|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$9,316.38
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,316.38 |
| 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 |
$9,316.38
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,316.38
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,316.38
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,316.38
|
|
|
Myelography Cervical Rs&I
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
Px09727224001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$1,068.47 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$989.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$1,068.47
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$989.32
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$989.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$744.82
|
|
|
Myelography Cervical Rs&I
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
Px09727224001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
Myelography via Lumbar Inject Rs&I Lumbosacral
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
Px09726230401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$1,068.47 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$989.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$1,068.47
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$989.32
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$989.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$744.82
|
|
|
Myelography via Lumbar Inject Rs&I Lumbosacral
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
Px09726230401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$10,862.64
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,862.64 |
| 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 |
$10,862.64
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$21,985.66
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,985.66 |
| 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 |
$21,985.66
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$8,007.86
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,007.86 |
| 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 |
$8,007.86
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$14,852.00
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,852.00 |
| 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 |
$14,852.00
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$7,073.50
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,073.50 |
| 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 |
$7,073.50
|
|
|
Myringotomy Aspir&/Eustachian Tube Nfltj Anes
|
Facility
|
OP
|
$161.74
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
Px09836942101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.19 |
| Max. Negotiated Rate |
$4,518.94 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$114.03
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$108.60
|
| Rate for Payer: Aetna Workers' Compensation |
$114.03
|
| Rate for Payer: Aetna Workers' Compensation |
$108.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$112.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$106.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$112.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$106.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$127.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$127.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$121.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$127.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$118.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$124.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$127.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$121.38
|
| Rate for Payer: Cash Price |
$161.74
|
| Rate for Payer: Cash Price |
$161.74
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cash Price |
$154.04
|
| Rate for Payer: Cigna Commercial |
$98.98
|
| Rate for Payer: Cigna Commercial |
$94.27
|
| Rate for Payer: Cigna Medicare Advantage |
$87.80
|
| Rate for Payer: Cigna Medicare Advantage |
$92.19
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Family Health Partners Medicaid |
$4,184.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$101.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$97.05
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Healthy Blue Medicaid |
$4,518.94
|
| Rate for Payer: Home State Health Plan Exchange |
$92.19
|
| Rate for Payer: Home State Health Plan Exchange |
$87.80
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,184.21
|
| Rate for Payer: Humana Medicare |
$115.53
|
| Rate for Payer: Humana Medicare |
$121.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,184.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$115.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$121.31
|
| Rate for Payer: Provider Network of America Commercial |
$123.23
|
| Rate for Payer: Provider Network of America Commercial |
$129.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$106.75
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$154.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$161.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,150.11
|
|
|
Myringotomy Aspir&/Eustachian Tube Nfltj Anes
|
Facility
|
IP
|
$161.74
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
Px09836942101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.31 |
| 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 |
$154.04
|
| Rate for Payer: Cash Price |
$161.74
|
| Rate for Payer: Cash Price |
$161.74
|
| Rate for Payer: Cash Price |
$154.04
|
| 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 |
$121.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$115.53
|
| Rate for Payer: Provider Network of America Commercial |
$129.39
|
| Rate for Payer: Provider Network of America Commercial |
$123.23
|
|
|
naloxone 0.4 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
NDC 67457029200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.00 |
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| 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 |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
|
|
naloxone 0.4 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
NDC 67457029200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.20
|
| Rate for Payer: Aetna Workers' Compensation |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: Cigna Medicare Advantage |
$22.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.20
|
| Rate for Payer: Home State Health Plan Exchange |
$22.80
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.00
|
|
|
naloxone 0.4 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.00 |
| 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 |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| 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 |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
|
|
naloxone 0.4 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$28.20
|
| Rate for Payer: Aetna Workers' Compensation |
$28.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$31.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$30.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$24.48
|
| Rate for Payer: Cigna Medicare Advantage |
$22.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$25.20
|
| Rate for Payer: Home State Health Plan Exchange |
$22.80
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Provider Network of America Commercial |
$32.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$26.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$40.00
|
|
|
naloxone 1 mg/mL syringe 2 mL Syringe
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 55150034501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| 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 |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
|
|
naloxone 1 mg/mL syringe 2 mL Syringe
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 55150034501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.83
|
| Rate for Payer: Aetna Workers' Compensation |
$88.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.29
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Cigna Medicare Advantage |
$71.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.38
|
| Rate for Payer: Home State Health Plan Exchange |
$71.82
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$126.00
|
|
|
naloxone 1 mg/mL syringe 2 mL Syringe
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| 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 |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
|
|
naloxone 1 mg/mL syringe 2 mL Syringe
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.83
|
| Rate for Payer: Aetna Workers' Compensation |
$88.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.29
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$77.11
|
| Rate for Payer: Cigna Medicare Advantage |
$71.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.38
|
| Rate for Payer: Home State Health Plan Exchange |
$71.82
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$126.00
|
|
|
naproxen 500 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 63739040310
|
|
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
|
|
|
naproxen 500 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 63739040310
|
|
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
|
|
|
naproxen 500 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687049111
|
|
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
|
|
|
naproxen 500 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687049111
|
|
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
|
|
|
Nasal Cannula W/25' Tubing
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A4615
|
| Hospital Charge Code |
Px0270A461501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| 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 |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
