|
Max Breathing Capacity Maximal Voluntary Ventj
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
Px00000094200
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$18.01 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$18.01
|
|
|
Measles Pcr
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
Px03068779835
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$246.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$217.14
|
| Rate for Payer: Aetna Workers' Compensation |
$217.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$213.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$213.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$242.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$242.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$242.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$242.70
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna Commercial |
$161.39
|
| Rate for Payer: Cigna Medicare Advantage |
$175.56
|
| Rate for Payer: Family Health Partners Medicaid |
$44.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$194.04
|
| Rate for Payer: Healthy Blue Medicaid |
$47.75
|
| Rate for Payer: Home State Health Plan Exchange |
$175.56
|
| Rate for Payer: Home State Health Plan Medicaid |
$44.21
|
| Rate for Payer: Humana Medicare |
$231.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$44.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$231.00
|
| Rate for Payer: Provider Network of America Commercial |
$246.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$203.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.29
|
|
|
Measles Pcr
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
Px03068779835
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$231.00 |
| 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 |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| 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 |
$231.00
|
| Rate for Payer: Provider Network of America Commercial |
$246.40
|
|
|
Meas Post-Voiding Residual Urine&/Bladder Cap
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
Px00000051798
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$13.78
|
|
|
Mechanical Chest Wall Oscillation Lung Function
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
Px04109466901
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$441.00 |
| 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 |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| 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 |
$441.00
|
| Rate for Payer: Provider Network of America Commercial |
$470.40
|
|
|
Mechanical Chest Wall Oscillation Lung Function
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
Px04109466901
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$414.54
|
| Rate for Payer: Aetna Workers' Compensation |
$414.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$407.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$407.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$463.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$463.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$463.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$452.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$463.34
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$359.86
|
| Rate for Payer: Cigna Medicare Advantage |
$335.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$370.44
|
| Rate for Payer: Home State Health Plan Exchange |
$335.16
|
| Rate for Payer: Humana Medicare |
$95.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Provider Network of America Commercial |
$470.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$388.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$588.00
|
|
|
Mechanical Chest Wall Oscillation Lung Function
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
Px00000094669
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$27.80 |
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.80
|
|
|
meclizine 25 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687073011
|
|
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
|
|
|
meclizine 25 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687073011
|
|
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
|
|
|
meclizine 25 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268052311
|
|
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
|
|
|
meclizine 25 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268052311
|
|
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
|
|
|
meclizine 25 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268052315
|
|
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
|
|
|
meclizine 25 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268052315
|
|
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
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$7,877.67
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,877.67 |
| 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 Freedom Network |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,910.00
|
| 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 |
$7,877.67
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,910.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,910.00
|
| 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 |
$4,518.11
|
|
|
medroxyPROGESTERone 150 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$137.56
|
|
|
Service Code
|
NDC 67457088799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.17 |
| 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 |
$137.56
|
| Rate for Payer: Cash Price |
$137.56
|
| 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 |
$103.17
|
| Rate for Payer: Provider Network of America Commercial |
$110.05
|
|
|
medroxyPROGESTERone 150 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$137.56
|
|
|
Service Code
|
NDC 67457088799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$137.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$96.98
|
| Rate for Payer: Aetna Workers' Compensation |
$96.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$105.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$108.40
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cigna Commercial |
$84.19
|
| Rate for Payer: Cigna Medicare Advantage |
$78.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$86.66
|
| Rate for Payer: Home State Health Plan Exchange |
$78.41
|
| Rate for Payer: Humana Medicare |
$103.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$103.17
|
| Rate for Payer: Provider Network of America Commercial |
$110.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.79
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$137.56
|
|
|
medroxyPROGESTERone 150 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$137.56
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$137.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$96.98
|
| Rate for Payer: Aetna Workers' Compensation |
$96.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$105.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$108.40
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cigna Commercial |
$84.19
|
| Rate for Payer: Cigna Medicare Advantage |
$78.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$86.66
|
| Rate for Payer: Home State Health Plan Exchange |
$78.41
|
| Rate for Payer: Humana Medicare |
$103.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$103.17
|
| Rate for Payer: Provider Network of America Commercial |
$110.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.79
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$137.56
|
|
|
medroxyPROGESTERone 150 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$137.56
|
|
|
Service Code
|
HCPCS J1050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.17 |
| 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 |
$137.56
|
| Rate for Payer: Cash Price |
$137.56
|
| 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 |
$103.17
|
| Rate for Payer: Provider Network of America Commercial |
$110.05
|
|
|
Medroxyprogesterone Acetate
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
Px0636J105001
|
|
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
|
|
|
Medroxyprogesterone Acetate
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
Px0636J105001
|
|
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
|
|
|
megestrol 400 mg/10 mL (10 mL) suspension 10 mL Cup
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 68094006359
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
megestrol 400 mg/10 mL (10 mL) suspension 10 mL Cup
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 68094006359
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
melatonin 5 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 77333052025
|
|
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
|
|
|
melatonin 5 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 77333052025
|
|
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
|
|
