|
Acetylcholine Receptor Blocking Antibody
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
Px03028604201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$27.07
|
| Rate for Payer: Aetna Workers' Compensation |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$30.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$29.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$30.26
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$20.12
|
| Rate for Payer: Cigna Medicare Advantage |
$21.89
|
| Rate for Payer: Family Health Partners Medicaid |
$23.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$24.19
|
| Rate for Payer: Healthy Blue Medicaid |
$25.04
|
| Rate for Payer: Home State Health Plan Exchange |
$21.89
|
| Rate for Payer: Home State Health Plan Medicaid |
$23.18
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Mercy CarePlus Medicaid |
$23.18
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.45
|
|
|
Acetylcholine Receptor Blocking Antibody
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
CPT 86042
|
| Hospital Charge Code |
Px03028604201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.80 |
| 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 |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| 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 |
$28.80
|
| Rate for Payer: Provider Network of America Commercial |
$30.72
|
|
|
Acetylcholine Receptor Modulating Antibody
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
Px03028604301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cigna Medicare Advantage |
$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 |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| 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 |
$16.54
|
| Rate for Payer: Provider Network of America Commercial |
$17.64
|
|
|
Acetylcholine Receptor Modulating Antibody
|
Facility
|
OP
|
$22.05
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
Px03028604301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.55
|
| Rate for Payer: Aetna Workers' Compensation |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.38
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna Commercial |
$11.55
|
| Rate for Payer: Cigna Medicare Advantage |
$12.57
|
| Rate for Payer: Family Health Partners Medicaid |
$15.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.89
|
| Rate for Payer: Healthy Blue Medicaid |
$16.41
|
| Rate for Payer: Home State Health Plan Exchange |
$12.57
|
| Rate for Payer: Home State Health Plan Medicaid |
$15.19
|
| Rate for Payer: Humana Medicare |
$16.54
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.54
|
| Rate for Payer: Provider Network of America Commercial |
$17.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.55
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
|
|
acetylcysteine 600 mg capsule 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 79854004097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
acetylcysteine 600 mg capsule 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 96295014038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
acetylcysteine 600 mg capsule 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 96295014038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
acetylcysteine 600 mg capsule 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 79854004097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$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
|
|
|
Acetylcysteine injection
|
Facility
|
IP
|
$110.48
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
Px0636J013201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.86 |
| 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 |
$110.48
|
| Rate for Payer: Cash Price |
$110.48
|
| 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 |
$82.86
|
| Rate for Payer: Provider Network of America Commercial |
$88.38
|
|
|
Acetylcysteine injection
|
Facility
|
OP
|
$110.48
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
Px0636J013201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$77.89
|
| Rate for Payer: Aetna Workers' Compensation |
$77.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$76.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$87.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$87.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$87.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$85.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$87.06
|
| Rate for Payer: Cash Price |
$110.48
|
| Rate for Payer: Cigna Commercial |
$67.61
|
| Rate for Payer: Cigna Medicare Advantage |
$62.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$69.60
|
| Rate for Payer: Home State Health Plan Exchange |
$62.97
|
| Rate for Payer: Humana Medicare |
$82.86
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$82.86
|
| Rate for Payer: Provider Network of America Commercial |
$88.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$110.48
|
|
|
acetylcysteine per 100 mg
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J0132
|
|
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
|
|
|
acetylcysteine per 100 mg
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 55150025930
|
|
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
|
|
|
acetylcysteine per 100 mg
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 55150025930
|
|
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
|
|
|
acetylcysteine per 100 mg
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J0132
|
|
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
|
|
|
activated charcoal-sorbitol 25 gram/120 mL suspension 120 mL Tube
|
Facility
|
OP
|
$53.44
|
|
|
Service Code
|
NDC 00574052074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$53.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$37.68
|
| Rate for Payer: Aetna Workers' Compensation |
$37.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$37.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$37.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$42.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$41.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$42.11
|
| Rate for Payer: Cash Price |
$53.44
|
| Rate for Payer: Cigna Commercial |
$32.71
|
| Rate for Payer: Cigna Medicare Advantage |
$30.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$33.67
|
| Rate for Payer: Home State Health Plan Exchange |
$30.46
|
| Rate for Payer: Humana Medicare |
$40.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$40.08
|
| Rate for Payer: Provider Network of America Commercial |
$42.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$53.44
|
|
|
activated charcoal-sorbitol 25 gram/120 mL suspension 120 mL Tube
|
Facility
|
IP
|
$53.44
|
|
|
Service Code
|
NDC 00574052074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.08 |
| 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 |
$53.44
|
| Rate for Payer: Cash Price |
$53.44
|
| 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 |
$40.08
|
| Rate for Payer: Provider Network of America Commercial |
$42.75
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 880
|
| 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 |
$4,512.94
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$25,192.22
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$25,192.22 |
| 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 |
$25,192.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$25,192.22
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$25,192.22
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$25,192.22
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$12,853.59
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,853.59 |
| 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 |
$12,853.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,853.59
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,853.59
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,853.59
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$17,263.54
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$17,263.54 |
| 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 |
$17,263.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$17,263.54
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$17,263.54
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17,263.54
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$11,211.64
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,211.64 |
| Rate for Payer: Cigna Medicare Advantage |
$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: Family Health Partners Medicaid |
$11,211.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,211.64
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,211.64
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,211.64
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$8,022.43
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,022.43 |
| 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 |
$8,022.43
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$12,719.14
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,719.14 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$12,719.14
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 290
|
| 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 |
$4,369.59
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$18,757.57
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$18,757.57 |
| 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 |
$18,757.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$18,757.57
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$18,757.57
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$18,757.57
|
|
