|
pegfilgrastim-pbbk 6 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS Q5130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,000.00 |
| 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 |
$10,000.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| 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 |
$7,500.00
|
| Rate for Payer: Provider Network of America Commercial |
$8,000.00
|
|
|
pegfilgrastim-pbbk 6 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
NDC 70121162701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,000.00 |
| 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 |
$10,000.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| 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 |
$7,500.00
|
| Rate for Payer: Provider Network of America Commercial |
$8,000.00
|
|
|
pegfilgrastim-pbbk 6 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS Q5130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,700.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7,050.00
|
| Rate for Payer: Aetna Workers' Compensation |
$7,050.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$6,930.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$6,930.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$7,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$7,880.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$6,120.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6,300.00
|
| Rate for Payer: Home State Health Plan Exchange |
$5,700.00
|
| Rate for Payer: Humana Medicare |
$7,500.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,500.00
|
| Rate for Payer: Provider Network of America Commercial |
$8,000.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,600.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10,000.00
|
|
|
pegfilgrastim-pbbk 6 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
NDC 70121162701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,700.00 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7,050.00
|
| Rate for Payer: Aetna Workers' Compensation |
$7,050.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$6,930.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$6,930.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$7,880.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$7,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$7,880.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$6,120.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6,300.00
|
| Rate for Payer: Home State Health Plan Exchange |
$5,700.00
|
| Rate for Payer: Humana Medicare |
$7,500.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,500.00
|
| Rate for Payer: Provider Network of America Commercial |
$8,000.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,600.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10,000.00
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$10,011.00
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,011.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$10,011.00
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$6,323.85
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,323.85 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,323.85
|
|
|
Peng benzathine/procaine inj
|
Facility
|
OP
|
$573.54
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
Px0636J055801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$326.92 |
| Max. Negotiated Rate |
$573.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$404.35
|
| Rate for Payer: Aetna Workers' Compensation |
$404.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$397.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$397.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$451.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$451.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$451.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$441.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$451.95
|
| Rate for Payer: Cash Price |
$573.54
|
| Rate for Payer: Cigna Commercial |
$351.01
|
| Rate for Payer: Cigna Medicare Advantage |
$326.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$361.33
|
| Rate for Payer: Home State Health Plan Exchange |
$326.92
|
| Rate for Payer: Humana Medicare |
$430.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$430.15
|
| Rate for Payer: Provider Network of America Commercial |
$458.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$378.54
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$573.54
|
|
|
Peng benzathine/procaine inj
|
Facility
|
IP
|
$573.54
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
Px0636J055801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$430.15 |
| 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 |
$573.54
|
| Rate for Payer: Cash Price |
$573.54
|
| 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 |
$430.15
|
| Rate for Payer: Provider Network of America Commercial |
$458.83
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,623.76
|
|
|
Service Code
|
NDC 60793070102
|
|
Hospital Revenue Code
|
250
|
| 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 |
$1,623.76
|
| Rate for Payer: Cash Price |
$1,623.76
|
| 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 |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,623.76
|
|
|
Service Code
|
NDC 60793070110
|
|
Hospital Revenue Code
|
250
|
| 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 |
$1,623.76
|
| Rate for Payer: Cash Price |
$1,623.76
|
| 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 |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,623.76
|
|
|
Service Code
|
NDC 60793070102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$925.54 |
| Max. Negotiated Rate |
$1,623.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,144.75
|
| Rate for Payer: Aetna Workers' Compensation |
$1,144.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,250.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,279.52
|
| Rate for Payer: Cash Price |
$1,623.76
|
| Rate for Payer: Cigna Commercial |
$993.74
|
| Rate for Payer: Cigna Medicare Advantage |
$925.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,022.97
|
| Rate for Payer: Home State Health Plan Exchange |
$925.54
|
| Rate for Payer: Humana Medicare |
$1,217.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,071.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,623.76
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,623.76
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
250
|
| 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 |
$1,623.76
|
| Rate for Payer: Cash Price |
$1,623.76
|
| 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 |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,623.76
|
|
|
Service Code
|
HCPCS J0561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$925.54 |
| Max. Negotiated Rate |
$1,623.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,144.75
|
| Rate for Payer: Aetna Workers' Compensation |
$1,144.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,250.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,279.52
|
| Rate for Payer: Cash Price |
$1,623.76
|
| Rate for Payer: Cigna Commercial |
$993.74
|
| Rate for Payer: Cigna Medicare Advantage |
$925.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,022.97
|
| Rate for Payer: Home State Health Plan Exchange |
$925.54
|
| Rate for Payer: Humana Medicare |
$1,217.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,071.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,623.76
|
|
|
penicillin G benzathine 1,200,000 unit/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,623.76
|
|
|
Service Code
|
NDC 60793070110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$925.54 |
| Max. Negotiated Rate |
$1,623.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,144.75
|
| Rate for Payer: Aetna Workers' Compensation |
$1,144.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,125.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,279.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,250.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,279.52
|
| Rate for Payer: Cash Price |
$1,623.76
|
| Rate for Payer: Cigna Commercial |
$993.74
|
| Rate for Payer: Cigna Medicare Advantage |
$925.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,022.97
|
| Rate for Payer: Home State Health Plan Exchange |
$925.54
|
| Rate for Payer: Humana Medicare |
$1,217.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,217.82
|
| Rate for Payer: Provider Network of America Commercial |
$1,299.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,071.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,623.76
|
|
|
Penicillin g benzathine inj
|
Facility
|
IP
|
$719.51
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
Px0636J056101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$539.63 |
| 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 |
$719.51
|
| Rate for Payer: Cash Price |
$719.51
|
| 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 |
$539.63
|
| Rate for Payer: Provider Network of America Commercial |
$575.61
|
|
|
Penicillin g benzathine inj
|
Facility
|
OP
|
$719.51
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
Px0636J056101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$410.12 |
| Max. Negotiated Rate |
$719.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$507.25
|
| Rate for Payer: Aetna Workers' Compensation |
$507.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$498.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$498.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$566.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$566.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$566.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$554.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$566.97
|
| Rate for Payer: Cash Price |
$719.51
|
| Rate for Payer: Cigna Commercial |
$440.34
|
| Rate for Payer: Cigna Medicare Advantage |
$410.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$453.29
|
| Rate for Payer: Home State Health Plan Exchange |
$410.12
|
| Rate for Payer: Humana Medicare |
$539.63
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$539.63
|
| Rate for Payer: Provider Network of America Commercial |
$575.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$474.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$719.51
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$10,937.37
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,937.37 |
| 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 |
$10,937.37
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,585.64
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,585.64 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,585.64
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$40,771.29
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$40,771.29 |
| 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 |
$40,771.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$40,771.29
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$40,771.29
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$40,771.29
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$15,216.66
|
|
|
Service Code
|
APR-DRG 4832
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,216.66 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$15,216.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,216.66
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,216.66
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,216.66
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$22,047.00
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,047.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$22,047.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,047.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,047.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,047.00
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$10,601.46
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,601.46 |
| 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 |
$10,601.46
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,601.46
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,601.46
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,601.46
|
|
|
peppermint spirit spirit 30 mL Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 24385093291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
peppermint spirit spirit 30 mL Bottle
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00395224391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
peppermint spirit spirit 30 mL Bottle
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00395224391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
