|
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
|
|
|
calcium chloride 100 mg/mL (10 %) syringe 10 mL Syringe
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 76329330401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$29.61
|
| Rate for Payer: Aetna Workers' Compensation |
$29.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$29.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$29.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$33.10
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$25.70
|
| Rate for Payer: Cigna Medicare Advantage |
$23.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$26.46
|
| Rate for Payer: Home State Health Plan Exchange |
$23.94
|
| Rate for Payer: Humana Medicare |
$31.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Provider Network of America Commercial |
$33.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$42.00
|
|
|
calcium chloride 100 mg/mL (10 %) syringe 10 mL Syringe
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 76329330401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$31.50 |
| 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 |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| 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 |
$31.50
|
| Rate for Payer: Provider Network of America Commercial |
$33.60
|
|
|
calcium gluconate 100 mg/mL (10%) solution 10 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J0612
|
|
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
|
|
|
calcium gluconate 100 mg/mL (10%) solution 10 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 63323036001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$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
|
|
|
calcium gluconate 100 mg/mL (10%) solution 10 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J0612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$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
|
|
|
calcium gluconate 100 mg/mL (10%) solution 10 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 63323036001
|
|
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
|
|
|
Calcium glucon (fresenius)
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
Px0636J061201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$19.14
|
| Rate for Payer: Aetna Workers' Compensation |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$21.39
|
| Rate for Payer: Cash Price |
$27.15
|
| Rate for Payer: Cigna Commercial |
$16.62
|
| Rate for Payer: Cigna Medicare Advantage |
$15.48
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$17.10
|
| Rate for Payer: Home State Health Plan Exchange |
$15.48
|
| Rate for Payer: Humana Medicare |
$20.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$20.36
|
| Rate for Payer: Provider Network of America Commercial |
$21.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$27.15
|
|
|
Calcium glucon (fresenius)
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
Px0636J061201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.36 |
| 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 |
$27.15
|
| Rate for Payer: Cash Price |
$27.15
|
| 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 |
$20.36
|
| Rate for Payer: Provider Network of America Commercial |
$21.72
|
|
|
Canalith Repositioning Procedure
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
Px09839599201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$57.81
|
| Rate for Payer: Aetna Workers' Compensation |
$57.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$56.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$56.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$64.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$64.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$64.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$63.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$64.62
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$50.18
|
| Rate for Payer: Cigna Medicare Advantage |
$46.74
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$51.66
|
| Rate for Payer: Home State Health Plan Exchange |
$46.74
|
| Rate for Payer: Humana Medicare |
$61.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Provider Network of America Commercial |
$65.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$82.00
|
|
|
Canalith Repositioning Procedure
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
Px09839599201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$61.50 |
| 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 |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| 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 |
$61.50
|
| Rate for Payer: Provider Network of America Commercial |
$65.60
|
|
|
capsaicin 0.025 % cream 60 g Tube
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00536252525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
capsaicin 0.025 % cream 60 g Tube
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00536252525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
Capsul Mttarphlngl Jt W/WO Tenorrhaphy Ea Jt Spx
|
Facility
|
IP
|
$342.68
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
Px09832827001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$257.01 |
| 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 |
$326.36
|
| Rate for Payer: Cash Price |
$342.68
|
| Rate for Payer: Cash Price |
$342.68
|
| Rate for Payer: Cash Price |
$326.36
|
| 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 |
$257.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$244.77
|
| Rate for Payer: Provider Network of America Commercial |
$274.14
|
| Rate for Payer: Provider Network of America Commercial |
$261.09
|
|
|
Capsul Mttarphlngl Jt W/WO Tenorrhaphy Ea Jt Spx
|
Facility
|
OP
|
$342.68
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
Px09832827001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$195.33 |
| Max. Negotiated Rate |
$4,459.70 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$241.59
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$230.08
|
| Rate for Payer: Aetna Workers' Compensation |
$241.59
|
| Rate for Payer: Aetna Workers' Compensation |
$230.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$226.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$237.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$226.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$270.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$257.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$270.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$257.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$257.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$270.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$251.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$263.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$270.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$257.17
|
| Rate for Payer: Cash Price |
$342.68
|
| Rate for Payer: Cash Price |
$342.68
|
| Rate for Payer: Cash Price |
$326.36
|
| Rate for Payer: Cash Price |
$326.36
|
| Rate for Payer: Cigna Commercial |
$209.72
|
| Rate for Payer: Cigna Commercial |
$199.73
|
| Rate for Payer: Cigna Medicare Advantage |
$186.03
|
| Rate for Payer: Cigna Medicare Advantage |
$195.33
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$215.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$205.61
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Home State Health Plan Exchange |
$195.33
|
| Rate for Payer: Home State Health Plan Exchange |
$186.03
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Humana Medicare |
$244.77
|
| Rate for Payer: Humana Medicare |
$257.01
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$244.77
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$257.01
|
| Rate for Payer: Provider Network of America Commercial |
$261.09
|
| Rate for Payer: Provider Network of America Commercial |
$274.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$215.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$226.17
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$326.36
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$342.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
|
|
Capsulotomy Iphal Joint Each Joint Spx
|
Facility
|
IP
|
$248.35
|
|
|
Service Code
|
CPT 28272
|
| Hospital Charge Code |
Px09832827201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$186.26 |
| 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 |
$236.52
|
| Rate for Payer: Cash Price |
$248.35
|
| Rate for Payer: Cash Price |
$248.35
|
| Rate for Payer: Cash Price |
$236.52
|
| 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 |
$186.26
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$177.39
|
| Rate for Payer: Provider Network of America Commercial |
$198.68
|
| Rate for Payer: Provider Network of America Commercial |
$189.22
|
|
|
Capsulotomy Iphal Joint Each Joint Spx
|
Facility
|
OP
|
$248.35
|
|
|
Service Code
|
CPT 28272
|
| Hospital Charge Code |
Px09832827201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$141.56 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$175.09
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$166.75
|
| Rate for Payer: Aetna Workers' Compensation |
$175.09
|
| Rate for Payer: Aetna Workers' Compensation |
$166.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$172.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$163.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$172.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$163.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$186.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$186.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$186.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$182.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$191.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$186.38
|
| Rate for Payer: Cash Price |
$248.35
|
| Rate for Payer: Cash Price |
$248.35
|
| Rate for Payer: Cash Price |
$236.52
|
| Rate for Payer: Cash Price |
$236.52
|
| Rate for Payer: Cigna Commercial |
$151.99
|
| Rate for Payer: Cigna Commercial |
$144.75
|
| Rate for Payer: Cigna Medicare Advantage |
$134.82
|
| Rate for Payer: Cigna Medicare Advantage |
$141.56
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$156.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$149.01
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Home State Health Plan Exchange |
$141.56
|
| Rate for Payer: Home State Health Plan Exchange |
$134.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Humana Medicare |
$177.39
|
| Rate for Payer: Humana Medicare |
$186.26
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$177.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$186.26
|
| Rate for Payer: Provider Network of America Commercial |
$189.22
|
| Rate for Payer: Provider Network of America Commercial |
$198.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$163.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$236.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$248.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
|
|
carbamide peroxide 6.5 % drops 15 mL DROP BTL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00904662735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
carbamide peroxide 6.5 % drops 15 mL DROP BTL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 46122055705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
carbamide peroxide 6.5 % drops 15 mL DROP BTL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 46122055705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
carbamide peroxide 6.5 % drops 15 mL DROP BTL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00904662735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
carbidopa-levodopa 25-100 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904750161
|
|
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
|
|
|
carbidopa-levodopa 25-100 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904750161
|
|
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
|
|
|
carbidopa-levodopa 25-100 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904725761
|
|
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
|
|
|
carbidopa-levodopa 25-100 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904725761
|
|
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
|
|
