|
piperacillin-tazobactam 3.375 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00781311390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$55.76
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.82 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| 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: 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: 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: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$44.61
|
| Rate for Payer: Provider Network of America Commercial |
$39.23
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00781311491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$49.04
|
|
|
Service Code
|
NDC 60505615900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.78 |
| 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 |
$49.04
|
| Rate for Payer: Cash Price |
$49.04
|
| 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 |
$36.78
|
| Rate for Payer: Provider Network of America Commercial |
$39.23
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00781311491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$55.76
|
|
|
Service Code
|
NDC 00409339011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$55.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$39.31
|
| Rate for Payer: Aetna Workers' Compensation |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$43.94
|
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Cigna Commercial |
$34.13
|
| Rate for Payer: Cigna Medicare Advantage |
$31.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$35.13
|
| Rate for Payer: Home State Health Plan Exchange |
$31.78
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Provider Network of America Commercial |
$44.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$55.76
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$55.76
|
|
|
Service Code
|
NDC 00409339011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.82 |
| 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 |
$55.76
|
| Rate for Payer: Cash Price |
$55.76
|
| 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 |
$41.82
|
| Rate for Payer: Provider Network of America Commercial |
$44.61
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$49.04
|
|
|
Service Code
|
NDC 60505615900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$49.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$34.57
|
| Rate for Payer: Aetna Workers' Compensation |
$34.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$37.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$38.64
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Commercial |
$30.01
|
| Rate for Payer: Cigna Medicare Advantage |
$27.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$30.90
|
| Rate for Payer: Home State Health Plan Exchange |
$27.95
|
| Rate for Payer: Humana Medicare |
$36.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.78
|
| Rate for Payer: Provider Network of America Commercial |
$39.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$49.04
|
|
|
piperacillin-tazobactam 4.5 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$34.57
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$39.31
|
| Rate for Payer: Aetna Workers' Compensation |
$34.57
|
| Rate for Payer: Aetna Workers' Compensation |
$39.31
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$33.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$38.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$37.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$43.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$38.64
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$55.76
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Commercial |
$30.01
|
| Rate for Payer: Cigna Commercial |
$34.13
|
| Rate for Payer: Cigna Medicare Advantage |
$27.95
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Cigna Medicare Advantage |
$31.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$30.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$35.13
|
| Rate for Payer: Home State Health Plan Exchange |
$27.95
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Home State Health Plan Exchange |
$31.78
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Humana Medicare |
$36.78
|
| Rate for Payer: Humana Medicare |
$41.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$36.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$39.23
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$44.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$49.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$55.76
|
|
|
Placement Needle Intraosseous Infusion
|
Facility
|
IP
|
$61.39
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
Px09833668001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$46.04 |
| 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 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 |
$58.47
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$58.47
|
| 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 |
$46.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.85
|
| Rate for Payer: Provider Network of America Commercial |
$49.11
|
| Rate for Payer: Provider Network of America Commercial |
$46.78
|
|
|
Placement Needle Intraosseous Infusion
|
Facility
|
OP
|
$61.39
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
Px09833668001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$608.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.28
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$41.22
|
| Rate for Payer: Aetna Workers' Compensation |
$43.28
|
| Rate for Payer: Aetna Workers' Compensation |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$42.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$45.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$47.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$46.07
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$58.47
|
| Rate for Payer: Cash Price |
$58.47
|
| Rate for Payer: Cigna Commercial |
$37.57
|
| Rate for Payer: Cigna Commercial |
$35.78
|
| Rate for Payer: Cigna Medicare Advantage |
$33.33
|
| Rate for Payer: Cigna Medicare Advantage |
$34.99
|
| Rate for Payer: Family Health Partners Medicaid |
$563.78
|
| Rate for Payer: Family Health Partners Medicaid |
$563.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$38.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.84
|
| Rate for Payer: Healthy Blue Medicaid |
$608.88
|
| Rate for Payer: Healthy Blue Medicaid |
$608.88
|
| Rate for Payer: Home State Health Plan Exchange |
$34.99
|
| Rate for Payer: Home State Health Plan Exchange |
$33.33
|
| Rate for Payer: Home State Health Plan Medicaid |
$563.78
|
| Rate for Payer: Home State Health Plan Medicaid |
$563.78
|
| Rate for Payer: Humana Medicare |
$43.85
|
| Rate for Payer: Humana Medicare |
$46.04
|
| Rate for Payer: Mercy CarePlus Medicaid |
$563.78
|
| Rate for Payer: Mercy CarePlus Medicaid |
$563.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.04
|
| Rate for Payer: Provider Network of America Commercial |
$46.78
|
| Rate for Payer: Provider Network of America Commercial |
$49.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$58.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$61.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$424.45
|
|
|
Plethysmography Lung Volumes W/WO Airway Resist
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
Px00000094726
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$70.33 |
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$70.33
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 187
|
| 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: 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 |
$4,648.77
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$7,324.95
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,324.95 |
| 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 |
$7,324.95
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 188
|
| 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: 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 |
$3,370.84
|
|
|
pneumococcal conjugate 20-valent 0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$1,265.64
|
|
|
Service Code
|
CPT 90677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$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: 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 |
$1,265.64
|
| Rate for Payer: Cash Price |
$1,265.64
|
| 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 |
$949.23
|
| Rate for Payer: Provider Network of America Commercial |
$1,012.51
|
|
|
pneumococcal conjugate 20-valent 0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$1,265.64
|
|
|
Service Code
|
CPT 90677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$1,265.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$892.28
|
| Rate for Payer: Aetna Workers' Compensation |
$892.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$974.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$997.32
|
| Rate for Payer: Cash Price |
$1,265.64
|
| Rate for Payer: Cash Price |
$1,265.64
|
| Rate for Payer: Cigna Commercial |
$774.57
|
| Rate for Payer: Cigna Medicare Advantage |
$721.41
|
| Rate for Payer: Family Health Partners Medicaid |
$11.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$797.35
|
| Rate for Payer: Healthy Blue Medicaid |
$12.20
|
| Rate for Payer: Home State Health Plan Exchange |
$721.41
|
| Rate for Payer: Home State Health Plan Medicaid |
$11.30
|
| Rate for Payer: Humana Medicare |
$949.23
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$949.23
|
| Rate for Payer: Provider Network of America Commercial |
$1,012.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$835.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,265.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.51
|
|
|
pneumococcal conjugate 20-valent 0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$1,265.64
|
|
|
Service Code
|
NDC 00005200002
|
|
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 |
$1,265.64
|
| Rate for Payer: Cash Price |
$1,265.64
|
| 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 |
$949.23
|
| Rate for Payer: Provider Network of America Commercial |
$1,012.51
|
|
|
pneumococcal conjugate 20-valent 0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$1,265.64
|
|
|
Service Code
|
NDC 00005200002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$721.41 |
| Max. Negotiated Rate |
$1,265.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$892.28
|
| Rate for Payer: Aetna Workers' Compensation |
$892.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$997.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$974.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$997.32
|
| Rate for Payer: Cash Price |
$1,265.64
|
| Rate for Payer: Cigna Commercial |
$774.57
|
| Rate for Payer: Cigna Medicare Advantage |
$721.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$797.35
|
| Rate for Payer: Home State Health Plan Exchange |
$721.41
|
| Rate for Payer: Humana Medicare |
$949.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$949.23
|
| Rate for Payer: Provider Network of America Commercial |
$1,012.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$835.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,265.64
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 200
|
| 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: 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 |
$5,166.71
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$8,291.27
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,291.27 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,291.27
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 201
|
| 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: 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 |
$3,360.97
|
|
|
Pnxr Aspir Hydrocele Tunica Vagis W/WO Njx Med
|
Facility
|
IP
|
$83.56
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
Px09835500001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$79.58
|
| Rate for Payer: Cash Price |
$83.56
|
| Rate for Payer: Cash Price |
$83.56
|
| Rate for Payer: Cash Price |
$79.58
|
| 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 |
$62.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.69
|
| Rate for Payer: Provider Network of America Commercial |
$66.85
|
| Rate for Payer: Provider Network of America Commercial |
$63.66
|
|
|
Pnxr Aspir Hydrocele Tunica Vagis W/WO Njx Med
|
Facility
|
OP
|
$83.56
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
Px09835500001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$58.91
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.10
|
| Rate for Payer: Aetna Workers' Compensation |
$58.91
|
| Rate for Payer: Aetna Workers' Compensation |
$56.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$65.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$65.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$65.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$64.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$65.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.71
|
| Rate for Payer: Cash Price |
$83.56
|
| Rate for Payer: Cash Price |
$83.56
|
| Rate for Payer: Cash Price |
$79.58
|
| Rate for Payer: Cash Price |
$79.58
|
| Rate for Payer: Cigna Commercial |
$51.14
|
| Rate for Payer: Cigna Commercial |
$48.70
|
| Rate for Payer: Cigna Medicare Advantage |
$45.36
|
| Rate for Payer: Cigna Medicare Advantage |
$47.63
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$52.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.14
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$47.63
|
| Rate for Payer: Home State Health Plan Exchange |
$45.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$59.69
|
| Rate for Payer: Humana Medicare |
$62.67
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$62.67
|
| Rate for Payer: Provider Network of America Commercial |
$63.66
|
| Rate for Payer: Provider Network of America Commercial |
$66.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$83.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$7,371.48
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,371.48 |
| 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 |
$7,371.48
|
|
