|
vancomycin per 500 mg
|
Facility
|
IP
|
$103.99
|
|
|
Service Code
|
NDC 70594005801
|
|
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 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 |
$103.99
|
| Rate for Payer: Cash Price |
$103.99
|
| 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 |
$77.99
|
| Rate for Payer: Provider Network of America Commercial |
$83.19
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$103.99
|
|
|
Service Code
|
NDC 70594005801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$103.99 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.31
|
| Rate for Payer: Aetna Workers' Compensation |
$73.31
|
| 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 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 Select |
$81.94
|
| 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 Blue Risk (PPO) |
$80.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.94
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Cigna Commercial |
$63.64
|
| Rate for Payer: Cigna Medicare Advantage |
$59.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.51
|
| Rate for Payer: Home State Health Plan Exchange |
$59.27
|
| Rate for Payer: Humana Medicare |
$77.99
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.99
|
| Rate for Payer: Provider Network of America Commercial |
$83.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.99
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 70594004201
|
|
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 per 500 mg
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 70594004201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cigna Commercial |
$39.78
|
| 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 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 per 500 mg
|
Facility
|
OP
|
$91.99
|
|
|
Service Code
|
NDC 70594004302
|
|
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
|
$112.00
|
|
|
Service Code
|
NDC 70594004401
|
|
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
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$65.12
|
|
|
Service Code
|
HCPCS J3373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$65.12
|
| 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 |
$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
|
|
|
vancomycin per 500 mg
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00409653359
|
|
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 Workers' Compensation |
$24.68
|
| 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 Care (HMO) |
$24.25
|
| 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 |
$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 Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00409653359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
vancomycin per 500 mg
|
Facility
|
IP
|
$65.12
|
|
|
Service Code
|
NDC 00409653311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.84 |
| 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 |
$65.12
|
| Rate for Payer: Cash Price |
$65.12
|
| 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 |
$48.84
|
| Rate for Payer: Provider Network of America Commercial |
$52.10
|
|
|
varicella-zoster recombinant adjuvanted 50 mcg/0.5 mL suspension for reconstitution 1 Each KIT
|
Facility
|
OP
|
$938.75
|
|
|
Service Code
|
NDC 58160082311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$535.09 |
| Max. Negotiated Rate |
$938.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$661.82
|
| Rate for Payer: Aetna Workers' Compensation |
$661.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$650.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$650.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$739.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$739.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$739.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$722.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$739.74
|
| Rate for Payer: Cash Price |
$938.75
|
| Rate for Payer: Cigna Commercial |
$574.51
|
| Rate for Payer: Cigna Medicare Advantage |
$535.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$591.41
|
| Rate for Payer: Home State Health Plan Exchange |
$535.09
|
| Rate for Payer: Humana Medicare |
$704.06
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$704.06
|
| Rate for Payer: Provider Network of America Commercial |
$751.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$619.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$938.75
|
|
|
varicella-zoster recombinant adjuvanted 50 mcg/0.5 mL suspension for reconstitution 1 Each KIT
|
Facility
|
IP
|
$938.75
|
|
|
Service Code
|
NDC 58160082311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$704.06 |
| 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 |
$938.75
|
| Rate for Payer: Cash Price |
$938.75
|
| 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 |
$704.06
|
| Rate for Payer: Provider Network of America Commercial |
$751.00
|
|
|
Vasc Duplex Extrem Venous,Uni or Ltd
|
Facility
|
IP
|
$1,063.65
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
Px09219397101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$797.74 |
| 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 |
$1,063.65
|
| Rate for Payer: Cash Price |
$1,063.65
|
| 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 |
$797.74
|
| Rate for Payer: Provider Network of America Commercial |
$850.92
|
|
|
Vasc Duplex Extrem Venous,Uni or Ltd
|
Facility
|
OP
|
$1,063.65
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
Px09219397101
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$1,063.65 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$749.87
|
| Rate for Payer: Aetna Workers' Compensation |
$749.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$737.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$737.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$838.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$838.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$838.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$819.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$838.16
|
| Rate for Payer: Cash Price |
$1,063.65
|
| Rate for Payer: Cash Price |
$1,063.65
|
| Rate for Payer: Cigna Commercial |
$650.95
|
| Rate for Payer: Cigna Medicare Advantage |
$606.28
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$670.10
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$606.28
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$797.74
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$797.74
|
| Rate for Payer: Provider Network of America Commercial |
$850.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$702.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,063.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
Vascular Endothelial Growth Factor (Vegf) Elisa-Quest
|
Facility
|
OP
|
$264.60
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
Px03018352032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$186.54
|
| Rate for Payer: Aetna Workers' Compensation |
$186.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$183.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$183.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$203.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$208.50
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$138.65
|
| Rate for Payer: Cigna Medicare Advantage |
$150.82
|
| Rate for Payer: Family Health Partners Medicaid |
$21.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$166.70
|
| Rate for Payer: Healthy Blue Medicaid |
$23.50
|
| Rate for Payer: Home State Health Plan Exchange |
$150.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$21.76
|
| Rate for Payer: Humana Medicare |
$198.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$21.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$198.45
|
| Rate for Payer: Provider Network of America Commercial |
$211.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$174.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
|
|
Vascular Endothelial Growth Factor (Vegf) Elisa-Quest
|
Facility
|
IP
|
$264.60
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
Px03018352032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.45 |
| 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 |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| 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 |
$198.45
|
| Rate for Payer: Provider Network of America Commercial |
$211.68
|
|
|
vasopressin 20 unit/mL solution 1 mL Vial
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J2598
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
vasopressin 20 unit/mL solution 1 mL Vial
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
NDC 55150037025
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
vasopressin 20 unit/mL solution 1 mL Vial
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J2598
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
vasopressin 20 unit/mL solution 1 mL Vial
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
NDC 55150037025
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$14,369.78
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,369.78 |
| 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: 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 |
$14,369.78
|
|
|
venlafaxine XR 37.5 mg capsule,extended release 24hr 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084069811
|
|
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
|
|
|
venlafaxine XR 37.5 mg capsule,extended release 24hr 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084069811
|
|
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
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$27,624.63
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,624.63 |
| 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 |
$27,624.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$27,624.63
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$27,624.63
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$27,624.63
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$14,559.33
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,559.33 |
| 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 |
$14,559.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,559.33
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,559.33
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,559.33
|
|
