|
Nasal Cannula W/25' Tubing
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A4615
|
| Hospital Charge Code |
Px0270A461501
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Nasal Cannula W/7' Tubing
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
CPT A4615
|
| Hospital Charge Code |
Px0270A461502
|
|
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
|
|
|
Nasal Cannula W/7' Tubing
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
CPT A4615
|
| Hospital Charge Code |
Px0270A461502
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Nasal Endoscopy Diagnostic Uni/Bi Spx
|
Facility
|
IP
|
$384.30
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
Px05103123101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.44 |
| 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 |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| 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: Provider Network of America Commercial |
$307.44
|
|
|
Nasal Endoscopy Diagnostic Uni/Bi Spx
|
Facility
|
OP
|
$384.30
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
Px05103123101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.65 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$270.93
|
| Rate for Payer: Aetna Workers' Compensation |
$270.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$266.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$266.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$302.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$302.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$302.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$295.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$302.83
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Medicare Advantage |
$219.05
|
| Rate for Payer: Family Health Partners Medicaid |
$251.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$242.11
|
| Rate for Payer: Healthy Blue Medicaid |
$272.05
|
| Rate for Payer: Home State Health Plan Exchange |
$219.05
|
| Rate for Payer: Home State Health Plan Medicaid |
$251.90
|
| Rate for Payer: Humana Medicare |
$288.23
|
| Rate for Payer: Mercy CarePlus Medicaid |
$251.90
|
| Rate for Payer: Provider Network of America Commercial |
$307.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$253.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$384.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$189.65
|
|
|
Nasal/Sinus Ndsc Surg W/Dilation Frontal Sinus
|
Facility
|
OP
|
$201.65
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
Px09833129601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$9,619.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$142.16
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$135.40
|
| Rate for Payer: Aetna Workers' Compensation |
$142.16
|
| Rate for Payer: Aetna Workers' Compensation |
$135.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$139.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$133.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$139.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$133.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$151.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$147.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$155.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$151.34
|
| Rate for Payer: Cash Price |
$201.65
|
| Rate for Payer: Cash Price |
$201.65
|
| Rate for Payer: Cash Price |
$192.05
|
| Rate for Payer: Cash Price |
$192.05
|
| Rate for Payer: Cigna Commercial |
$123.41
|
| Rate for Payer: Cigna Commercial |
$117.53
|
| Rate for Payer: Cigna Medicare Advantage |
$109.47
|
| Rate for Payer: Cigna Medicare Advantage |
$114.94
|
| Rate for Payer: Family Health Partners Medicaid |
$8,906.72
|
| Rate for Payer: Family Health Partners Medicaid |
$8,906.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$120.99
|
| Rate for Payer: Healthy Blue Medicaid |
$9,619.25
|
| Rate for Payer: Healthy Blue Medicaid |
$9,619.25
|
| Rate for Payer: Home State Health Plan Exchange |
$114.94
|
| Rate for Payer: Home State Health Plan Exchange |
$109.47
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,906.72
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,906.72
|
| Rate for Payer: Humana Medicare |
$144.04
|
| Rate for Payer: Humana Medicare |
$151.24
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,906.72
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,906.72
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$144.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$151.24
|
| Rate for Payer: Provider Network of America Commercial |
$153.64
|
| Rate for Payer: Provider Network of America Commercial |
$161.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$126.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$133.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$192.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$201.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,705.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,705.48
|
|
|
Nasal/Sinus Ndsc Surg W/Dilation Frontal Sinus
|
Facility
|
IP
|
$201.65
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
Px09833129601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.24 |
| 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 |
$192.05
|
| Rate for Payer: Cash Price |
$201.65
|
| Rate for Payer: Cash Price |
$201.65
|
| Rate for Payer: Cash Price |
$192.05
|
| 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 |
$151.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$144.04
|
| Rate for Payer: Provider Network of America Commercial |
$161.32
|
| Rate for Payer: Provider Network of America Commercial |
$153.64
|
|
|
Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus
|
Facility
|
IP
|
$167.98
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
Px09833129501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$125.98 |
| 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 |
$159.98
|
| Rate for Payer: Cash Price |
$167.98
|
| Rate for Payer: Cash Price |
$167.98
|
| Rate for Payer: Cash Price |
$159.98
|
| 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 |
$125.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$119.98
|
| Rate for Payer: Provider Network of America Commercial |
$134.38
|
| Rate for Payer: Provider Network of America Commercial |
$127.98
|
|
|
Nasal/Sinus Ndsc Surg W/Dilation Maxillary Sinus
|
Facility
|
OP
|
$167.98
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
Px09833129501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$9,619.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$118.43
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$112.79
|
| Rate for Payer: Aetna Workers' Compensation |
$118.43
|
| Rate for Payer: Aetna Workers' Compensation |
$112.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$110.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$116.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$110.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$126.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$126.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$126.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$123.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$129.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$126.06
|
| Rate for Payer: Cash Price |
$167.98
|
| Rate for Payer: Cash Price |
$167.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cigna Commercial |
$102.80
|
| Rate for Payer: Cigna Commercial |
$97.91
|
| Rate for Payer: Cigna Medicare Advantage |
$91.19
|
| Rate for Payer: Cigna Medicare Advantage |
$95.75
|
| Rate for Payer: Family Health Partners Medicaid |
$8,906.72
|
| Rate for Payer: Family Health Partners Medicaid |
$8,906.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$105.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$100.79
|
| Rate for Payer: Healthy Blue Medicaid |
$9,619.25
|
| Rate for Payer: Healthy Blue Medicaid |
$9,619.25
|
| Rate for Payer: Home State Health Plan Exchange |
$95.75
|
| Rate for Payer: Home State Health Plan Exchange |
$91.19
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,906.72
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,906.72
|
| Rate for Payer: Humana Medicare |
$119.98
|
| Rate for Payer: Humana Medicare |
$125.98
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,906.72
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,906.72
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$119.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$125.98
|
| Rate for Payer: Provider Network of America Commercial |
$127.98
|
| Rate for Payer: Provider Network of America Commercial |
$134.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.87
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$159.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$167.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,705.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,705.48
|
|
|
neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 16571075453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.09 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$112.66
|
| Rate for Payer: Aetna Workers' Compensation |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$110.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$125.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$125.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$125.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$123.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$125.92
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cigna Commercial |
$97.80
|
| Rate for Payer: Cigna Medicare Advantage |
$91.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$100.67
|
| Rate for Payer: Home State Health Plan Exchange |
$91.09
|
| Rate for Payer: Humana Medicare |
$119.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$119.85
|
| Rate for Payer: Provider Network of America Commercial |
$127.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$105.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$159.80
|
|
|
neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube
|
Facility
|
IP
|
$182.28
|
|
|
Service Code
|
NDC 24208078055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.71 |
| 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 |
$182.28
|
| Rate for Payer: Cash Price |
$182.28
|
| 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 |
$136.71
|
| Rate for Payer: Provider Network of America Commercial |
$145.82
|
|
|
neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube
|
Facility
|
OP
|
$182.28
|
|
|
Service Code
|
NDC 24208078055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.90 |
| Max. Negotiated Rate |
$182.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$128.51
|
| Rate for Payer: Aetna Workers' Compensation |
$128.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$126.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$143.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$143.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$143.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$140.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$143.64
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cigna Commercial |
$111.56
|
| Rate for Payer: Cigna Medicare Advantage |
$103.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$114.84
|
| Rate for Payer: Home State Health Plan Exchange |
$103.90
|
| Rate for Payer: Humana Medicare |
$136.71
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$136.71
|
| Rate for Payer: Provider Network of America Commercial |
$145.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.30
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$182.28
|
|
|
neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 16571075453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.85 |
| 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 |
$159.80
|
| Rate for Payer: Cash Price |
$159.80
|
| 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 |
$119.85
|
| Rate for Payer: Provider Network of America Commercial |
$127.84
|
|
|
neomycin-bacitracnZn-polymyxnB 3.5-400-5,000 mg-unit-unit ointment in packet 144 Each Packet
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 45802014370
|
|
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
|
|
|
neomycin-bacitracnZn-polymyxnB 3.5-400-5,000 mg-unit-unit ointment in packet 144 Each Packet
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 45802014370
|
|
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
|
|
|
neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 28 g Tube
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 45802014303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 28 g Tube
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 45802014303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
neomycin-polymyxin-dexAMETHasone 3.5mg/mL-10,000 unit/mL-0.1 % drops,suspension 5 mL DROP BTL
|
Facility
|
IP
|
$63.56
|
|
|
Service Code
|
NDC 24208083060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.67 |
| 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 |
$63.56
|
| Rate for Payer: Cash Price |
$63.56
|
| 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 |
$47.67
|
| Rate for Payer: Provider Network of America Commercial |
$50.85
|
|
|
neomycin-polymyxin-dexAMETHasone 3.5mg/mL-10,000 unit/mL-0.1 % drops,suspension 5 mL DROP BTL
|
Facility
|
OP
|
$63.56
|
|
|
Service Code
|
NDC 24208083060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$44.81
|
| Rate for Payer: Aetna Workers' Compensation |
$44.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.09
|
| Rate for Payer: Cash Price |
$63.56
|
| Rate for Payer: Cigna Commercial |
$38.90
|
| Rate for Payer: Cigna Medicare Advantage |
$36.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.04
|
| Rate for Payer: Home State Health Plan Exchange |
$36.23
|
| Rate for Payer: Humana Medicare |
$47.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$47.67
|
| Rate for Payer: Provider Network of America Commercial |
$50.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.95
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$63.56
|
|
|
neomycin-polymyxin-gramicidin 1.75 mg-10,000 unit-0.025mg/mL drops 10 mL DROP BTL
|
Facility
|
IP
|
$204.20
|
|
|
Service Code
|
NDC 24208079062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.15 |
| 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 |
$204.20
|
| Rate for Payer: Cash Price |
$204.20
|
| 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 |
$153.15
|
| Rate for Payer: Provider Network of America Commercial |
$163.36
|
|
|
neomycin-polymyxin-gramicidin 1.75 mg-10,000 unit-0.025mg/mL drops 10 mL DROP BTL
|
Facility
|
OP
|
$204.20
|
|
|
Service Code
|
NDC 24208079062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$204.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$143.96
|
| Rate for Payer: Aetna Workers' Compensation |
$143.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$141.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$141.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$160.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$160.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$160.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$157.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$160.91
|
| Rate for Payer: Cash Price |
$204.20
|
| Rate for Payer: Cigna Commercial |
$124.97
|
| Rate for Payer: Cigna Medicare Advantage |
$116.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$128.65
|
| Rate for Payer: Home State Health Plan Exchange |
$116.39
|
| Rate for Payer: Humana Medicare |
$153.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$153.15
|
| Rate for Payer: Provider Network of America Commercial |
$163.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$134.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$204.20
|
|
|
neomycin-polymyxin-HC 3.5-10,000-1 mg/mL-unit/mL-% drops,suspension 10 mL DROP BTL
|
Facility
|
OP
|
$335.60
|
|
|
Service Code
|
NDC 24208063562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.29 |
| Max. Negotiated Rate |
$335.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$236.60
|
| Rate for Payer: Aetna Workers' Compensation |
$236.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$232.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$232.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$264.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$264.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$264.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$258.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$264.45
|
| Rate for Payer: Cash Price |
$335.60
|
| Rate for Payer: Cigna Commercial |
$205.39
|
| Rate for Payer: Cigna Medicare Advantage |
$191.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$211.43
|
| Rate for Payer: Home State Health Plan Exchange |
$191.29
|
| Rate for Payer: Humana Medicare |
$251.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$251.70
|
| Rate for Payer: Provider Network of America Commercial |
$268.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$221.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$335.60
|
|
|
neomycin-polymyxin-HC 3.5-10,000-1 mg/mL-unit/mL-% drops,suspension 10 mL DROP BTL
|
Facility
|
IP
|
$335.60
|
|
|
Service Code
|
NDC 24208063562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.70 |
| 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 |
$335.60
|
| Rate for Payer: Cash Price |
$335.60
|
| 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 |
$251.70
|
| Rate for Payer: Provider Network of America Commercial |
$268.48
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$102,984.94
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$102,984.94 |
| 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 |
$102,984.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$102,984.94
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$102,984.94
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$102,984.94
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$12,906.29
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,906.29 |
| 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 |
$12,906.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,906.29
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,906.29
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,906.29
|
|
