|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$5,499.94
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$3,393.40
|
|
|
benralizumab 30 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$24,089.88
|
|
|
Service Code
|
HCPCS J0517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,271.90 |
| 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: Cash Price |
$24,089.88
|
| Rate for Payer: Cash Price |
$24,089.88
|
| 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 |
$18,067.41
|
| Rate for Payer: Provider Network of America Commercial |
$19,271.90
|
|
|
benralizumab 30 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$24,089.88
|
|
|
Service Code
|
NDC 00310173030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,731.23 |
| Max. Negotiated Rate |
$24,089.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$16,983.37
|
| Rate for Payer: Aetna Workers' Compensation |
$16,983.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$16,694.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$16,694.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$18,549.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$18,982.83
|
| Rate for Payer: Cash Price |
$24,089.88
|
| Rate for Payer: Cigna Commercial |
$14,743.01
|
| Rate for Payer: Cigna Medicare Advantage |
$13,731.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15,176.62
|
| Rate for Payer: Home State Health Plan Exchange |
$13,731.23
|
| Rate for Payer: Humana Medicare |
$18,067.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,067.41
|
| Rate for Payer: Provider Network of America Commercial |
$19,271.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$15,899.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$24,089.88
|
|
|
benralizumab 30 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$24,089.88
|
|
|
Service Code
|
HCPCS J0517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,731.23 |
| Max. Negotiated Rate |
$24,089.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$16,983.37
|
| Rate for Payer: Aetna Workers' Compensation |
$16,983.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$16,694.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$16,694.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$18,982.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$18,549.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$18,982.83
|
| Rate for Payer: Cash Price |
$24,089.88
|
| Rate for Payer: Cigna Commercial |
$14,743.01
|
| Rate for Payer: Cigna Medicare Advantage |
$13,731.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15,176.62
|
| Rate for Payer: Home State Health Plan Exchange |
$13,731.23
|
| Rate for Payer: Humana Medicare |
$18,067.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,067.41
|
| Rate for Payer: Provider Network of America Commercial |
$19,271.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$15,899.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$24,089.88
|
|
|
benralizumab 30 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$24,089.88
|
|
|
Service Code
|
NDC 00310173030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,271.90 |
| 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: Cash Price |
$24,089.88
|
| Rate for Payer: Cash Price |
$24,089.88
|
| 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 |
$18,067.41
|
| Rate for Payer: Provider Network of America Commercial |
$19,271.90
|
|
|
benzocaine-menthol 15-3.6 mg lozenge 18 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904625549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
benzocaine-menthol 15-3.6 mg lozenge 18 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904625549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
benzoin (bulk) tincture 59 mL Bottle
|
Facility
|
OP
|
$43.80
|
|
|
Service Code
|
NDC 00395024792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$30.88
|
| Rate for Payer: Aetna Workers' Compensation |
$30.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$34.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$34.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$34.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$33.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$34.51
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$26.81
|
| Rate for Payer: Cigna Medicare Advantage |
$24.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$27.59
|
| Rate for Payer: Home State Health Plan Exchange |
$24.97
|
| Rate for Payer: Humana Medicare |
$32.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$32.85
|
| Rate for Payer: Provider Network of America Commercial |
$35.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$43.80
|
|
|
benzoin (bulk) tincture 59 mL Bottle
|
Facility
|
IP
|
$43.80
|
|
|
Service Code
|
NDC 00395024792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.85 |
| 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 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 |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| 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 |
$32.85
|
| Rate for Payer: Provider Network of America Commercial |
$35.04
|
|
|
benzonatate 100 mg capsule 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904715361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
benzonatate 100 mg capsule 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904715361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
benztropine 0.5 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904728861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
benztropine 0.5 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904728861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
benztropine 0.5 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084038111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| 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 |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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 |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
benztropine 0.5 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084038111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
Beta Amyloid 42
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
Px03018352044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$251.25 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| 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 |
$251.25
|
| Rate for Payer: Provider Network of America Commercial |
$268.00
|
|
|
Beta Amyloid 42
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
Px03018352044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$236.18
|
| Rate for Payer: Aetna Workers' Compensation |
$236.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$232.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$232.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$263.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$263.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$263.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$257.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$263.98
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$175.54
|
| Rate for Payer: Cigna Medicare Advantage |
$190.95
|
| Rate for Payer: Family Health Partners Medicaid |
$21.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$211.05
|
| Rate for Payer: Healthy Blue Medicaid |
$23.50
|
| Rate for Payer: Home State Health Plan Exchange |
$190.95
|
| Rate for Payer: Home State Health Plan Medicaid |
$21.76
|
| Rate for Payer: Humana Medicare |
$251.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$251.25
|
| Rate for Payer: Provider Network of America Commercial |
$268.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
IP
|
$44.02
|
|
|
Service Code
|
HCPCS J0702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.02 |
| 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 |
$44.02
|
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cash Price |
$44.02
|
| Rate for Payer: Cash Price |
$36.67
|
| 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 |
$33.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.50
|
| Rate for Payer: Provider Network of America Commercial |
$35.22
|
| Rate for Payer: Provider Network of America Commercial |
$29.34
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
OP
|
$36.67
|
|
|
Service Code
|
NDC 78206011801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$36.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.85
|
| Rate for Payer: Aetna Workers' Compensation |
$25.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.90
|
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cigna Commercial |
$22.44
|
| Rate for Payer: Cigna Medicare Advantage |
$20.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.10
|
| Rate for Payer: Home State Health Plan Exchange |
$20.90
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.50
|
| Rate for Payer: Provider Network of America Commercial |
$29.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$36.67
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
OP
|
$44.02
|
|
|
Service Code
|
NDC 00517072001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$44.02 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.03
|
| Rate for Payer: Aetna Workers' Compensation |
$31.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$33.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$34.69
|
| Rate for Payer: Cash Price |
$44.02
|
| Rate for Payer: Cigna Commercial |
$26.94
|
| Rate for Payer: Cigna Medicare Advantage |
$25.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$27.73
|
| Rate for Payer: Home State Health Plan Exchange |
$25.09
|
| Rate for Payer: Humana Medicare |
$33.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.02
|
| Rate for Payer: Provider Network of America Commercial |
$35.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$44.02
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
IP
|
$44.02
|
|
|
Service Code
|
NDC 00517072001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.02 |
| 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 |
$44.02
|
| Rate for Payer: Cash Price |
$44.02
|
| 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 |
$33.02
|
| Rate for Payer: Provider Network of America Commercial |
$35.22
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
IP
|
$36.67
|
|
|
Service Code
|
NDC 78206011801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| 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 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 |
$36.67
|
| Rate for Payer: Cash Price |
$36.67
|
| 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 |
$27.50
|
| Rate for Payer: Provider Network of America Commercial |
$29.34
|
|
|
betamethasone acet,sod phos 6 mg/mL suspension 5 mL Vial
|
Facility
|
OP
|
$44.02
|
|
|
Service Code
|
HCPCS J0702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$44.02 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.03
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.85
|
| Rate for Payer: Aetna Workers' Compensation |
$25.85
|
| Rate for Payer: Aetna Workers' Compensation |
$31.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$30.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$34.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$33.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$34.69
|
| Rate for Payer: Cash Price |
$44.02
|
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cigna Commercial |
$22.44
|
| Rate for Payer: Cigna Commercial |
$26.94
|
| Rate for Payer: Cigna Medicare Advantage |
$25.09
|
| Rate for Payer: Cigna Medicare Advantage |
$20.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$27.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.10
|
| Rate for Payer: Home State Health Plan Exchange |
$20.90
|
| Rate for Payer: Home State Health Plan Exchange |
$25.09
|
| Rate for Payer: Humana Medicare |
$33.02
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.02
|
| Rate for Payer: Provider Network of America Commercial |
$35.22
|
| Rate for Payer: Provider Network of America Commercial |
$29.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$36.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$44.02
|
|
|
Betamethasone Acet&Sod Phosp
|
Facility
|
IP
|
$171.39
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
Px0636J070201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.54 |
| 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 |
$171.39
|
| Rate for Payer: Cash Price |
$171.39
|
| 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 |
$128.54
|
| Rate for Payer: Provider Network of America Commercial |
$137.11
|
|
