|
buspirone 5 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 51079098501
|
|
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
|
|
|
buspirone 5 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 51079098501
|
|
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
|
|
|
butalbital-acetaminophen-caff 50-325-40 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
NDC 00904693806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.42 |
| 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 |
$7.22
|
| Rate for Payer: Cash Price |
$7.22
|
| 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 |
$5.42
|
| Rate for Payer: Provider Network of America Commercial |
$5.78
|
|
|
butalbital-acetaminophen-caff 50-325-40 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 00904693806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.09
|
| Rate for Payer: Aetna Workers' Compensation |
$5.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5.69
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna Commercial |
$4.42
|
| Rate for Payer: Cigna Medicare Advantage |
$4.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4.55
|
| Rate for Payer: Home State Health Plan Exchange |
$4.12
|
| Rate for Payer: Humana Medicare |
$5.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5.42
|
| Rate for Payer: Provider Network of America Commercial |
$5.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7.22
|
|
|
butamben-tetracaine-benzocaine 2 %-2 %-14 % (200 mg/sec) aerosol,spray 5 g Bottle
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
NDC 10223020104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.06 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$181.89
|
| Rate for Payer: Aetna Workers' Compensation |
$181.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$178.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$203.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$203.30
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$157.90
|
| Rate for Payer: Cigna Medicare Advantage |
$147.06
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$162.54
|
| Rate for Payer: Home State Health Plan Exchange |
$147.06
|
| Rate for Payer: Humana Medicare |
$193.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Provider Network of America Commercial |
$206.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$170.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$258.00
|
|
|
butamben-tetracaine-benzocaine 2 %-2 %-14 % (200 mg/sec) aerosol,spray 5 g Bottle
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
NDC 10223020104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.50 |
| 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 |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| 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 |
$193.50
|
| Rate for Payer: Provider Network of America Commercial |
$206.40
|
|
|
Butorphanol tartrate 1 mg
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
Px0636J059501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$18.51
|
| Rate for Payer: Aetna Workers' Compensation |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$20.68
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$14.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$16.54
|
| Rate for Payer: Home State Health Plan Exchange |
$14.96
|
| Rate for Payer: Humana Medicare |
$19.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$26.25
|
|
|
Butorphanol tartrate 1 mg
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
Px0636J059501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| 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 |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| 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 |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
|
|
Bx Breast W/Device 1st Lesion Ultrasound Guid
|
Facility
|
OP
|
$98.80
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
Px09831908301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$2,251.11 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.65
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$69.65
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Cigna Medicare Advantage |
$56.32
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Home State Health Plan Exchange |
$56.32
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Humana Medicare |
$74.10
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.10
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
|
|
Bx Breast W/Device 1st Lesion Ultrasound Guid
|
Facility
|
IP
|
$98.80
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
Px09831908301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.10 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$74.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Bx Breast W/Device 1st Lesion Ultrasound Guid
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
Px09721908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Bx Breast W/Device 1st Lesion Ultrasound Guid
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
Px09721908301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$2,251.11 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
|
|
Bx Breast W/Device Addl Lesion Ultrasound Guid
|
Facility
|
IP
|
$98.80
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
Px09831908401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.10 |
| 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 |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$74.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Bx Breast W/Device Addl Lesion Ultrasound Guid
|
Facility
|
OP
|
$98.80
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
Px09831908401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.65
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$69.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.85
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Cigna Medicare Advantage |
$56.32
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Exchange |
$56.32
|
| Rate for Payer: Humana Medicare |
$74.10
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.10
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.80
|
|
|
calcitriol 0.25 mcg capsule 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687034511
|
|
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
|
|
|
calcitriol 0.25 mcg capsule 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687034511
|
|
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
|
|
|
calcium 500 mg calcium (1,250 mg) tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904188361
|
|
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
|
|
|
calcium 500 mg calcium (1,250 mg) tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904188361
|
|
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
|
|
|
calcium acetate 667 mg capsule 50 Each BLIST PACK
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 00904711906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.86
|
| Rate for Payer: Aetna Workers' Compensation |
$2.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.19
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna Commercial |
$2.48
|
| Rate for Payer: Cigna Medicare Advantage |
$2.31
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.55
|
| Rate for Payer: Home State Health Plan Exchange |
$2.31
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.04
|
| Rate for Payer: Provider Network of America Commercial |
$3.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.05
|
|
|
calcium acetate 667 mg capsule 50 Each BLIST PACK
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 00904711906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| 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 |
$4.05
|
| Rate for Payer: Cash Price |
$4.05
|
| 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 |
$3.04
|
| Rate for Payer: Provider Network of America Commercial |
$3.24
|
|
|
calcium carbonate 500 mg calcium (1,250 mg) tablet,chewable 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268014911
|
|
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
|
|
|
calcium carbonate 500 mg calcium (1,250 mg) tablet,chewable 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268014911
|
|
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
|
|
|
calcium carbonate 500 mg calcium (1,250 mg) tablet,chewable 30 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268014913
|
|
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
|
|
|
calcium carbonate 500 mg calcium (1,250 mg) tablet,chewable 30 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268014913
|
|
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
|
|
|
calcium carbonate-vitamin D3 500 mg-5 mcg (200 unit) tablet 60 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00536781708
|
|
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
|
|
