|
denosumab-nxxp 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$3,376.00
|
|
|
Service Code
|
NDC 78206019301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,924.32 |
| Max. Negotiated Rate |
$3,376.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,380.08
|
| Rate for Payer: Aetna Workers' Compensation |
$2,380.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,339.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,339.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,599.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,660.29
|
| Rate for Payer: Cash Price |
$3,376.00
|
| Rate for Payer: Cigna Commercial |
$2,066.11
|
| Rate for Payer: Cigna Medicare Advantage |
$1,924.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,126.88
|
| Rate for Payer: Home State Health Plan Exchange |
$1,924.32
|
| Rate for Payer: Humana Medicare |
$2,532.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,532.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,700.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,228.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,376.00
|
|
|
denosumab-nxxp 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$3,376.00
|
|
|
Service Code
|
NDC 78206019301
|
|
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 |
$3,376.00
|
| Rate for Payer: Cash Price |
$3,376.00
|
| 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 |
$2,532.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,700.80
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 158
|
| 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 |
$4,276.06
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$8,068.96
|
|
|
Service Code
|
MSDRG 157
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,068.96 |
| 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 |
$8,068.96
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 159
|
| 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 |
$3,329.95
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$10,787.29
|
|
|
Service Code
|
APR-DRG 1143
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,787.29 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$10,787.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,787.29
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,787.29
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,787.29
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$24,211.30
|
|
|
Service Code
|
APR-DRG 1144
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,211.30 |
| 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 |
$24,211.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$24,211.30
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$24,211.30
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$24,211.30
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,560.39
|
|
|
Service Code
|
APR-DRG 1142
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,560.39 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$6,560.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,560.39
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,560.39
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,560.39
|
|
|
DENTAL DISEASES AND DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 1141
|
| 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: Family Health Partners Medicaid |
$4,948.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,948.95
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,948.95
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,948.95
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$10,305.61
|
|
|
Service Code
|
APR-DRG 7513
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,305.61 |
| 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 |
$10,305.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,305.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,305.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,305.61
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7511
|
| 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: Family Health Partners Medicaid |
$3,785.91
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$3,785.91
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$3,785.91
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$3,785.91
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7512
|
| 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: Family Health Partners Medicaid |
$5,098.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,098.72
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,098.72
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,098.72
|
|
|
DEPRESSIVE DISORDERS
|
Facility
|
IP
|
$21,265.79
|
|
|
Service Code
|
APR-DRG 7514
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,265.79 |
| 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 |
$21,265.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,265.79
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,265.79
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,265.79
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 881
|
| 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 |
$4,422.23
|
|
|
Dermabrasion Superficial Any Site
|
Facility
|
OP
|
$446.78
|
|
|
Service Code
|
CPT 15783
|
| Hospital Charge Code |
Px09831578301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$446.78 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$314.98
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$299.98
|
| Rate for Payer: Aetna Workers' Compensation |
$299.98
|
| Rate for Payer: Aetna Workers' Compensation |
$314.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$294.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$309.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$294.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$309.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$352.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$335.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$335.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$352.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$352.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$335.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$344.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$327.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$335.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$352.06
|
| Rate for Payer: Cash Price |
$446.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$260.41
|
| Rate for Payer: Cigna Commercial |
$273.43
|
| Rate for Payer: Cigna Medicare Advantage |
$254.66
|
| Rate for Payer: Cigna Medicare Advantage |
$242.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$281.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$268.06
|
| Rate for Payer: Home State Health Plan Exchange |
$242.53
|
| Rate for Payer: Home State Health Plan Exchange |
$254.66
|
| Rate for Payer: Humana Medicare |
$335.08
|
| Rate for Payer: Humana Medicare |
$319.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$319.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$335.08
|
| Rate for Payer: Provider Network of America Commercial |
$357.42
|
| Rate for Payer: Provider Network of America Commercial |
$340.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$280.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$294.87
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$425.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$446.78
|
|
|
Dermabrasion Superficial Any Site
|
Facility
|
IP
|
$446.78
|
|
|
Service Code
|
CPT 15783
|
| Hospital Charge Code |
Px09831578301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$335.08 |
| 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 |
$446.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$446.78
|
| Rate for Payer: Cash Price |
$425.50
|
| 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 |
$335.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$319.12
|
| Rate for Payer: Provider Network of America Commercial |
$357.42
|
| Rate for Payer: Provider Network of America Commercial |
$340.40
|
|
|
desmopressin 0.1 mg tablet 100 Each Bottle
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 23155048901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.96
|
| Rate for Payer: Aetna Workers' Compensation |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$2.57
|
| Rate for Payer: Cigna Medicare Advantage |
$2.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.65
|
| Rate for Payer: Home State Health Plan Exchange |
$2.39
|
| Rate for Payer: Humana Medicare |
$3.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.15
|
| Rate for Payer: Provider Network of America Commercial |
$3.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.20
|
|
|
desmopressin 0.1 mg tablet 100 Each Bottle
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
NDC 23155048901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| 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 |
$3.15
|
| Rate for Payer: Provider Network of America Commercial |
$3.36
|
|
|
desmopressin 4 mcg/mL solution 10 mL Vial
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS J2597
|
|
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 |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| 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 |
$1,185.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,264.00
|
|
|
desmopressin 4 mcg/mL solution 10 mL Vial
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS J2597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$900.60 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,113.90
|
| Rate for Payer: Aetna Workers' Compensation |
$1,113.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,094.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,094.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,216.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,245.04
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$966.96
|
| Rate for Payer: Cigna Medicare Advantage |
$900.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$995.40
|
| Rate for Payer: Home State Health Plan Exchange |
$900.60
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,185.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,264.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,042.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,580.00
|
|
|
desmopressin 4 mcg/mL solution 10 mL Vial
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
NDC 69918090110
|
|
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 |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| 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 |
$1,185.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,264.00
|
|
|
desmopressin 4 mcg/mL solution 10 mL Vial
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
NDC 69918090110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$900.60 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,113.90
|
| Rate for Payer: Aetna Workers' Compensation |
$1,113.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,094.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,094.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,245.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,216.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,245.04
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$966.96
|
| Rate for Payer: Cigna Medicare Advantage |
$900.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$995.40
|
| Rate for Payer: Home State Health Plan Exchange |
$900.60
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,185.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,264.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,042.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,580.00
|
|
|
Destruct by Neuro Agent; Other Periph Nerve
|
Facility
|
IP
|
$2,768.33
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
Px07616464001
|
|
Hospital Revenue Code
|
761
|
| 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 |
$2,768.33
|
| Rate for Payer: Cash Price |
$2,768.33
|
| 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 |
$2,076.25
|
| Rate for Payer: Provider Network of America Commercial |
$2,214.66
|
|
|
Destruct by Neuro Agent; Other Periph Nerve
|
Facility
|
OP
|
$94.72
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
Px09836464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$1,205.53 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$66.78
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$63.60
|
| Rate for Payer: Aetna Workers' Compensation |
$66.78
|
| Rate for Payer: Aetna Workers' Compensation |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$65.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$62.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$65.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$62.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$69.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$72.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$74.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$71.09
|
| Rate for Payer: Cash Price |
$94.72
|
| Rate for Payer: Cash Price |
$94.72
|
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Cigna Commercial |
$57.97
|
| Rate for Payer: Cigna Commercial |
$55.21
|
| Rate for Payer: Cigna Medicare Advantage |
$51.42
|
| Rate for Payer: Cigna Medicare Advantage |
$53.99
|
| Rate for Payer: Family Health Partners Medicaid |
$1,116.23
|
| Rate for Payer: Family Health Partners Medicaid |
$1,116.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$59.67
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$56.83
|
| Rate for Payer: Healthy Blue Medicaid |
$1,205.53
|
| Rate for Payer: Healthy Blue Medicaid |
$1,205.53
|
| Rate for Payer: Home State Health Plan Exchange |
$53.99
|
| Rate for Payer: Home State Health Plan Exchange |
$51.42
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,116.23
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,116.23
|
| Rate for Payer: Humana Medicare |
$67.66
|
| Rate for Payer: Humana Medicare |
$71.04
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,116.23
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,116.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$67.66
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$71.04
|
| Rate for Payer: Provider Network of America Commercial |
$72.17
|
| Rate for Payer: Provider Network of America Commercial |
$75.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$62.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$90.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$94.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$840.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$840.36
|
|
|
Destruct by Neuro Agent; Other Periph Nerve
|
Facility
|
IP
|
$94.72
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
Px09836464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.04 |
| 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 |
$90.21
|
| Rate for Payer: Cash Price |
$94.72
|
| Rate for Payer: Cash Price |
$94.72
|
| Rate for Payer: Cash Price |
$90.21
|
| 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 |
$71.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$67.66
|
| Rate for Payer: Provider Network of America Commercial |
$75.78
|
| Rate for Payer: Provider Network of America Commercial |
$72.17
|
|
