|
Exc Tumor Soft Tissue Neck/Thorax Subfasc 5 Cm/>
|
Facility
|
IP
|
$5,848.50
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
Px03602155401
|
|
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
|
|
|
Exploration Penetrating Wound Spx Neck
|
Facility
|
OP
|
$163.80
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
Px09832010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$735.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$115.48
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$109.98
|
| Rate for Payer: Aetna Workers' Compensation |
$115.48
|
| Rate for Payer: Aetna Workers' Compensation |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$113.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$113.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$129.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$129.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$129.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$126.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$129.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$122.93
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$100.25
|
| Rate for Payer: Cigna Commercial |
$95.47
|
| Rate for Payer: Cigna Medicare Advantage |
$88.92
|
| Rate for Payer: Cigna Medicare Advantage |
$93.37
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Family Health Partners Medicaid |
$680.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$103.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$98.28
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Healthy Blue Medicaid |
$735.10
|
| Rate for Payer: Home State Health Plan Exchange |
$93.37
|
| Rate for Payer: Home State Health Plan Exchange |
$88.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Home State Health Plan Medicaid |
$680.65
|
| Rate for Payer: Humana Medicare |
$117.00
|
| Rate for Payer: Humana Medicare |
$122.85
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Mercy CarePlus Medicaid |
$680.65
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$122.85
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
| Rate for Payer: Provider Network of America Commercial |
$131.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$108.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$156.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$163.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$512.43
|
|
|
Exploration Penetrating Wound Spx Neck
|
Facility
|
IP
|
$163.80
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
Px09832010001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.85 |
| 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 |
$156.00
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$156.00
|
| 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 |
$122.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Provider Network of America Commercial |
$131.04
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
|
|
Extension Set 2 Ports
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
HCPCS A4222
|
| Hospital Charge Code |
Px0272A422201
|
|
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
|
|
|
Extension Set 2 Ports
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
HCPCS A4222
|
| Hospital Charge Code |
Px0272A422201
|
|
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
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$37,100.02
|
|
|
Service Code
|
APR-DRG 9113
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$37,100.02 |
| 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 |
$37,100.02
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$37,100.02
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$37,100.02
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$37,100.02
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$25,922.59
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$25,922.59 |
| 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 |
$25,922.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$25,922.59
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$25,922.59
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$25,922.59
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$20,194.27
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,194.27 |
| 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 |
$20,194.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,194.27
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,194.27
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,194.27
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$71,609.54
|
|
|
Service Code
|
APR-DRG 9114
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$71,609.54 |
| 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 |
$71,609.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$71,609.54
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$71,609.54
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$71,609.54
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$17,938.49
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$17,938.49 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$17,938.49
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$86,621.94
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$86,621.94 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$86,621.94
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$48,433.70
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$48,433.70 |
| 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 |
$48,433.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$48,433.70
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$48,433.70
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$48,433.70
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$19,916.91
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,916.91 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$19,916.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,916.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,916.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,916.91
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$28,406.77
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$28,406.77 |
| 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 |
$28,406.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$28,406.77
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$28,406.77
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$28,406.77
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$15,771.37
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,771.37 |
| 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 |
$15,771.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,771.37
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,771.37
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,771.37
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$11,554.95
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,554.95 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$11,554.95
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$22,051.46
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,051.46 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$22,051.46
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,055.80
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,055.80 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,055.80
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$55,571.91
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$55,571.91 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$55,571.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$55,571.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$55,571.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$55,571.91
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$32,969.27
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$32,969.27 |
| 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 |
$32,969.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$32,969.27
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$32,969.27
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32,969.27
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$16,377.85
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,377.85 |
| 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 |
$16,377.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$16,377.85
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$16,377.85
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16,377.85
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,342.52
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,342.52 |
| 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 |
$21,342.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,342.52
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,342.52
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,342.52
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$11,201.47
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,201.47 |
| 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 |
$11,201.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,201.47
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,201.47
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,201.47
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$8,289.24
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,289.24 |
| 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 |
$8,289.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,289.24
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,289.24
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,289.24
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$19,700.58
|
|
|
Service Code
|
APR-DRG 8433
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,700.58 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$19,700.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$19,700.58
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$19,700.58
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19,700.58
|
|
