|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$11,050.17
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,050.17 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$11,050.17
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,359.10
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,359.10 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,359.10
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$10,458.16
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,458.16 |
| 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 |
$10,458.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,458.16
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,458.16
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,458.16
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$20,499.36
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,499.36 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$20,499.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,499.36
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,499.36
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,499.36
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$14,782.13
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,782.13 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$14,782.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,782.13
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,782.13
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,782.13
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$37,040.85
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$37,040.85 |
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$37,040.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$37,040.85
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$37,040.85
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$37,040.85
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$7,561.83
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,561.83 |
| 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 |
$7,561.83
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$13,124.47
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,124.47 |
| 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 |
$13,124.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,124.47
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,124.47
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,124.47
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$8,675.69
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,675.69 |
| 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 |
$8,675.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,675.69
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,675.69
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,675.69
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$6,076.86
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,076.86 |
| 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: Family Health Partners Medicaid |
$6,076.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,076.86
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,076.86
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,076.86
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$30,578.47
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$30,578.47 |
| 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 |
$30,578.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$30,578.47
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$30,578.47
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$30,578.47
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$62.40
|
|
|
Service Code
|
NDC 00641618201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.80 |
| 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 |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| 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 |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$62.40
|
|
|
Service Code
|
NDC 00641618201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.99
|
| Rate for Payer: Aetna Workers' Compensation |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$49.17
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$38.19
|
| Rate for Payer: Cigna Medicare Advantage |
$35.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.31
|
| Rate for Payer: Home State Health Plan Exchange |
$35.57
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$62.40
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$62.40
|
|
|
Service Code
|
NDC 00641618210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cash Price |
$62.40
|
| 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 |
$62.40
|
| 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 |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J2360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.00 |
| 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 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 |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| 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 |
$36.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
| Rate for Payer: Provider Network of America Commercial |
$38.40
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$62.40
|
|
|
Service Code
|
NDC 00641618210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.99
|
| Rate for Payer: Aetna Workers' Compensation |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$49.17
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$38.19
|
| Rate for Payer: Cigna Medicare Advantage |
$35.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.31
|
| Rate for Payer: Home State Health Plan Exchange |
$35.57
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$62.40
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J2360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$33.84
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.99
|
| Rate for Payer: Aetna Workers' Compensation |
$33.84
|
| Rate for Payer: Aetna Workers' Compensation |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$33.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$33.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$49.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$37.82
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$29.38
|
| Rate for Payer: Cigna Commercial |
$38.19
|
| Rate for Payer: Cigna Medicare Advantage |
$27.36
|
| Rate for Payer: Cigna Medicare Advantage |
$35.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$30.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.31
|
| Rate for Payer: Home State Health Plan Exchange |
$27.36
|
| Rate for Payer: Home State Health Plan Exchange |
$35.57
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Humana Medicare |
$46.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Provider Network of America Commercial |
$38.40
|
| Rate for Payer: Provider Network of America Commercial |
$49.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$48.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$62.40
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
NDC 25021065102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$33.84
|
| Rate for Payer: Aetna Workers' Compensation |
$33.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$33.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$33.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$37.82
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$29.38
|
| Rate for Payer: Cigna Medicare Advantage |
$27.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$30.24
|
| Rate for Payer: Home State Health Plan Exchange |
$27.36
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Provider Network of America Commercial |
$38.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$48.00
|
|
|
orphenadrine 30 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
NDC 25021065102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.00 |
| 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 |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| 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 |
$36.00
|
| Rate for Payer: Provider Network of America Commercial |
$38.40
|
|
|
Orphenadrine Injection
|
Facility
|
IP
|
$42.24
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
Px0636J236001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.68 |
| 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 |
$42.24
|
| Rate for Payer: Cash Price |
$42.24
|
| 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 |
$31.68
|
| Rate for Payer: Provider Network of America Commercial |
$33.79
|
|
|
Orphenadrine Injection
|
Facility
|
OP
|
$42.24
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
Px0636J236001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$29.78
|
| Rate for Payer: Aetna Workers' Compensation |
$29.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$29.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$32.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$33.29
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cigna Commercial |
$25.85
|
| Rate for Payer: Cigna Medicare Advantage |
$24.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$26.61
|
| Rate for Payer: Home State Health Plan Exchange |
$24.08
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$31.68
|
| Rate for Payer: Provider Network of America Commercial |
$33.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$42.24
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$7,521.41
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,521.41 |
| 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 |
$7,521.41
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$13,570.78
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,570.78 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$13,570.78
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$7,089.48
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,089.48 |
| 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 |
$7,089.48
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$10,983.43
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,983.43 |
| 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 |
$10,983.43
|
|
