|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$20,419.85
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,419.85 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$20,419.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,419.85
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,419.85
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,419.85
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$6,680.11
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,680.11 |
| 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 |
$6,680.11
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 603
|
| 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 |
$4,093.23
|
|
|
Centromere Antibodies, Igg, Serum - Cma and Diabetes Mellitus Type 1 Eva
|
Facility
|
OP
|
$202.65
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
Px03018351639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$162.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$142.87
|
| Rate for Payer: Aetna Workers' Compensation |
$142.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$140.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$159.69
|
| Rate for Payer: Cash Price |
$202.65
|
| Rate for Payer: Cash Price |
$202.65
|
| Rate for Payer: Cigna Commercial |
$106.19
|
| Rate for Payer: Cigna Medicare Advantage |
$115.51
|
| Rate for Payer: Family Health Partners Medicaid |
$14.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.67
|
| Rate for Payer: Healthy Blue Medicaid |
$15.69
|
| Rate for Payer: Home State Health Plan Exchange |
$115.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$14.53
|
| Rate for Payer: Humana Medicare |
$151.99
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$151.99
|
| Rate for Payer: Provider Network of America Commercial |
$162.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.75
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.94
|
|
|
Centromere Antibodies, Igg, Serum - Cma and Diabetes Mellitus Type 1 Eva
|
Facility
|
IP
|
$202.65
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
Px03018351639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$151.99 |
| 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 |
$202.65
|
| Rate for Payer: Cash Price |
$202.65
|
| 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 |
$151.99
|
| Rate for Payer: Provider Network of America Commercial |
$162.12
|
|
|
cephalexin 250 mg/5 mL suspension for reconstitution 100 mL Bottle
|
Facility
|
OP
|
$51.80
|
|
|
Service Code
|
NDC 67877054588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$36.52
|
| Rate for Payer: Aetna Workers' Compensation |
$36.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$35.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$35.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$40.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$39.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$40.82
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cigna Commercial |
$31.70
|
| Rate for Payer: Cigna Medicare Advantage |
$29.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$32.63
|
| Rate for Payer: Home State Health Plan Exchange |
$29.53
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$38.85
|
| Rate for Payer: Provider Network of America Commercial |
$41.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$51.80
|
|
|
cephalexin 250 mg/5 mL suspension for reconstitution 100 mL Bottle
|
Facility
|
IP
|
$51.80
|
|
|
Service Code
|
NDC 67877054588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$38.85
|
| Rate for Payer: Provider Network of America Commercial |
$41.44
|
|
|
cephalexin 500 mg capsule 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687016301
|
|
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
|
|
|
cephalexin 500 mg capsule 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687016301
|
|
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
|
|
|
cephalexin 500 mg capsule 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687016311
|
|
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
|
|
|
cephalexin 500 mg capsule 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687016311
|
|
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
|
|
|
certolizumab pegol 400 mg (200 mg x 2 vials) kit 1 Each KIT
|
Facility
|
IP
|
$25,197.60
|
|
|
Service Code
|
NDC 50474070062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,158.08 |
| 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 |
$25,197.60
|
| Rate for Payer: Cash Price |
$25,197.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,898.20
|
| Rate for Payer: Provider Network of America Commercial |
$20,158.08
|
|
|
certolizumab pegol 400 mg (200 mg x 2 vials) kit 1 Each KIT
|
Facility
|
OP
|
$25,197.60
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14,362.63 |
| Max. Negotiated Rate |
$25,197.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$17,764.31
|
| Rate for Payer: Aetna Workers' Compensation |
$17,764.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$17,461.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$17,461.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$19,402.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$19,855.71
|
| Rate for Payer: Cash Price |
$25,197.60
|
| Rate for Payer: Cigna Commercial |
$15,420.93
|
| Rate for Payer: Cigna Medicare Advantage |
$14,362.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15,874.49
|
| Rate for Payer: Home State Health Plan Exchange |
$14,362.63
|
| Rate for Payer: Humana Medicare |
$18,898.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,898.20
|
| Rate for Payer: Provider Network of America Commercial |
$20,158.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,630.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25,197.60
|
|
|
certolizumab pegol 400 mg (200 mg x 2 vials) kit 1 Each KIT
|
Facility
|
OP
|
$25,197.60
|
|
|
Service Code
|
NDC 50474070062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14,362.63 |
| Max. Negotiated Rate |
$25,197.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$17,764.31
|
| Rate for Payer: Aetna Workers' Compensation |
$17,764.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$17,461.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$17,461.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$19,855.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$19,402.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$19,855.71
|
| Rate for Payer: Cash Price |
$25,197.60
|
| Rate for Payer: Cigna Commercial |
$15,420.93
|
| Rate for Payer: Cigna Medicare Advantage |
$14,362.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15,874.49
|
| Rate for Payer: Home State Health Plan Exchange |
$14,362.63
|
| Rate for Payer: Humana Medicare |
$18,898.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,898.20
|
| Rate for Payer: Provider Network of America Commercial |
$20,158.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$16,630.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25,197.60
|
|
|
certolizumab pegol 400 mg (200 mg x 2 vials) kit 1 Each KIT
|
Facility
|
IP
|
$25,197.60
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,158.08 |
| 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 |
$25,197.60
|
| Rate for Payer: Cash Price |
$25,197.60
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18,898.20
|
| Rate for Payer: Provider Network of America Commercial |
$20,158.08
|
|
|
Certolizumab pegol inj 1mg
|
Facility
|
IP
|
$16,337.66
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
Px0636J071701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,070.13 |
| 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 |
$16,337.66
|
| Rate for Payer: Cash Price |
$16,337.66
|
| 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 |
$12,253.25
|
| Rate for Payer: Provider Network of America Commercial |
$13,070.13
|
|
|
Certolizumab pegol inj 1mg
|
Facility
|
OP
|
$16,337.66
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
Px0636J071701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,312.47 |
| Max. Negotiated Rate |
$16,337.66 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11,518.05
|
| Rate for Payer: Aetna Workers' Compensation |
$11,518.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11,322.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11,322.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12,874.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12,874.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12,874.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12,580.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12,874.08
|
| Rate for Payer: Cash Price |
$16,337.66
|
| Rate for Payer: Cigna Commercial |
$9,998.65
|
| Rate for Payer: Cigna Medicare Advantage |
$9,312.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10,292.73
|
| Rate for Payer: Home State Health Plan Exchange |
$9,312.47
|
| Rate for Payer: Humana Medicare |
$12,253.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12,253.25
|
| Rate for Payer: Provider Network of America Commercial |
$13,070.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,782.86
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16,337.66
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$13,846.67
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,846.67 |
| 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 |
$13,846.67
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$22,694.89
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,694.89 |
| 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 |
$22,694.89
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$11,474.11
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,474.11 |
| 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 |
$11,474.11
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$7,556.09
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,556.09 |
| 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 |
$7,556.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,556.09
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,556.09
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,556.09
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$26,260.96
|
|
|
Service Code
|
APR-DRG 5404
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,260.96 |
| 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 |
$26,260.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,260.96
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,260.96
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,260.96
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$5,911.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,911.37
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,911.37
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,911.37
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$11,622.13
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,622.13 |
| 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 |
$11,622.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,622.13
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,622.13
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,622.13
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$5,248.96
|
|
