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.95
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7702
|
| 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 |
$4,488.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,488.54
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,488.54
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,488.54
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7701
|
| 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 |
$2,748.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$2,748.59
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,748.59
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,748.59
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$19,041.39
|
|
|
Service Code
|
APR-DRG 7704
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,041.39 |
| 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 |
$19,041.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,041.39
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,041.39
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,041.39
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$7,606.02
|
|
|
Service Code
|
APR-DRG 7703
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,606.02 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$7,606.02
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,606.02
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,606.02
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,606.02
|
|
|
Drug Assay Flecainide
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
Px03018018101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.04 |
| 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 |
$148.05
|
| Rate for Payer: Cash Price |
$148.05
|
| 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 |
$111.04
|
| Rate for Payer: Provider Network of America Commercial |
$118.44
|
|
|
Drug Assay Flecainide
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
Px03018018101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$104.38
|
| Rate for Payer: Aetna Workers' Compensation |
$104.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$116.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$116.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$116.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$116.66
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: Cigna Commercial |
$77.58
|
| Rate for Payer: Cigna Medicare Advantage |
$84.39
|
| Rate for Payer: Family Health Partners Medicaid |
$23.49
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$93.27
|
| Rate for Payer: Healthy Blue Medicaid |
$25.37
|
| Rate for Payer: Home State Health Plan Exchange |
$84.39
|
| Rate for Payer: Home State Health Plan Medicaid |
$23.49
|
| Rate for Payer: Humana Medicare |
$111.04
|
| Rate for Payer: Mercy CarePlus Medicaid |
$23.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$111.04
|
| Rate for Payer: Provider Network of America Commercial |
$118.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.69
|
|
|
Drugs unclassified injection
|
Facility
|
OP
|
$2,650.44
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
Px0636J349001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,510.75 |
| Max. Negotiated Rate |
$2,650.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,868.56
|
| Rate for Payer: Aetna Workers' Compensation |
$1,868.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,836.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,836.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,088.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,088.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,088.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,040.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,088.55
|
| Rate for Payer: Cash Price |
$2,650.44
|
| Rate for Payer: Cigna Commercial |
$1,622.07
|
| Rate for Payer: Cigna Medicare Advantage |
$1,510.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,669.78
|
| Rate for Payer: Home State Health Plan Exchange |
$1,510.75
|
| Rate for Payer: Humana Medicare |
$1,987.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,987.83
|
| Rate for Payer: Provider Network of America Commercial |
$2,120.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,749.29
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,650.44
|
|
|
Drugs unclassified injection
|
Facility
|
IP
|
$2,650.44
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
Px0636J349001
|
|
Hospital Revenue Code
|
636
|
| 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 |
$2,650.44
|
| Rate for Payer: Cash Price |
$2,650.44
|
| 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 |
$1,987.83
|
| Rate for Payer: Provider Network of America Commercial |
$2,120.35
|
|
|
Dstrj Lesion Anus Simple Surg Excision
|
Facility
|
IP
|
$5,701.50
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
Px05104692201
|
|
Hospital Revenue Code
|
510
|
| 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 |
$5,701.50
|
| Rate for Payer: Cash Price |
$5,701.50
|
| 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: Provider Network of America Commercial |
$4,561.20
|
|
|
Dstrj Lesion Anus Simple Surg Excision
|
Facility
|
OP
|
$5,701.50
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
Px05104692201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,637.22 |
| Max. Negotiated Rate |
$5,701.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,019.56
|
| Rate for Payer: Aetna Workers' Compensation |
$4,019.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,951.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,951.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,492.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,492.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,492.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,390.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,492.78
|
| Rate for Payer: Cash Price |
$5,701.50
|
| Rate for Payer: Cash Price |
$5,701.50
|
| Rate for Payer: Cigna Medicare Advantage |
$3,249.86
|
| Rate for Payer: Family Health Partners Medicaid |
$3,502.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,591.95
|
| Rate for Payer: Healthy Blue Medicaid |
$3,783.19
|
| Rate for Payer: Home State Health Plan Exchange |
$3,249.86
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,502.95
|
| Rate for Payer: Humana Medicare |
$4,276.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,502.95
|
| Rate for Payer: Provider Network of America Commercial |
$4,561.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,762.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,701.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,637.22
|
|
|
Dstrj Neurolytic Agent Intercostal Nerve
|
Professional
|
Both
|
$2,879.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
Px00000064620
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$198.24 |
| Rate for Payer: Cash Price |
$2,879.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$198.24
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
Px07616463401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.00 |
| 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 |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| 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 |
$252.00
|
| Rate for Payer: Provider Network of America Commercial |
$268.80
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
Px09836463401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$236.88
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$225.60
|
| Rate for Payer: Aetna Workers' Compensation |
$225.60
|
| Rate for Payer: Aetna Workers' Compensation |
$236.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$221.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$221.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$252.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$252.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$252.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$246.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$252.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$264.77
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$195.84
|
| Rate for Payer: Cigna Commercial |
$205.63
|
| Rate for Payer: Cigna Medicare Advantage |
$191.52
|
| Rate for Payer: Cigna Medicare Advantage |
$182.40
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$211.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$201.60
|
| Rate for Payer: Home State Health Plan Exchange |
$182.40
|
| Rate for Payer: Home State Health Plan Exchange |
$191.52
|
| Rate for Payer: Humana Medicare |
$252.00
|
| Rate for Payer: Humana Medicare |
$240.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$240.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$252.00
|
| Rate for Payer: Provider Network of America Commercial |
$268.80
|
| Rate for Payer: Provider Network of America Commercial |
$256.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$211.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.76
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$320.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$336.00
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
Px09836463401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$252.00 |
| 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 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 |
$336.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$320.00
|
| 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 |
$252.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$240.00
|
| Rate for Payer: Provider Network of America Commercial |
$268.80
|
| Rate for Payer: Provider Network of America Commercial |
$256.00
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
Px07616463401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$236.88
|
| Rate for Payer: Aetna Workers' Compensation |
$236.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$264.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$264.77
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$205.63
|
| Rate for Payer: Cigna Medicare Advantage |
$191.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$211.68
|
| Rate for Payer: Home State Health Plan Exchange |
$191.52
|
| Rate for Payer: Humana Medicare |
$252.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$252.00
|
| Rate for Payer: Provider Network of America Commercial |
$268.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.76
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$336.00
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral
|
Facility
|
IP
|
$3,134.25
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
Px07616463601
|
|
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 |
$3,134.25
|
| Rate for Payer: Cash Price |
$3,134.25
|
| 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 |
$2,350.69
|
| Rate for Payer: Provider Network of America Commercial |
$2,507.40
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral
|
Facility
|
OP
|
$3,134.25
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
Px07616463601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,786.52 |
| Max. Negotiated Rate |
$3,134.25 |
| Rate for Payer: Cigna Commercial |
$1,918.16
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,209.65
|
| Rate for Payer: Aetna Workers' Compensation |
$2,209.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,172.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,172.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,469.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,469.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,469.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,413.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,469.79
|
| Rate for Payer: Cash Price |
$3,134.25
|
| Rate for Payer: Cigna Medicare Advantage |
$1,786.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,974.58
|
| Rate for Payer: Home State Health Plan Exchange |
$1,786.52
|
| Rate for Payer: Humana Medicare |
$2,350.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,350.69
|
| Rate for Payer: Provider Network of America Commercial |
$2,507.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,068.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,134.25
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora
|
Facility
|
OP
|
$951.30
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
Px09836463301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$542.24 |
| Max. Negotiated Rate |
$2,661.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$670.67
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$638.73
|
| Rate for Payer: Aetna Workers' Compensation |
$670.67
|
| Rate for Payer: Aetna Workers' Compensation |
$638.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$659.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$627.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$659.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$627.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$713.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$713.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$713.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$697.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$732.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$713.93
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$582.20
|
| Rate for Payer: Cigna Commercial |
$554.47
|
| Rate for Payer: Cigna Medicare Advantage |
$516.42
|
| Rate for Payer: Cigna Medicare Advantage |
$542.24
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$599.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$570.78
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Home State Health Plan Exchange |
$542.24
|
| Rate for Payer: Home State Health Plan Exchange |
$516.42
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Humana Medicare |
$679.50
|
| Rate for Payer: Humana Medicare |
$713.48
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$679.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$713.48
|
| Rate for Payer: Provider Network of America Commercial |
$724.80
|
| Rate for Payer: Provider Network of America Commercial |
$761.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$597.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$627.86
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$906.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$951.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora
|
Facility
|
IP
|
$951.30
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
Px09836463301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$713.48 |
| 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 |
$906.00
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$906.00
|
| 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 |
$713.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$679.50
|
| Rate for Payer: Provider Network of America Commercial |
$761.04
|
| Rate for Payer: Provider Network of America Commercial |
$724.80
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora
|
Facility
|
OP
|
$4,095.23
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
Px07616463301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,855.34 |
| Max. Negotiated Rate |
$4,095.23 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,887.14
|
| Rate for Payer: Aetna Workers' Compensation |
$2,887.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,153.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,227.04
|
| Rate for Payer: Cash Price |
$4,095.23
|
| Rate for Payer: Cash Price |
$4,095.23
|
| Rate for Payer: Cigna Commercial |
$2,506.28
|
| Rate for Payer: Cigna Medicare Advantage |
$2,334.28
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,579.99
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Home State Health Plan Exchange |
$2,334.28
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Humana Medicare |
$3,071.42
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,071.42
|
| Rate for Payer: Provider Network of America Commercial |
$3,276.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,702.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,095.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
|
