|
cycloSPORINE 0.05 % dropperette 30 Each BLIST PACK
|
Facility
|
IP
|
$8.05
|
|
|
Service Code
|
NDC 00378876058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| 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 |
$8.05
|
| Rate for Payer: Cash Price |
$8.05
|
| 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 |
$6.04
|
| Rate for Payer: Provider Network of America Commercial |
$6.44
|
|
|
cycloSPORINE 0.05 % dropperette 30 Each BLIST PACK
|
Facility
|
OP
|
$8.05
|
|
|
Service Code
|
NDC 00378876058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.68
|
| Rate for Payer: Aetna Workers' Compensation |
$5.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.34
|
| Rate for Payer: Cash Price |
$8.05
|
| Rate for Payer: Cigna Commercial |
$4.93
|
| Rate for Payer: Cigna Medicare Advantage |
$4.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5.07
|
| Rate for Payer: Home State Health Plan Exchange |
$4.59
|
| Rate for Payer: Humana Medicare |
$6.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6.04
|
| Rate for Payer: Provider Network of America Commercial |
$6.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.31
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.05
|
|
|
cyproheptadine 4 mg tablet 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 70752010710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
cyproheptadine 4 mg tablet 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 70752010710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
cyproheptadine 4 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268018911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
cyproheptadine 4 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268018911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
cyproheptadine 4 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268018915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
cyproheptadine 4 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268018915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$18,245.38
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$18,245.38 |
| 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 |
$18,245.38
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$18,245.38
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$18,245.38
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$18,245.38
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$22,766.28
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,766.28 |
| 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 |
$22,766.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,766.28
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,766.28
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,766.28
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$26,876.69
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,876.69 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$26,876.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,876.69
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,876.69
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,876.69
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$10,946.30
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,946.30 |
| 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 |
$10,946.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,946.30
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,946.30
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,946.30
|
|
|
Cysto Bladder W/Ureteral Catheterization
|
Facility
|
IP
|
$3,832.50
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
Px03615200501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| 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 |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Medicare Advantage |
$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: Oscar Health EPO/HMO/POS/PPO |
$2,874.38
|
| Rate for Payer: Provider Network of America Commercial |
$3,066.00
|
|
|
Cysto Bladder W/Ureteral Catheterization
|
Facility
|
IP
|
$307.65
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
Px09835200501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$230.74 |
| 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 |
$293.00
|
| Rate for Payer: Cash Price |
$307.65
|
| Rate for Payer: Cash Price |
$307.65
|
| Rate for Payer: Cash Price |
$293.00
|
| 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 |
$230.74
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$219.75
|
| Rate for Payer: Provider Network of America Commercial |
$246.12
|
| Rate for Payer: Provider Network of America Commercial |
$234.40
|
|
|
Cysto Bladder W/Ureteral Catheterization
|
Facility
|
OP
|
$3,832.50
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
Px03615200501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,986.14 |
| Max. Negotiated Rate |
$3,832.50 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,655.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,655.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,020.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,020.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,020.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,951.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,020.01
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$2,540.95
|
| Rate for Payer: Cigna Medicare Advantage |
$2,184.53
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,414.47
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$2,184.53
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$2,874.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,874.38
|
| Rate for Payer: Provider Network of America Commercial |
$3,066.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,529.45
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,832.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Cysto Bladder W/Ureteral Catheterization
|
Facility
|
OP
|
$307.65
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
Px09835200501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.36 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$216.89
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$206.56
|
| Rate for Payer: Aetna Workers' Compensation |
$216.89
|
| Rate for Payer: Aetna Workers' Compensation |
$206.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$203.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$213.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$203.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$242.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$230.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$242.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$230.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$230.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$242.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$225.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$236.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$242.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$307.65
|
| Rate for Payer: Cash Price |
$307.65
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cash Price |
$293.00
|
| Rate for Payer: Cigna Commercial |
$188.28
|
| Rate for Payer: Cigna Commercial |
$179.32
|
| Rate for Payer: Cigna Medicare Advantage |
$167.01
|
| Rate for Payer: Cigna Medicare Advantage |
$175.36
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$193.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$184.59
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$175.36
|
| Rate for Payer: Home State Health Plan Exchange |
$167.01
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$219.75
|
| Rate for Payer: Humana Medicare |
$230.74
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$219.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$230.74
|
| Rate for Payer: Provider Network of America Commercial |
$234.40
|
| Rate for Payer: Provider Network of America Commercial |
$246.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$193.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$203.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$293.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$307.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Cysto Calibration Dilat Urtl Strix/Stenosis
|
Facility
|
IP
|
$4,410.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
Px07615228101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| 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 |
$3,307.50
|
| Rate for Payer: Provider Network of America Commercial |
$3,528.00
|
|
|
Cysto Calibration Dilat Urtl Strix/Stenosis
|
Facility
|
OP
|
$4,410.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
Px07615228101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,986.14 |
| Max. Negotiated Rate |
$4,410.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3,109.05
|
| Rate for Payer: Aetna Workers' Compensation |
$3,109.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,056.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,056.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,475.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,475.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,475.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,475.08
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cash Price |
$4,410.00
|
| Rate for Payer: Cigna Commercial |
$2,698.92
|
| Rate for Payer: Cigna Medicare Advantage |
$2,513.70
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,778.30
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$2,513.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$3,307.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,307.50
|
| Rate for Payer: Provider Network of America Commercial |
$3,528.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,910.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,410.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Cysto Calibration Dilat Urtl Strix/Stenosis
|
Facility
|
IP
|
$158.51
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
Px09835228101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$118.88 |
| 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 |
$150.96
|
| Rate for Payer: Cash Price |
$158.51
|
| Rate for Payer: Cash Price |
$158.51
|
| Rate for Payer: Cash Price |
$150.96
|
| 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 |
$118.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$113.22
|
| Rate for Payer: Provider Network of America Commercial |
$126.81
|
| Rate for Payer: Provider Network of America Commercial |
$120.77
|
|
|
Cysto Calibration Dilat Urtl Strix/Stenosis
|
Facility
|
OP
|
$158.51
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
Px09835228101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$111.75
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$106.43
|
| Rate for Payer: Aetna Workers' Compensation |
$111.75
|
| Rate for Payer: Aetna Workers' Compensation |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$109.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$109.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$124.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$124.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$124.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$116.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$122.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$124.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$118.96
|
| Rate for Payer: Cash Price |
$158.51
|
| Rate for Payer: Cash Price |
$158.51
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cigna Commercial |
$97.01
|
| Rate for Payer: Cigna Commercial |
$92.39
|
| Rate for Payer: Cigna Medicare Advantage |
$86.05
|
| Rate for Payer: Cigna Medicare Advantage |
$90.35
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$99.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$95.10
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$90.35
|
| Rate for Payer: Home State Health Plan Exchange |
$86.05
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$113.22
|
| Rate for Payer: Humana Medicare |
$118.88
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$113.22
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$118.88
|
| Rate for Payer: Provider Network of America Commercial |
$120.77
|
| Rate for Payer: Provider Network of America Commercial |
$126.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.62
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$150.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$158.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Cystography Minimum 3 Views Rs&I
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
Px09727443001
|
|
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
|
|
|
Cystography Minimum 3 Views Rs&I
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
Px09727443001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$475.51 |
| 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 |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| 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 |
$331.47
|
|
|
Cystourethroscopy W/Dil Bladder General Anesth
|
Facility
|
OP
|
$286.65
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
Px09835226001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$163.39 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$202.09
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$192.47
|
| Rate for Payer: Aetna Workers' Compensation |
$202.09
|
| Rate for Payer: Aetna Workers' Compensation |
$192.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$198.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$189.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$198.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$189.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$225.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$215.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$225.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$215.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$215.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$225.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$210.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$220.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$225.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$215.12
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$175.43
|
| Rate for Payer: Cigna Commercial |
$167.08
|
| Rate for Payer: Cigna Medicare Advantage |
$155.61
|
| Rate for Payer: Cigna Medicare Advantage |
$163.39
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Family Health Partners Medicaid |
$2,638.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$180.59
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$171.99
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Healthy Blue Medicaid |
$2,849.18
|
| Rate for Payer: Home State Health Plan Exchange |
$163.39
|
| Rate for Payer: Home State Health Plan Exchange |
$155.61
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,638.13
|
| Rate for Payer: Humana Medicare |
$204.75
|
| Rate for Payer: Humana Medicare |
$214.99
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,638.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$204.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$214.99
|
| Rate for Payer: Provider Network of America Commercial |
$218.40
|
| Rate for Payer: Provider Network of America Commercial |
$229.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$180.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$189.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$273.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$286.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,986.14
|
|
|
Cystourethroscopy W/Dil Bladder General Anesth
|
Facility
|
IP
|
$286.65
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
Px09835226001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$214.99 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$273.00
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$273.00
|
| 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 |
$214.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$204.75
|
| Rate for Payer: Provider Network of America Commercial |
$229.32
|
| Rate for Payer: Provider Network of America Commercial |
$218.40
|
|
|
Dacarbazine 100 mg inj
|
Facility
|
IP
|
$163.23
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
Px0636J913001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.42 |
| 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 |
$163.23
|
| Rate for Payer: Cash Price |
$163.23
|
| 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 |
$122.42
|
| Rate for Payer: Provider Network of America Commercial |
$130.58
|
|
