|
Tegaderm 4x4
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02720000060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
Tegaderm Clear Acryl Dressing 3 3/8" X 4 1/4"
|
Facility
|
IP
|
$8.35
|
|
| Hospital Charge Code |
Px02720000515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.26 |
| 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 |
$8.35
|
| Rate for Payer: Cash Price |
$8.35
|
| 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 |
$6.26
|
| Rate for Payer: Provider Network of America Commercial |
$6.68
|
|
|
Tegaderm Clear Acryl Dressing 3 3/8" X 4 1/4"
|
Facility
|
OP
|
$8.35
|
|
| Hospital Charge Code |
Px02720000515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.89
|
| Rate for Payer: Aetna Workers' Compensation |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.58
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cigna Commercial |
$5.11
|
| Rate for Payer: Cigna Medicare Advantage |
$4.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5.26
|
| Rate for Payer: Home State Health Plan Exchange |
$4.76
|
| Rate for Payer: Humana Medicare |
$6.26
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6.26
|
| Rate for Payer: Provider Network of America Commercial |
$6.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.35
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$6,988.43
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,988.43 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,988.43
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 558
|
| 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 |
$4,198.04
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$11,463.11
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,463.11 |
| 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 |
$11,463.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,463.11
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,463.11
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,463.11
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$14,934.68
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,934.68 |
| 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 |
$14,934.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,934.68
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,934.68
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,934.68
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$21,627.27
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$21,627.27 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$21,627.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$21,627.27
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$21,627.27
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21,627.27
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$35,614.32
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$35,614.32 |
| 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 |
$35,614.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$35,614.32
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$35,614.32
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$35,614.32
|
|
|
Tendon sheath incision (e.g., for trigger finger)
|
Facility
|
OP
|
$2,191.67
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.79 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Family Health Partners Medicaid |
$2,029.33
|
| Rate for Payer: Healthy Blue Medicaid |
$2,191.67
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,029.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,029.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,527.79
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242000901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19,485.29 |
| Max. Negotiated Rate |
$34,184.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24,100.23
|
| Rate for Payer: Aetna Workers' Compensation |
$24,100.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26,322.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,937.56
|
| Rate for Payer: Cash Price |
$34,184.72
|
| Rate for Payer: Cigna Commercial |
$20,921.05
|
| Rate for Payer: Cigna Medicare Advantage |
$19,485.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21,536.37
|
| Rate for Payer: Home State Health Plan Exchange |
$19,485.29
|
| Rate for Payer: Humana Medicare |
$25,638.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$22,561.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34,184.72
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242000901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,347.78 |
| 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 |
$34,184.72
|
| Rate for Payer: Cash Price |
$34,184.72
|
| 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 |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242001403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19,485.29 |
| Max. Negotiated Rate |
$34,184.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24,100.23
|
| Rate for Payer: Aetna Workers' Compensation |
$24,100.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26,322.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,937.56
|
| Rate for Payer: Cash Price |
$34,184.72
|
| Rate for Payer: Cigna Commercial |
$20,921.05
|
| Rate for Payer: Cigna Medicare Advantage |
$19,485.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21,536.37
|
| Rate for Payer: Home State Health Plan Exchange |
$19,485.29
|
| Rate for Payer: Humana Medicare |
$25,638.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$22,561.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34,184.72
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$34,184.72
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19,485.29 |
| Max. Negotiated Rate |
$34,184.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24,100.23
|
| Rate for Payer: Aetna Workers' Compensation |
$24,100.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26,322.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,937.56
|
| Rate for Payer: Cash Price |
$34,184.72
|
| Rate for Payer: Cigna Commercial |
$20,921.05
|
| Rate for Payer: Cigna Medicare Advantage |
$19,485.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21,536.37
|
| Rate for Payer: Home State Health Plan Exchange |
$19,485.29
|
| Rate for Payer: Humana Medicare |
$25,638.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$22,561.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34,184.72
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$34,184.72
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,347.78 |
| 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 |
$34,184.72
|
| Rate for Payer: Cash Price |
$34,184.72
|
| 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 |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
|
|
tenecteplase 25 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242001403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,347.78 |
| 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 |
$34,184.72
|
| Rate for Payer: Cash Price |
$34,184.72
|
| 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 |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
|
|
Tenecteplase injection
|
Facility
|
OP
|
$21,063.80
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
Px0636J310101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,006.37 |
| Max. Negotiated Rate |
$21,063.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$14,849.98
|
| Rate for Payer: Aetna Workers' Compensation |
$14,849.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$14,597.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$14,597.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$16,598.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$16,598.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$16,598.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16,219.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$16,598.27
|
| Rate for Payer: Cash Price |
$21,063.80
|
| Rate for Payer: Cigna Commercial |
$12,891.05
|
| Rate for Payer: Cigna Medicare Advantage |
$12,006.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13,270.19
|
| Rate for Payer: Home State Health Plan Exchange |
$12,006.37
|
| Rate for Payer: Humana Medicare |
$15,797.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$15,797.85
|
| Rate for Payer: Provider Network of America Commercial |
$16,851.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$13,902.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21,063.80
|
|
|
Tenecteplase injection
|
Facility
|
IP
|
$21,063.80
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
Px0636J310101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$16,851.04 |
| 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 |
$21,063.80
|
| Rate for Payer: Cash Price |
$21,063.80
|
| 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 |
$15,797.85
|
| Rate for Payer: Provider Network of America Commercial |
$16,851.04
|
|
|
tenecteplase per 1 mg
|
Facility
|
IP
|
$33,189.04
|
|
|
Service Code
|
NDC 50242012047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,551.23 |
| 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 |
$33,189.04
|
| Rate for Payer: Cash Price |
$33,189.04
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$24,891.78
|
| Rate for Payer: Provider Network of America Commercial |
$26,551.23
|
|
|
tenecteplase per 1 mg
|
Facility
|
IP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242017601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,347.78 |
| 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 |
$34,184.72
|
| Rate for Payer: Cash Price |
$34,184.72
|
| 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 |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
|
|
tenecteplase per 1 mg
|
Facility
|
OP
|
$33,189.04
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18,917.75 |
| Max. Negotiated Rate |
$33,189.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$23,398.27
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24,100.23
|
| Rate for Payer: Aetna Workers' Compensation |
$23,398.27
|
| Rate for Payer: Aetna Workers' Compensation |
$24,100.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,000.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,000.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$25,555.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26,322.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,152.96
|
| Rate for Payer: Cash Price |
$34,184.72
|
| Rate for Payer: Cash Price |
$33,189.04
|
| Rate for Payer: Cigna Commercial |
$20,311.69
|
| Rate for Payer: Cigna Commercial |
$20,921.05
|
| Rate for Payer: Cigna Medicare Advantage |
$18,917.75
|
| Rate for Payer: Cigna Medicare Advantage |
$19,485.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$20,909.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21,536.37
|
| Rate for Payer: Home State Health Plan Exchange |
$18,917.75
|
| Rate for Payer: Home State Health Plan Exchange |
$19,485.29
|
| Rate for Payer: Humana Medicare |
$24,891.78
|
| Rate for Payer: Humana Medicare |
$25,638.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$24,891.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$26,551.23
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$21,904.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$22,561.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$33,189.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34,184.72
|
|
|
tenecteplase per 1 mg
|
Facility
|
IP
|
$34,184.72
|
|
|
Service Code
|
HCPCS J3101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,347.78 |
| 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 |
$34,184.72
|
| Rate for Payer: Cash Price |
$33,189.04
|
| Rate for Payer: Cash Price |
$33,189.04
|
| Rate for Payer: Cash Price |
$34,184.72
|
| 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 |
$24,891.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$26,551.23
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
|
|
tenecteplase per 1 mg
|
Facility
|
OP
|
$34,184.72
|
|
|
Service Code
|
NDC 50242017601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19,485.29 |
| Max. Negotiated Rate |
$34,184.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24,100.23
|
| Rate for Payer: Aetna Workers' Compensation |
$24,100.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,937.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26,322.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,937.56
|
| Rate for Payer: Cash Price |
$34,184.72
|
| Rate for Payer: Cigna Commercial |
$20,921.05
|
| Rate for Payer: Cigna Medicare Advantage |
$19,485.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21,536.37
|
| Rate for Payer: Home State Health Plan Exchange |
$19,485.29
|
| Rate for Payer: Humana Medicare |
$25,638.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$25,638.54
|
| Rate for Payer: Provider Network of America Commercial |
$27,347.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$22,561.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34,184.72
|
|
|
tenecteplase per 1 mg
|
Facility
|
OP
|
$33,189.04
|
|
|
Service Code
|
NDC 50242012047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18,917.75 |
| Max. Negotiated Rate |
$33,189.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$23,398.27
|
| Rate for Payer: Aetna Workers' Compensation |
$23,398.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$23,000.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$23,000.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$26,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$25,555.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$26,152.96
|
| Rate for Payer: Cash Price |
$33,189.04
|
| Rate for Payer: Cigna Commercial |
$20,311.69
|
| Rate for Payer: Cigna Medicare Advantage |
$18,917.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$20,909.10
|
| Rate for Payer: Home State Health Plan Exchange |
$18,917.75
|
| Rate for Payer: Humana Medicare |
$24,891.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$24,891.78
|
| Rate for Payer: Provider Network of America Commercial |
$26,551.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$21,904.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$33,189.04
|
|
|
Tenotomy Percutaneous Toe Multiple Tendon
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
Px07612801101
|
|
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 |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,465.00
|
| 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 |
$2,598.75
|
| Rate for Payer: Provider Network of America Commercial |
$2,772.00
|
|
