|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J2704
|
|
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
|
|
|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J2704
|
|
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
|
|
|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00069020901
|
|
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
|
|
|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00069020901
|
|
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
|
|
|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 63323026929
|
|
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
|
|
|
propofol 10 mg/mL emulsion 20 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 63323026929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| 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 Individual Exchange |
$35.00
|
|
|
propranolol 10 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904655061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
propranolol 10 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904655061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
propranolol 10 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687058711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
propranolol 10 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687058711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
propranolol per 1 mg
|
Facility
|
IP
|
$52.32
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$52.32
|
| Rate for Payer: Cash Price |
$52.32
|
| 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 |
$39.24
|
| Rate for Payer: Provider Network of America Commercial |
$41.86
|
|
|
propranolol per 1 mg
|
Facility
|
OP
|
$52.32
|
|
|
Service Code
|
NDC 63323060401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$36.89
|
| Rate for Payer: Aetna Workers' Compensation |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$41.23
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Cigna Commercial |
$32.02
|
| Rate for Payer: Cigna Medicare Advantage |
$29.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$32.96
|
| Rate for Payer: Home State Health Plan Exchange |
$29.82
|
| Rate for Payer: Humana Medicare |
$39.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$39.24
|
| Rate for Payer: Provider Network of America Commercial |
$41.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$52.32
|
|
|
propranolol per 1 mg
|
Facility
|
OP
|
$52.32
|
|
|
Service Code
|
HCPCS J1800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$36.89
|
| Rate for Payer: Aetna Workers' Compensation |
$36.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$36.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$41.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$41.23
|
| Rate for Payer: Cash Price |
$52.32
|
| Rate for Payer: Cigna Commercial |
$32.02
|
| Rate for Payer: Cigna Medicare Advantage |
$29.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$32.96
|
| Rate for Payer: Home State Health Plan Exchange |
$29.82
|
| Rate for Payer: Humana Medicare |
$39.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$39.24
|
| Rate for Payer: Provider Network of America Commercial |
$41.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$52.32
|
|
|
propranolol per 1 mg
|
Facility
|
IP
|
$52.32
|
|
|
Service Code
|
NDC 63323060401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$52.32
|
| Rate for Payer: Cash Price |
$52.32
|
| 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 |
$39.24
|
| Rate for Payer: Provider Network of America Commercial |
$41.86
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$39,101.61
|
|
|
Service Code
|
APR-DRG 4854
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$39,101.61 |
| 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 |
$39,101.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$39,101.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$39,101.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$39,101.61
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$14,944.85
|
|
|
Service Code
|
APR-DRG 4851
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,944.85 |
| 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 |
$14,944.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,944.85
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,944.85
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,944.85
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$17,479.88
|
|
|
Service Code
|
APR-DRG 4852
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$17,479.88 |
| 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 |
$17,479.88
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$17,479.88
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$17,479.88
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17,479.88
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$27,768.85
|
|
|
Service Code
|
APR-DRG 4853
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,768.85 |
| 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 |
$27,768.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$27,768.85
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$27,768.85
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$27,768.85
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$8,221.71
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,221.71 |
| 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 |
$8,221.71
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$14,669.64
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,669.64 |
| 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 |
$14,669.64
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 667
|
| 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 |
$5,199.14
|
|
|
Prosthetic implant nos
|
Facility
|
OP
|
$3,770.55
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
Px0278L869901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,111.51 |
| Max. Negotiated Rate |
$3,770.55 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,111.51
|
| Rate for Payer: Aetna Workers' Compensation |
$2,111.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,612.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,612.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,971.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,971.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,971.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,903.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,971.19
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cigna Commercial |
$2,239.71
|
| Rate for Payer: Cigna Medicare Advantage |
$2,149.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,375.45
|
| Rate for Payer: Home State Health Plan Exchange |
$2,149.21
|
| Rate for Payer: Humana Medicare |
$2,827.91
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,827.91
|
| Rate for Payer: Provider Network of America Commercial |
$3,016.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,488.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,770.55
|
|
|
Prosthetic implant nos
|
Facility
|
IP
|
$3,770.55
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
Px0278L869901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,111.51
|
| Rate for Payer: Aetna Workers' Compensation |
$2,111.51
|
| 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 |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cigna Commercial |
$2,239.71
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,827.91
|
| Rate for Payer: Provider Network of America Commercial |
$3,016.44
|
|
|
protamine 10 mg/mL solution 25 mL Vial
|
Facility
|
OP
|
$241.24
|
|
|
Service Code
|
NDC 63323022930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.51 |
| Max. Negotiated Rate |
$241.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$170.07
|
| Rate for Payer: Aetna Workers' Compensation |
$170.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$190.10
|
| Rate for Payer: Cash Price |
$241.24
|
| Rate for Payer: Cigna Commercial |
$147.64
|
| Rate for Payer: Cigna Medicare Advantage |
$137.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$151.98
|
| Rate for Payer: Home State Health Plan Exchange |
$137.51
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$180.93
|
| Rate for Payer: Provider Network of America Commercial |
$192.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$241.24
|
|
|
protamine 10 mg/mL solution 25 mL Vial
|
Facility
|
OP
|
$241.24
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.51 |
| Max. Negotiated Rate |
$241.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$170.07
|
| Rate for Payer: Aetna Workers' Compensation |
$170.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$167.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$190.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$190.10
|
| Rate for Payer: Cash Price |
$241.24
|
| Rate for Payer: Cigna Commercial |
$147.64
|
| Rate for Payer: Cigna Medicare Advantage |
$137.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$151.98
|
| Rate for Payer: Home State Health Plan Exchange |
$137.51
|
| Rate for Payer: Humana Medicare |
$180.93
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$180.93
|
| Rate for Payer: Provider Network of America Commercial |
$192.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$241.24
|
|
