|
rabies immune globulin (PF) 300 unit/mL solution 3 mL Vial
|
Facility
|
IP
|
$8,329.32
|
|
|
Service Code
|
NDC 13533031803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,663.46 |
| 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 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 |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cash Price |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| 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 |
$6,246.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12,248.92
|
| Rate for Payer: Provider Network of America Commercial |
$6,663.46
|
| Rate for Payer: Provider Network of America Commercial |
$13,065.52
|
|
|
rabies immune globulin (PF) 300 unit/mL solution 3 mL Vial
|
Facility
|
OP
|
$8,329.32
|
|
|
Service Code
|
NDC 13533031803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,747.71 |
| Max. Negotiated Rate |
$8,329.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,872.17
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11,513.99
|
| Rate for Payer: Aetna Workers' Compensation |
$11,513.99
|
| Rate for Payer: Aetna Workers' Compensation |
$5,872.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11,318.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,772.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11,318.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,772.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,413.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12,575.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,563.50
|
| Rate for Payer: Cash Price |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cigna Commercial |
$9,995.12
|
| Rate for Payer: Cigna Commercial |
$5,097.54
|
| Rate for Payer: Cigna Medicare Advantage |
$4,747.71
|
| Rate for Payer: Cigna Medicare Advantage |
$9,309.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5,247.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10,289.10
|
| Rate for Payer: Home State Health Plan Exchange |
$9,309.18
|
| Rate for Payer: Home State Health Plan Exchange |
$4,747.71
|
| Rate for Payer: Humana Medicare |
$6,246.99
|
| Rate for Payer: Humana Medicare |
$12,248.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12,248.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6,246.99
|
| Rate for Payer: Provider Network of America Commercial |
$6,663.46
|
| Rate for Payer: Provider Network of America Commercial |
$13,065.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,779.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,497.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16,331.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8,329.32
|
|
|
rabies immune globulin (PF) 300 unit/mL solution 3 mL Vial
|
Facility
|
IP
|
$8,329.32
|
|
|
Service Code
|
CPT 90375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,663.46 |
| 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 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 |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cash Price |
$8,329.32
|
| 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: 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 |
$12,248.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6,246.99
|
| Rate for Payer: Provider Network of America Commercial |
$13,065.52
|
| Rate for Payer: Provider Network of America Commercial |
$6,663.46
|
|
|
rabies immune globulin (PF) 300 unit/mL solution 3 mL Vial
|
Facility
|
IP
|
$8,329.32
|
|
|
Service Code
|
NDC 13533031830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,663.46 |
| 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 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 |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cash Price |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| 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 |
$6,246.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12,248.92
|
| Rate for Payer: Provider Network of America Commercial |
$6,663.46
|
| Rate for Payer: Provider Network of America Commercial |
$13,065.52
|
|
|
rabies immune globulin (PF) 300 unit/mL solution 3 mL Vial
|
Facility
|
OP
|
$8,329.32
|
|
|
Service Code
|
NDC 13533031830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,747.71 |
| Max. Negotiated Rate |
$8,329.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,872.17
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11,513.99
|
| Rate for Payer: Aetna Workers' Compensation |
$11,513.99
|
| Rate for Payer: Aetna Workers' Compensation |
$5,872.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11,318.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,772.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11,318.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,772.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,413.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12,575.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12,869.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,563.50
|
| Rate for Payer: Cash Price |
$8,329.32
|
| Rate for Payer: Cash Price |
$16,331.90
|
| Rate for Payer: Cigna Commercial |
$9,995.12
|
| Rate for Payer: Cigna Commercial |
$5,097.54
|
| Rate for Payer: Cigna Medicare Advantage |
$4,747.71
|
| Rate for Payer: Cigna Medicare Advantage |
$9,309.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5,247.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10,289.10
|
| Rate for Payer: Home State Health Plan Exchange |
$9,309.18
|
| Rate for Payer: Home State Health Plan Exchange |
$4,747.71
|
| Rate for Payer: Humana Medicare |
$6,246.99
|
| Rate for Payer: Humana Medicare |
$12,248.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12,248.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6,246.99
|
| Rate for Payer: Provider Network of America Commercial |
$6,663.46
|
| Rate for Payer: Provider Network of America Commercial |
$13,065.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,779.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,497.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16,331.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8,329.32
|
|
|
rabies vaccine (from purified chicken embryo cells) 2.5 unit suspension for reconstitution 1 Each KIT
|
Facility
|
IP
|
$1,738.44
|
|
|
Service Code
|
CPT 90675
|
|
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 |
$1,738.44
|
| Rate for Payer: Cash Price |
$1,738.44
|
| 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 |
$1,303.83
|
| Rate for Payer: Provider Network of America Commercial |
$1,390.75
|
|
|
rabies vaccine (from purified chicken embryo cells) 2.5 unit suspension for reconstitution 1 Each KIT
|
Facility
|
OP
|
$1,738.44
|
|
|
Service Code
|
NDC 50632001001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$990.91 |
| Max. Negotiated Rate |
$1,738.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,225.60
|
| Rate for Payer: Aetna Workers' Compensation |
$1,225.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,204.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,204.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,338.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,369.89
|
| Rate for Payer: Cash Price |
$1,738.44
|
| Rate for Payer: Cigna Commercial |
$1,063.93
|
| Rate for Payer: Cigna Medicare Advantage |
$990.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,095.22
|
| Rate for Payer: Home State Health Plan Exchange |
$990.91
|
| Rate for Payer: Humana Medicare |
$1,303.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,303.83
|
| Rate for Payer: Provider Network of America Commercial |
$1,390.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,147.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,738.44
|
|
|
rabies vaccine (from purified chicken embryo cells) 2.5 unit suspension for reconstitution 1 Each KIT
|
Facility
|
IP
|
$1,738.44
|
|
|
Service Code
|
NDC 50632001001
|
|
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 |
$1,738.44
|
| Rate for Payer: Cash Price |
$1,738.44
|
| 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 |
$1,303.83
|
| Rate for Payer: Provider Network of America Commercial |
$1,390.75
|
|
|
rabies vaccine (from purified chicken embryo cells) 2.5 unit suspension for reconstitution 1 Each KIT
|
Facility
|
OP
|
$1,738.44
|
|
|
Service Code
|
CPT 90675
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$990.91 |
| Max. Negotiated Rate |
$1,738.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,225.60
|
| Rate for Payer: Aetna Workers' Compensation |
$1,225.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,204.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,204.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,369.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,338.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,369.89
|
| Rate for Payer: Cash Price |
$1,738.44
|
| Rate for Payer: Cigna Commercial |
$1,063.93
|
| Rate for Payer: Cigna Medicare Advantage |
$990.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,095.22
|
| Rate for Payer: Home State Health Plan Exchange |
$990.91
|
| Rate for Payer: Humana Medicare |
$1,303.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,303.83
|
| Rate for Payer: Provider Network of America Commercial |
$1,390.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,147.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,738.44
|
|
|
Rabies Vaccine, Im
|
Facility
|
OP
|
$842.50
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
Px06369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$480.23 |
| Max. Negotiated Rate |
$842.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$593.96
|
| Rate for Payer: Aetna Workers' Compensation |
$593.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$583.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$583.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$663.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$663.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$663.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$648.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$663.89
|
| Rate for Payer: Cash Price |
$842.50
|
| Rate for Payer: Cigna Commercial |
$515.61
|
| Rate for Payer: Cigna Medicare Advantage |
$480.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$530.77
|
| Rate for Payer: Home State Health Plan Exchange |
$480.23
|
| Rate for Payer: Humana Medicare |
$631.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$631.88
|
| Rate for Payer: Provider Network of America Commercial |
$674.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$556.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$842.50
|
|
|
Rabies Vaccine, Im
|
Facility
|
IP
|
$842.50
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
Px06369067501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$631.88 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$842.50
|
| Rate for Payer: Cash Price |
$842.50
|
| 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 |
$631.88
|
| Rate for Payer: Provider Network of America Commercial |
$674.00
|
|
|
racepinephrine 2.25 % solution for nebulization 1 Each Vial
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00487590199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.00 |
| 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 |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| 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 |
$6.00
|
| Rate for Payer: Provider Network of America Commercial |
$6.40
|
|
|
racepinephrine 2.25 % solution for nebulization 1 Each Vial
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00487590199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.64
|
| Rate for Payer: Aetna Workers' Compensation |
$5.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.30
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cigna Commercial |
$4.90
|
| Rate for Payer: Cigna Medicare Advantage |
$4.56
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5.04
|
| Rate for Payer: Home State Health Plan Exchange |
$4.56
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Provider Network of America Commercial |
$6.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.00
|
|
|
racepinephrine 2.25 % solution for nebulization 1 Each Vial
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.00 |
| 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 |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| 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 |
$6.00
|
| Rate for Payer: Provider Network of America Commercial |
$6.40
|
|
|
racepinephrine 2.25 % solution for nebulization 1 Each Vial
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.64
|
| Rate for Payer: Aetna Workers' Compensation |
$5.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.30
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cigna Commercial |
$4.90
|
| Rate for Payer: Cigna Medicare Advantage |
$4.56
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5.04
|
| Rate for Payer: Home State Health Plan Exchange |
$4.56
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Provider Network of America Commercial |
$6.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.00
|
|
|
Rad Exam Hip Uni 2-3 Views - Xr Hip 2 or 3 Vw Bilateral
|
Facility
|
IP
|
$393.75
|
|
|
Service Code
|
CPT 73502 50
|
| Hospital Charge Code |
Px03207350203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.31 |
| 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 |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| 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 |
$295.31
|
| Rate for Payer: Provider Network of America Commercial |
$315.00
|
|
|
Rad Exam Hip Uni 2-3 Views - Xr Hip 2 or 3 Vw Bilateral
|
Facility
|
OP
|
$393.75
|
|
|
Service Code
|
CPT 73502 50
|
| Hospital Charge Code |
Px03207350203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.69 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$277.59
|
| Rate for Payer: Aetna Workers' Compensation |
$277.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$272.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$272.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$310.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$310.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$310.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$303.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$310.27
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$240.97
|
| Rate for Payer: Cigna Medicare Advantage |
$224.44
|
| Rate for Payer: Family Health Partners Medicaid |
$109.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$248.06
|
| Rate for Payer: Healthy Blue Medicaid |
$118.62
|
| Rate for Payer: Home State Health Plan Exchange |
$224.44
|
| Rate for Payer: Home State Health Plan Medicaid |
$109.83
|
| Rate for Payer: Humana Medicare |
$295.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$109.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$295.31
|
| Rate for Payer: Provider Network of America Commercial |
$315.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$259.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$393.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.69
|
|
|
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw
|
Professional
|
Both
|
$259.70
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
Px00000072081
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$49.09 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Cash Price |
$259.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$49.09
|
|
|
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 2/3 Vw
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
Px09727208201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 2/3 Vw
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
Px09727208201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
Radex Facial Bones < 3 Views
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
Px00000070140
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$35.38
|
|
|
Radex Hip Arthrography Rs&I
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
Px09727352501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
Radex Hip Arthrography Rs&I
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
Px09727352501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
Radex Shoulder Arthrography Rs&I
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
Px09727304001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
Radex Shoulder Arthrography Rs&I
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
Px09727304001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
