|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$54,737.07
|
|
|
Service Code
|
APR-DRG 4044
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$54,737.07 |
| 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 |
$54,737.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$54,737.07
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$54,737.07
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$54,737.07
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$11,426.13
|
|
|
Service Code
|
APR-DRG 4041
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,426.13 |
| 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 |
$11,426.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,426.13
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,426.13
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,426.13
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$26,830.47
|
|
|
Service Code
|
APR-DRG 4043
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,830.47 |
| 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 |
$26,830.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,830.47
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,830.47
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,830.47
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$15,791.71
|
|
|
Service Code
|
APR-DRG 4042
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,791.71 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$15,791.71
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,791.71
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,791.71
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,791.71
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$7,047.18
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,047.18 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$7,047.18
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$14,194.47
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,194.47 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$14,194.47
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,243.01
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,243.01 |
| 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 |
$6,243.01
|
|
|
Thyroid Uptake Single/Multiple Quant Measurement
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
Px09727801201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.47 |
| 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 |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| 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 |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
|
|
Thyroid Uptake Single/Multiple Quant Measurement
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
Px09727801201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$544.89 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.08
|
| Rate for Payer: Aetna Workers' Compensation |
$100.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.86
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cigna Commercial |
$86.88
|
| Rate for Payer: Cigna Medicare Advantage |
$80.92
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.43
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$80.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$106.47
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$141.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
Px09727801401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.47 |
| 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 |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| 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 |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
|
|
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
Px09727801401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$544.89 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.08
|
| Rate for Payer: Aetna Workers' Compensation |
$100.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.86
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cigna Commercial |
$86.88
|
| Rate for Payer: Cigna Medicare Advantage |
$80.92
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.43
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$80.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$106.47
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$141.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
ticagrelor 90 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$30.98
|
|
|
Service Code
|
NDC 00186077739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$30.98 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.84
|
| Rate for Payer: Aetna Workers' Compensation |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$24.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$24.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$24.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$24.41
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cigna Commercial |
$18.96
|
| Rate for Payer: Cigna Medicare Advantage |
$17.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$19.52
|
| Rate for Payer: Home State Health Plan Exchange |
$17.66
|
| Rate for Payer: Humana Medicare |
$23.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$23.23
|
| Rate for Payer: Provider Network of America Commercial |
$24.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$20.45
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.98
|
|
|
ticagrelor 90 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$30.98
|
|
|
Service Code
|
NDC 00186077739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.23 |
| 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 |
$30.98
|
| Rate for Payer: Cash Price |
$30.98
|
| 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 |
$23.23
|
| Rate for Payer: Provider Network of America Commercial |
$24.78
|
|
|
timolol 0.5 % drops 5 mL DROP BTL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 61314022705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
timolol 0.5 % drops 5 mL DROP BTL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 61314022705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| 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 |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
tiZANidine 4 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084064511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
tiZANidine 4 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084064511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
Tnot Elbow Lateral/Medial Debride Open Tdn Rpr
|
Facility
|
IP
|
$6,987.75
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
Px03602435901
|
|
Hospital Revenue Code
|
360
|
| 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 |
$6,987.75
|
| Rate for Payer: Cash Price |
$6,987.75
|
| 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 |
$5,240.81
|
| Rate for Payer: Provider Network of America Commercial |
$5,590.20
|
|
|
Tnot Elbow Lateral/Medial Debride Open Tdn Rpr
|
Facility
|
OP
|
$6,987.75
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
Px03602435901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,108.82 |
| Max. Negotiated Rate |
$6,987.75 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,842.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,842.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,506.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,506.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,506.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,380.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,506.35
|
| Rate for Payer: Cash Price |
$6,987.75
|
| Rate for Payer: Cash Price |
$6,987.75
|
| Rate for Payer: Cigna Commercial |
$4,632.88
|
| Rate for Payer: Cigna Medicare Advantage |
$3,983.02
|
| Rate for Payer: Family Health Partners Medicaid |
$4,129.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,402.28
|
| Rate for Payer: Healthy Blue Medicaid |
$4,459.70
|
| Rate for Payer: Home State Health Plan Exchange |
$3,983.02
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,129.36
|
| Rate for Payer: Humana Medicare |
$5,240.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,129.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,240.81
|
| Rate for Payer: Provider Network of America Commercial |
$5,590.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,611.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,987.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,108.82
|
|
|
tobramycin 0.3 % drops 5 mL Bottle
|
Facility
|
OP
|
$61.96
|
|
|
Service Code
|
NDC 62332051805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$61.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.68
|
| Rate for Payer: Aetna Workers' Compensation |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$42.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$48.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$48.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$48.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$47.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$48.82
|
| Rate for Payer: Cash Price |
$61.96
|
| Rate for Payer: Cigna Commercial |
$37.92
|
| Rate for Payer: Cigna Medicare Advantage |
$35.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.03
|
| Rate for Payer: Home State Health Plan Exchange |
$35.32
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.47
|
| Rate for Payer: Provider Network of America Commercial |
$49.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$61.96
|
|
|
tobramycin 0.3 % drops 5 mL Bottle
|
Facility
|
IP
|
$61.96
|
|
|
Service Code
|
NDC 62332051805
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.47 |
| 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 |
$61.96
|
| Rate for Payer: Cash Price |
$61.96
|
| 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 |
$46.47
|
| Rate for Payer: Provider Network of America Commercial |
$49.57
|
|
|
tobramycin-dexamethasone 0.3-0.1 % drops,suspension 2.5 mL DROP BTL
|
Facility
|
OP
|
$151.72
|
|
|
Service Code
|
NDC 00574403125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$106.96
|
| Rate for Payer: Aetna Workers' Compensation |
$106.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$105.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$119.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$116.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$119.56
|
| Rate for Payer: Cash Price |
$151.72
|
| Rate for Payer: Cigna Commercial |
$92.85
|
| Rate for Payer: Cigna Medicare Advantage |
$86.48
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$95.58
|
| Rate for Payer: Home State Health Plan Exchange |
$86.48
|
| Rate for Payer: Humana Medicare |
$113.79
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$113.79
|
| Rate for Payer: Provider Network of America Commercial |
$121.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$151.72
|
|
|
tobramycin-dexamethasone 0.3-0.1 % drops,suspension 2.5 mL DROP BTL
|
Facility
|
IP
|
$151.72
|
|
|
Service Code
|
NDC 00574403125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.79 |
| 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 |
$151.72
|
| Rate for Payer: Cash Price |
$151.72
|
| 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 |
$113.79
|
| Rate for Payer: Provider Network of America Commercial |
$121.38
|
|
|
tobramycin-dexamethasone 0.3-0.1 % ointment 3.5 g Tube
|
Facility
|
OP
|
$1,310.40
|
|
|
Service Code
|
NDC 00078087601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$746.93 |
| Max. Negotiated Rate |
$1,310.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$923.83
|
| Rate for Payer: Aetna Workers' Compensation |
$923.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$908.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$908.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,032.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,032.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,032.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,009.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,032.60
|
| Rate for Payer: Cash Price |
$1,310.40
|
| Rate for Payer: Cigna Commercial |
$801.96
|
| Rate for Payer: Cigna Medicare Advantage |
$746.93
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$825.55
|
| Rate for Payer: Home State Health Plan Exchange |
$746.93
|
| Rate for Payer: Humana Medicare |
$982.80
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$982.80
|
| Rate for Payer: Provider Network of America Commercial |
$1,048.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$864.86
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,310.40
|
|
|
tobramycin-dexamethasone 0.3-0.1 % ointment 3.5 g Tube
|
Facility
|
IP
|
$1,310.40
|
|
|
Service Code
|
NDC 00078087601
|
|
Hospital Revenue Code
|
637
|
| 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 |
$1,310.40
|
| Rate for Payer: Cash Price |
$1,310.40
|
| 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 |
$982.80
|
| Rate for Payer: Provider Network of America Commercial |
$1,048.32
|
|
