|
vancomycin-diluent combo no.1 750 mg/150 mL piggyback 150 mL Bag
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 70594005601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 00143947101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 00143947112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 00143947112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 00143947101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
vancomycin-diluent no.2 (NADA) 500 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
Vancomycin hcl injection
|
Facility
|
IP
|
$209.98
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
Px0636J337001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.49 |
| 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 |
$209.98
|
| Rate for Payer: Cash Price |
$209.98
|
| 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 |
$157.49
|
| Rate for Payer: Provider Network of America Commercial |
$167.98
|
|
|
Vancomycin hcl injection
|
Facility
|
OP
|
$209.98
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
Px0636J337001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.69 |
| Max. Negotiated Rate |
$209.98 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$148.04
|
| Rate for Payer: Aetna Workers' Compensation |
$148.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$145.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$145.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$165.46
|
| Rate for Payer: Cash Price |
$209.98
|
| Rate for Payer: Cigna Commercial |
$128.51
|
| Rate for Payer: Cigna Medicare Advantage |
$119.69
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$132.29
|
| Rate for Payer: Home State Health Plan Exchange |
$119.69
|
| Rate for Payer: Humana Medicare |
$157.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$157.49
|
| Rate for Payer: Provider Network of America Commercial |
$167.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$138.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$209.98
|
|
|
vancomycin per 500
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
NDC 70594005701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.00 |
| 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 |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| 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 |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
|
|
vancomycin per 500
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
NDC 70594005702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.58
|
| Rate for Payer: Aetna Workers' Compensation |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.89
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$46.51
|
| Rate for Payer: Cigna Medicare Advantage |
$43.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.88
|
| Rate for Payer: Home State Health Plan Exchange |
$43.32
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.00
|
|
|
vancomycin per 500
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.58
|
| Rate for Payer: Aetna Workers' Compensation |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.89
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$46.51
|
| Rate for Payer: Cigna Medicare Advantage |
$43.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.88
|
| Rate for Payer: Home State Health Plan Exchange |
$43.32
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.00
|
|
|
vancomycin per 500
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
NDC 70594005702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.00 |
| 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 |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| 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 |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
|
|
vancomycin per 500
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
NDC 70594005701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.58
|
| Rate for Payer: Aetna Workers' Compensation |
$53.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.89
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$46.51
|
| Rate for Payer: Cigna Medicare Advantage |
$43.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.88
|
| Rate for Payer: Home State Health Plan Exchange |
$43.32
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.00
|
|
|
vancomycin per 500
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.00 |
| 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 |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| 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 |
$57.00
|
| Rate for Payer: Provider Network of America Commercial |
$60.80
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
NDC 70594004402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$78.96
|
| Rate for Payer: Aetna Workers' Compensation |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$88.26
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$68.54
|
| Rate for Payer: Cigna Medicare Advantage |
$63.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$70.56
|
| Rate for Payer: Home State Health Plan Exchange |
$63.84
|
| Rate for Payer: Humana Medicare |
$84.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Provider Network of America Commercial |
$89.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$112.00
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$65.12
|
|
|
Service Code
|
NDC 00409653311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.12 |
| Max. Negotiated Rate |
$65.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.91
|
| Rate for Payer: Aetna Workers' Compensation |
$45.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.31
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cigna Commercial |
$39.85
|
| Rate for Payer: Cigna Medicare Advantage |
$37.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.03
|
| Rate for Payer: Home State Health Plan Exchange |
$37.12
|
| Rate for Payer: Humana Medicare |
$48.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.84
|
| Rate for Payer: Provider Network of America Commercial |
$52.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.12
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$91.99
|
|
|
Service Code
|
NDC 70594004301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.99 |
| 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 |
$91.99
|
| Rate for Payer: Cash Price |
$91.99
|
| 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 |
$68.99
|
| Rate for Payer: Provider Network of America Commercial |
$73.59
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$91.99
|
|
|
Service Code
|
NDC 70594004301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$91.99 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$64.85
|
| Rate for Payer: Aetna Workers' Compensation |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$70.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$72.49
|
| Rate for Payer: Cash Price |
$91.99
|
| Rate for Payer: Cigna Commercial |
$56.30
|
| Rate for Payer: Cigna Medicare Advantage |
$52.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$57.95
|
| Rate for Payer: Home State Health Plan Exchange |
$52.43
|
| Rate for Payer: Humana Medicare |
$68.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$68.99
|
| Rate for Payer: Provider Network of America Commercial |
$73.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$91.99
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$91.99
|
|
|
Service Code
|
NDC 70594004302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.99 |
| 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 |
$91.99
|
| Rate for Payer: Cash Price |
$91.99
|
| 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 |
$68.99
|
| Rate for Payer: Provider Network of America Commercial |
$73.59
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J3373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.91
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$45.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Commercial |
$39.85
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Cigna Medicare Advantage |
$37.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.03
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.12
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Humana Medicare |
$48.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.84
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: Provider Network of America Commercial |
$52.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.12
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$103.99
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.99 |
| 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 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 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: 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 |
$91.99
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Cash Price |
$91.99
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| 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: 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: 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: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$68.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Provider Network of America Commercial |
$73.59
|
| Rate for Payer: Provider Network of America Commercial |
$83.19
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: Provider Network of America Commercial |
$89.60
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J3375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$78.96
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$64.85
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.31
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$64.85
|
| Rate for Payer: Aetna Workers' Compensation |
$78.96
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$73.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$72.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$63.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$72.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$72.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$70.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$72.49
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Cash Price |
$91.99
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Commercial |
$63.64
|
| Rate for Payer: Cigna Commercial |
$68.54
|
| Rate for Payer: Cigna Commercial |
$56.30
|
| Rate for Payer: Cigna Medicare Advantage |
$52.43
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Cigna Medicare Advantage |
$63.84
|
| Rate for Payer: Cigna Medicare Advantage |
$59.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$70.56
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$57.95
|
| Rate for Payer: Home State Health Plan Exchange |
$59.27
|
| Rate for Payer: Home State Health Plan Exchange |
$52.43
|
| Rate for Payer: Home State Health Plan Exchange |
$63.84
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Humana Medicare |
$84.00
|
| Rate for Payer: Humana Medicare |
$68.99
|
| Rate for Payer: Humana Medicare |
$77.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$68.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.99
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: Provider Network of America Commercial |
$73.59
|
| Rate for Payer: Provider Network of America Commercial |
$89.60
|
| Rate for Payer: Provider Network of America Commercial |
$83.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$91.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$112.00
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
NDC 70594004401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$78.96
|
| Rate for Payer: Aetna Workers' Compensation |
$78.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$77.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$88.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$88.26
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$68.54
|
| Rate for Payer: Cigna Medicare Advantage |
$63.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$70.56
|
| Rate for Payer: Home State Health Plan Exchange |
$63.84
|
| Rate for Payer: Humana Medicare |
$84.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Provider Network of America Commercial |
$89.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.92
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$112.00
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
NDC 70594004402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.00 |
| 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 |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| 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 |
$84.00
|
| Rate for Payer: Provider Network of America Commercial |
$89.60
|
|
