|
brimonidine 0.15 % drops 5 mL DROP BTL
|
Facility
|
OP
|
$279.08
|
|
|
Service Code
|
NDC 82182077305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.08 |
| Max. Negotiated Rate |
$279.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$196.75
|
| Rate for Payer: Aetna Workers' Compensation |
$196.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$193.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$193.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$219.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$219.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$219.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$214.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$219.92
|
| Rate for Payer: Cash Price |
$279.08
|
| Rate for Payer: Cigna Commercial |
$170.80
|
| Rate for Payer: Cigna Medicare Advantage |
$159.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$175.82
|
| Rate for Payer: Home State Health Plan Exchange |
$159.08
|
| Rate for Payer: Humana Medicare |
$209.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$209.31
|
| Rate for Payer: Provider Network of America Commercial |
$223.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$279.08
|
|
|
brimonidine 0.15 % drops 5 mL DROP BTL
|
Facility
|
IP
|
$613.40
|
|
|
Service Code
|
NDC 61314014405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.05 |
| 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 |
$613.40
|
| Rate for Payer: Cash Price |
$613.40
|
| 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 |
$460.05
|
| Rate for Payer: Provider Network of America Commercial |
$490.72
|
|
|
brimonidine 0.15 % drops 5 mL DROP BTL
|
Facility
|
OP
|
$613.40
|
|
|
Service Code
|
NDC 61314014405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.64 |
| Max. Negotiated Rate |
$613.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$432.45
|
| Rate for Payer: Aetna Workers' Compensation |
$432.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$425.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$425.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$483.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$483.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$483.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$472.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$483.36
|
| Rate for Payer: Cash Price |
$613.40
|
| Rate for Payer: Cigna Commercial |
$375.40
|
| Rate for Payer: Cigna Medicare Advantage |
$349.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$386.44
|
| Rate for Payer: Home State Health Plan Exchange |
$349.64
|
| Rate for Payer: Humana Medicare |
$460.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$460.05
|
| Rate for Payer: Provider Network of America Commercial |
$490.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$404.84
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$613.40
|
|
|
Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
Px00000094060
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.09 |
| Max. Negotiated Rate |
$48.09 |
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.09
|
|
|
Brncspsm Provocation Eval Mlt Spmtry W/Admn Agt
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
Px00000094070
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$78.85
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$10,429.50
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,429.50 |
| 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 |
$10,429.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,429.50
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,429.50
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,429.50
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$5,337.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,337.25
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,337.25
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,337.25
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$3,415.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$3,415.17
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,415.17
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,415.17
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$20,029.70
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,029.70 |
| 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 |
$20,029.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,029.70
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,029.70
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,029.70
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 202
|
| 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 |
$4,564.64
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 203
|
| 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 Freedom Network |
$4,551.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,551.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,551.00
|
| 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 Traditional |
$4,551.00
|
| 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 |
$3,149.00
|
|
|
budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
NDC 00093681555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Aetna Workers' Compensation |
$21.24
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.74
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$18.44
|
| Rate for Payer: Cigna Medicare Advantage |
$17.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.98
|
| Rate for Payer: Home State Health Plan Exchange |
$17.17
|
| Rate for Payer: Humana Medicare |
$22.60
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.60
|
| Rate for Payer: Provider Network of America Commercial |
$24.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.13
|
|
|
budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.24
|
| Rate for Payer: Aetna Workers' Compensation |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.74
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$18.44
|
| Rate for Payer: Cigna Medicare Advantage |
$17.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.98
|
| Rate for Payer: Home State Health Plan Exchange |
$17.17
|
| Rate for Payer: Humana Medicare |
$22.60
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.60
|
| Rate for Payer: Provider Network of America Commercial |
$24.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.13
|
|
|
budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
NDC 00093681555
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.60 |
| 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 |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| 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 |
$22.60
|
| Rate for Payer: Provider Network of America Commercial |
$24.10
|
|
|
budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.60 |
| 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 |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| 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 |
$22.60
|
| Rate for Payer: Provider Network of America Commercial |
$24.10
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
OP
|
$37.33
|
|
|
Service Code
|
NDC 60687052479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.32
|
| Rate for Payer: Aetna Workers' Compensation |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.42
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cigna Commercial |
$22.85
|
| Rate for Payer: Cigna Medicare Advantage |
$21.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.52
|
| Rate for Payer: Home State Health Plan Exchange |
$21.28
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.33
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
IP
|
$37.33
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.00 |
| 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 |
$37.33
|
| Rate for Payer: Cash Price |
$37.33
|
| 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 |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
IP
|
$37.33
|
|
|
Service Code
|
NDC 60687052479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.00 |
| 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 |
$37.33
|
| Rate for Payer: Cash Price |
$37.33
|
| 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 |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
OP
|
$37.33
|
|
|
Service Code
|
NDC 60687052483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.32
|
| Rate for Payer: Aetna Workers' Compensation |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.42
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cigna Commercial |
$22.85
|
| Rate for Payer: Cigna Medicare Advantage |
$21.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.52
|
| Rate for Payer: Home State Health Plan Exchange |
$21.28
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.33
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
IP
|
$37.33
|
|
|
Service Code
|
NDC 60687052483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.00 |
| 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 |
$37.33
|
| Rate for Payer: Cash Price |
$37.33
|
| 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 |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
|
|
budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL
|
Facility
|
OP
|
$37.33
|
|
|
Service Code
|
HCPCS J7626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.32
|
| Rate for Payer: Aetna Workers' Compensation |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.42
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cigna Commercial |
$22.85
|
| Rate for Payer: Cigna Medicare Advantage |
$21.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.52
|
| Rate for Payer: Home State Health Plan Exchange |
$21.28
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$29.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.33
|
|
|
bumetanide 0.25 mg/mL solution 4 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00641600801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
bumetanide 0.25 mg/mL solution 4 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 68462046954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
bumetanide 0.25 mg/mL solution 4 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00641600801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
bumetanide 0.25 mg/mL solution 4 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J1939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
