|
Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm
|
Facility
|
OP
|
$2,005.50
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
Px05101140301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$672.81 |
| Max. Negotiated Rate |
$2,005.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,413.88
|
| Rate for Payer: Aetna Workers' Compensation |
$1,413.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,389.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,389.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,580.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,580.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,580.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,544.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,580.33
|
| Rate for Payer: Cash Price |
$2,005.50
|
| Rate for Payer: Cash Price |
$2,005.50
|
| Rate for Payer: Cigna Medicare Advantage |
$1,143.13
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,263.46
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$1,143.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$1,504.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Provider Network of America Commercial |
$1,604.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,323.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,005.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
Px00000011403
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$157.60 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$157.60
|
|
|
Excision/Destruction Intranasal Lesion Int Appr
|
Facility
|
IP
|
$331.41
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
Px09833011701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$248.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$315.63
|
| Rate for Payer: Cash Price |
$331.41
|
| Rate for Payer: Cash Price |
$331.41
|
| Rate for Payer: Cash Price |
$315.63
|
| 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 |
$248.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$236.72
|
| Rate for Payer: Provider Network of America Commercial |
$265.13
|
| Rate for Payer: Provider Network of America Commercial |
$252.50
|
|
|
Excision/Destruction Intranasal Lesion Int Appr
|
Facility
|
OP
|
$331.41
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
Px09833011701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$188.90 |
| Max. Negotiated Rate |
$4,518.94 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$233.64
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$222.52
|
| Rate for Payer: Aetna Workers' Compensation |
$233.64
|
| Rate for Payer: Aetna Workers' Compensation |
$222.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$229.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$218.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$229.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$218.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$261.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$248.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$261.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$248.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$248.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$261.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$243.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$255.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$261.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$248.72
|
| Rate for Payer: Cash Price |
$331.41
|
| Rate for Payer: Cash Price |
$331.41
|
| Rate for Payer: Cash Price |
$315.63
|
| Rate for Payer: Cash Price |
$315.63
|
| Rate for Payer: Cigna Commercial |
$202.82
|
| Rate for Payer: Cigna Commercial |
$193.17
|
| Rate for Payer: Cigna Medicare Advantage |
$179.91
|
| Rate for Payer: Cigna Medicare Advantage |
$188.90
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$208.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$198.85
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$188.90
|
| Rate for Payer: Home State Health Plan Exchange |
$179.91
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$236.72
|
| Rate for Payer: Humana Medicare |
$248.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$236.72
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$248.56
|
| Rate for Payer: Provider Network of America Commercial |
$252.50
|
| Rate for Payer: Provider Network of America Commercial |
$265.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$208.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$218.73
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$315.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$331.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Excision Interdigital Morton Neuroma Single Each
|
Facility
|
IP
|
$292.66
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
Px09832808001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$219.50 |
| 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 |
$278.72
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$278.72
|
| 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 |
$219.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$209.04
|
| Rate for Payer: Provider Network of America Commercial |
$234.13
|
| Rate for Payer: Provider Network of America Commercial |
$222.98
|
|
|
Excision Interdigital Morton Neuroma Single Each
|
Facility
|
OP
|
$292.66
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
Px09832808001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$166.82 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$206.33
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$196.50
|
| Rate for Payer: Aetna Workers' Compensation |
$206.33
|
| Rate for Payer: Aetna Workers' Compensation |
$196.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$202.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$193.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$202.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$193.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$214.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$225.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$230.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$219.63
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$292.66
|
| Rate for Payer: Cash Price |
$278.72
|
| Rate for Payer: Cash Price |
$278.72
|
| Rate for Payer: Cigna Commercial |
$179.11
|
| Rate for Payer: Cigna Commercial |
$170.58
|
| Rate for Payer: Cigna Medicare Advantage |
$158.87
|
| Rate for Payer: Cigna Medicare Advantage |
$166.82
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$184.38
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$175.59
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Home State Health Plan Exchange |
$166.82
|
| Rate for Payer: Home State Health Plan Exchange |
$158.87
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Humana Medicare |
$209.04
|
| Rate for Payer: Humana Medicare |
$219.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$209.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$219.50
|
| Rate for Payer: Provider Network of America Commercial |
$222.98
|
| Rate for Payer: Provider Network of America Commercial |
$234.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$278.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$292.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
|
|
Excision Lesion Tongue W/O Closure
|
Facility
|
OP
|
$138.74
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
Px09834111001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.08 |
| Max. Negotiated Rate |
$4,518.94 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$97.81
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$93.15
|
| Rate for Payer: Aetna Workers' Compensation |
$97.81
|
| Rate for Payer: Aetna Workers' Compensation |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$96.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$91.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$96.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$91.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$109.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$109.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$104.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$109.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$101.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$106.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$109.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$104.12
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cigna Commercial |
$84.91
|
| Rate for Payer: Cigna Commercial |
$80.86
|
| Rate for Payer: Cigna Medicare Advantage |
$75.31
|
| Rate for Payer: Cigna Medicare Advantage |
$79.08
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$87.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$83.24
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$79.08
|
| Rate for Payer: Home State Health Plan Exchange |
$75.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$99.10
|
| Rate for Payer: Humana Medicare |
$104.06
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$99.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.06
|
| Rate for Payer: Provider Network of America Commercial |
$105.70
|
| Rate for Payer: Provider Network of America Commercial |
$110.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$132.13
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$138.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Excision Lesion Tongue W/O Closure
|
Facility
|
IP
|
$138.74
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
Px09834111001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.06 |
| 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 |
$132.13
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cash Price |
$138.74
|
| Rate for Payer: Cash Price |
$132.13
|
| 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 |
$104.06
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$99.10
|
| Rate for Payer: Provider Network of America Commercial |
$110.99
|
| Rate for Payer: Provider Network of America Commercial |
$105.70
|
|
|
Excision Malignant Lesion F/E/E/N/L 1.1-2.0 Cm
|
Facility
|
IP
|
$1,451.34
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
Px03601164201
|
|
Hospital Revenue Code
|
360
|
| 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 |
$1,451.34
|
| Rate for Payer: Cash Price |
$1,451.34
|
| 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 |
$1,088.51
|
| Rate for Payer: Provider Network of America Commercial |
$1,161.07
|
|
|
Excision Malignant Lesion F/E/E/N/L 1.1-2.0 Cm
|
Facility
|
OP
|
$1,451.34
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
Px03601164201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$672.81 |
| Max. Negotiated Rate |
$1,451.34 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,005.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,005.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,143.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,143.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,143.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,117.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,143.66
|
| Rate for Payer: Cash Price |
$1,451.34
|
| Rate for Payer: Cash Price |
$1,451.34
|
| Rate for Payer: Cigna Commercial |
$962.24
|
| Rate for Payer: Cigna Medicare Advantage |
$827.26
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$914.34
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$827.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$1,088.51
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,088.51
|
| Rate for Payer: Provider Network of America Commercial |
$1,161.07
|
| Rate for Payer: UnitedHealthcare Commercial |
$957.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,451.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
Excision Multiple External Papillae/Tags Anus
|
Facility
|
OP
|
$5,697.72
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
Px03604623001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,637.22 |
| Max. Negotiated Rate |
$5,697.72 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,948.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,948.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,489.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,489.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,489.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,387.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,489.80
|
| Rate for Payer: Cash Price |
$5,697.72
|
| Rate for Payer: Cash Price |
$5,697.72
|
| Rate for Payer: Cigna Commercial |
$3,777.59
|
| Rate for Payer: Cigna Medicare Advantage |
$3,247.70
|
| Rate for Payer: Family Health Partners Medicaid |
$3,502.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,589.56
|
| Rate for Payer: Healthy Blue Medicaid |
$3,783.19
|
| Rate for Payer: Home State Health Plan Exchange |
$3,247.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,502.95
|
| Rate for Payer: Humana Medicare |
$4,273.29
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,502.95
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,273.29
|
| Rate for Payer: Provider Network of America Commercial |
$4,558.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,760.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,697.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,637.22
|
|
|
Excision Multiple External Papillae/Tags Anus
|
Facility
|
IP
|
$5,697.72
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
Px03604623001
|
|
Hospital Revenue Code
|
360
|
| 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 |
$5,697.72
|
| Rate for Payer: Cash Price |
$5,697.72
|
| 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 |
$4,273.29
|
| Rate for Payer: Provider Network of America Commercial |
$4,558.18
|
|
|
Excision Pilonidal Cyst/Sinus Simple
|
Facility
|
OP
|
$5,848.50
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
Px03601177001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,759.85 |
| Max. Negotiated Rate |
$5,848.50 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,503.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,608.62
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cigna Commercial |
$3,877.56
|
| Rate for Payer: Cigna Medicare Advantage |
$3,333.64
|
| Rate for Payer: Family Health Partners Medicaid |
$3,665.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,684.55
|
| Rate for Payer: Healthy Blue Medicaid |
$3,959.10
|
| Rate for Payer: Home State Health Plan Exchange |
$3,333.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,665.83
|
| Rate for Payer: Humana Medicare |
$4,386.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,665.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,386.38
|
| Rate for Payer: Provider Network of America Commercial |
$4,678.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,860.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,848.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,759.85
|
|
|
Excision Pilonidal Cyst/Sinus Simple
|
Facility
|
IP
|
$5,848.50
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
Px03601177001
|
|
Hospital Revenue Code
|
360
|
| 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 |
$5,848.50
|
| Rate for Payer: Cash Price |
$5,848.50
|
| 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 |
$4,386.38
|
| Rate for Payer: Provider Network of America Commercial |
$4,678.80
|
|
|
Excision Tumor Soft Tissue Back/Flank Subq <3cm
|
Facility
|
IP
|
$3,286.50
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
Px05102193001
|
|
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 |
$3,286.50
|
| Rate for Payer: Cash Price |
$3,286.50
|
| 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 |
$2,629.20
|
|
|
Excision Tumor Soft Tissue Back/Flank Subq <3cm
|
Facility
|
OP
|
$3,286.50
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
Px05102193001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,569.23 |
| Max. Negotiated Rate |
$3,286.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,316.98
|
| Rate for Payer: Aetna Workers' Compensation |
$2,316.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,277.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,277.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,589.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,589.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,589.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,530.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,589.76
|
| Rate for Payer: Cash Price |
$3,286.50
|
| Rate for Payer: Cash Price |
$3,286.50
|
| Rate for Payer: Cigna Medicare Advantage |
$1,873.31
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,070.49
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Home State Health Plan Exchange |
$1,873.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Humana Medicare |
$2,464.88
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Provider Network of America Commercial |
$2,629.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,169.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,286.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
|
|
Excision, tumor, soft tissue of back or flank, subfascial (e.g., intramuscular); 5 cm or greater
|
Facility
|
OP
|
$3,959.10
|
|
|
Service Code
|
CPT 21933
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,759.85 |
| Max. Negotiated Rate |
$3,959.10 |
| Rate for Payer: Family Health Partners Medicaid |
$3,665.83
|
| Rate for Payer: Healthy Blue Medicaid |
$3,959.10
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,665.83
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,665.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,759.85
|
|
|
Exc Lesion Mucosa & Sbmcsl Vestibule Smpl Rpr
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
Px09834081201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$209.76 |
| Max. Negotiated Rate |
$2,114.79 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$259.44
|
| Rate for Payer: Aetna Workers' Compensation |
$259.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$255.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$255.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$283.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$289.98
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cigna Commercial |
$225.22
|
| Rate for Payer: Cigna Medicare Advantage |
$209.76
|
| Rate for Payer: Family Health Partners Medicaid |
$1,958.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$231.84
|
| Rate for Payer: Healthy Blue Medicaid |
$2,114.79
|
| Rate for Payer: Home State Health Plan Exchange |
$209.76
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,958.14
|
| Rate for Payer: Humana Medicare |
$276.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,958.14
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$276.00
|
| Rate for Payer: Provider Network of America Commercial |
$294.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$242.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$368.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,474.20
|
|
|
Exc Lesion Mucosa & Sbmcsl Vestibule Smpl Rpr
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
Px09834081201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$276.00 |
| 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 |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| 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 |
$276.00
|
| Rate for Payer: Provider Network of America Commercial |
$294.40
|
|
|
Exc Les Mucosa & Sbmcsl Vestibule Mouth W/O Rpr
|
Facility
|
OP
|
$6,380.38
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
Px05104081001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,150.11 |
| Max. Negotiated Rate |
$6,380.38 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,498.17
|
| Rate for Payer: Aetna Workers' Compensation |
$4,498.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,421.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,421.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,912.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,027.74
|
| Rate for Payer: Cash Price |
$6,380.38
|
| Rate for Payer: Cash Price |
$6,380.38
|
| Rate for Payer: Cigna Commercial |
$3,904.79
|
| Rate for Payer: Cigna Medicare Advantage |
$3,636.82
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,019.64
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$3,636.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$4,785.28
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,785.28
|
| Rate for Payer: Provider Network of America Commercial |
$5,104.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,211.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,380.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Exc Les Mucosa & Sbmcsl Vestibule Mouth W/O Rpr
|
Facility
|
IP
|
$6,380.38
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
Px05104081001
|
|
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 |
$6,380.38
|
| Rate for Payer: Cash Price |
$6,380.38
|
| 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 |
$4,785.28
|
| Rate for Payer: Provider Network of America Commercial |
$5,104.30
|
|
|
Exc Les Mucosa & Sbmcsl Vestibule Mouth W/O Rpr
|
Facility
|
OP
|
$6,380.38
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
Px07614081001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,150.11 |
| Max. Negotiated Rate |
$6,380.38 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,498.17
|
| Rate for Payer: Aetna Workers' Compensation |
$4,498.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,421.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,421.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,027.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,912.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,027.74
|
| Rate for Payer: Cash Price |
$6,380.38
|
| Rate for Payer: Cash Price |
$6,380.38
|
| Rate for Payer: Cigna Commercial |
$3,904.79
|
| Rate for Payer: Cigna Medicare Advantage |
$3,636.82
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,019.64
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$3,636.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$4,785.28
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,785.28
|
| Rate for Payer: Provider Network of America Commercial |
$5,104.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,211.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,380.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Exc Les Mucosa & Sbmcsl Vestibule Mouth W/O Rpr
|
Facility
|
IP
|
$6,380.38
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
Px07614081001
|
|
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 |
$6,380.38
|
| Rate for Payer: Cash Price |
$6,380.38
|
| 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 |
$4,785.28
|
| Rate for Payer: Provider Network of America Commercial |
$5,104.30
|
|
|
Exc Tumor Soft Tissue Abdominal Wall Subq 3 Cm/>
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
Px00000022903
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$505.30 |
| Max. Negotiated Rate |
$505.30 |
| Rate for Payer: Cash Price |
$1,213.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$505.30
|
|
|
Exc Tumor Soft Tissue Neck/Thorax Subfasc 5 Cm/>
|
Facility
|
OP
|
$5,848.50
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
Px03602155401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,759.85 |
| Max. Negotiated Rate |
$5,848.50 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,608.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,503.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,608.62
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cash Price |
$5,848.50
|
| Rate for Payer: Cigna Commercial |
$3,877.56
|
| Rate for Payer: Cigna Medicare Advantage |
$3,333.64
|
| Rate for Payer: Family Health Partners Medicaid |
$3,665.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,684.55
|
| Rate for Payer: Healthy Blue Medicaid |
$3,959.10
|
| Rate for Payer: Home State Health Plan Exchange |
$3,333.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,665.83
|
| Rate for Payer: Humana Medicare |
$4,386.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,665.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,386.38
|
| Rate for Payer: Provider Network of America Commercial |
$4,678.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,860.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,848.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,759.85
|
|
