|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$21,914.80
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,914.80 |
| 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: Family Health Partners Medicaid |
$21,914.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,914.80
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,914.80
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,914.80
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$13,302.90
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,302.90 |
| 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 |
$13,302.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,302.90
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,302.90
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,302.90
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$15,078.90
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,078.90 |
| 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 |
$15,078.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,078.90
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,078.90
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,078.90
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$12,122.24
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,122.24 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$12,122.24
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$16,541.18
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,541.18 |
| 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 |
$16,541.18
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$12,122.24
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,122.24 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$12,122.24
|
|
|
balsam peru-castor oil ointment 60 g Tube
|
Facility
|
OP
|
$106.96
|
|
|
Service Code
|
NDC 71351001460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$106.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.41
|
| Rate for Payer: Aetna Workers' Compensation |
$75.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$74.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$74.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.28
|
| Rate for Payer: Cash Price |
$106.96
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: Cigna Medicare Advantage |
$60.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.38
|
| Rate for Payer: Home State Health Plan Exchange |
$60.97
|
| Rate for Payer: Humana Medicare |
$80.22
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.22
|
| Rate for Payer: Provider Network of America Commercial |
$85.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$106.96
|
|
|
balsam peru-castor oil ointment 60 g Tube
|
Facility
|
IP
|
$106.96
|
|
|
Service Code
|
NDC 71351001460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.22 |
| 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 |
$106.96
|
| Rate for Payer: Cash Price |
$106.96
|
| 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 |
$80.22
|
| Rate for Payer: Provider Network of America Commercial |
$85.57
|
|
|
Bandage Ace 4"
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
Px0270A644901
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
Bandage Ace 4"
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
Px0270A644901
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Bandage Coban 1"
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A4653
|
| Hospital Charge Code |
Px0270A465301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
Bandage Coban 1"
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A4653
|
| Hospital Charge Code |
Px0270A465301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Bandage Coban 2-Layer Comp Lite System
|
Facility
|
IP
|
$32.05
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
Px0270A645401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.04 |
| 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 |
$32.05
|
| Rate for Payer: Cash Price |
$32.05
|
| 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 |
$24.04
|
| Rate for Payer: Provider Network of America Commercial |
$25.64
|
|
|
Bandage Coban 2-Layer Comp Lite System
|
Facility
|
OP
|
$32.05
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
Px0270A645401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$32.05 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$22.60
|
| Rate for Payer: Aetna Workers' Compensation |
$22.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$22.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$22.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$25.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$25.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$25.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$25.26
|
| Rate for Payer: Cash Price |
$32.05
|
| Rate for Payer: Cigna Commercial |
$19.61
|
| Rate for Payer: Cigna Medicare Advantage |
$18.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$20.19
|
| Rate for Payer: Home State Health Plan Exchange |
$18.27
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$24.04
|
| Rate for Payer: Provider Network of America Commercial |
$25.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$32.05
|
|
|
Bandage Coban 3"
|
Facility
|
IP
|
$32.37
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
Px0270A645402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.28 |
| 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 |
$32.37
|
| Rate for Payer: Cash Price |
$32.37
|
| 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 |
$24.28
|
| Rate for Payer: Provider Network of America Commercial |
$25.90
|
|
|
Bandage Coban 3"
|
Facility
|
OP
|
$32.37
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
Px0270A645402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$22.82
|
| Rate for Payer: Aetna Workers' Compensation |
$22.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$22.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$22.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$25.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$25.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$25.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$24.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$25.51
|
| Rate for Payer: Cash Price |
$32.37
|
| Rate for Payer: Cigna Commercial |
$19.81
|
| Rate for Payer: Cigna Medicare Advantage |
$18.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$20.39
|
| Rate for Payer: Home State Health Plan Exchange |
$18.45
|
| Rate for Payer: Humana Medicare |
$24.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$24.28
|
| Rate for Payer: Provider Network of America Commercial |
$25.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$21.36
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$32.37
|
|
|
barium sulfate 2.1 % (w/v), 2.0 % (w/w) suspension 450 mL Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 69307102402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
barium sulfate 2.1 % (w/v), 2.0 % (w/w) suspension 450 mL Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 69307102402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
barium sulfate 60 % cream 454 g Tube
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 32909077001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$163.41 |
| 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 |
$217.88
|
| Rate for Payer: Cash Price |
$217.88
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.41
|
| Rate for Payer: Provider Network of America Commercial |
$174.30
|
|
|
barium sulfate 60 % cream 454 g Tube
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 32909077001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$153.61
|
| Rate for Payer: Aetna Workers' Compensation |
$153.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$150.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$150.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$171.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$171.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$171.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$167.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$171.69
|
| Rate for Payer: Cash Price |
$217.88
|
| Rate for Payer: Cigna Commercial |
$133.34
|
| Rate for Payer: Cigna Medicare Advantage |
$124.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$137.26
|
| Rate for Payer: Home State Health Plan Exchange |
$124.19
|
| Rate for Payer: Humana Medicare |
$163.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.41
|
| Rate for Payer: Provider Network of America Commercial |
$174.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$143.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$217.88
|
|
|
barium sulfate 96 % (w/w) suspension for reconstitution 176 g Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 69307409602
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
barium sulfate 96 % (w/w) suspension for reconstitution 176 g Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 69307409602
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$9,753.91
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,753.91 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$9,753.91
|
|
|
Belimumab injection
|
Facility
|
IP
|
$10,669.73
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
Px0636J049001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,535.78 |
| 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 |
$10,669.73
|
| Rate for Payer: Cash Price |
$10,669.73
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$8,002.30
|
| Rate for Payer: Provider Network of America Commercial |
$8,535.78
|
|
|
Belimumab injection
|
Facility
|
OP
|
$10,669.73
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
Px0636J049001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,081.75 |
| Max. Negotiated Rate |
$10,669.73 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7,522.16
|
| Rate for Payer: Aetna Workers' Compensation |
$7,522.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7,394.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7,394.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$8,407.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$8,407.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$8,407.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8,215.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$8,407.75
|
| Rate for Payer: Cash Price |
$10,669.73
|
| Rate for Payer: Cigna Commercial |
$6,529.87
|
| Rate for Payer: Cigna Medicare Advantage |
$6,081.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6,721.93
|
| Rate for Payer: Home State Health Plan Exchange |
$6,081.75
|
| Rate for Payer: Humana Medicare |
$8,002.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$8,002.30
|
| Rate for Payer: Provider Network of America Commercial |
$8,535.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,042.02
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10,669.73
|
|
