|
albumin human 25 % parenteral solution 50 mL Glass Cont
|
Facility
|
IP
|
$459.20
|
|
|
Service Code
|
NDC 68982064301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$344.40 |
| 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 |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$344.40
|
| Rate for Payer: Provider Network of America Commercial |
$367.36
|
|
|
albumin human 25 % parenteral solution 50 mL Glass Cont
|
Facility
|
IP
|
$459.20
|
|
|
Service Code
|
HCPCS P9047
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$344.40 |
| 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 |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$344.40
|
| Rate for Payer: Provider Network of America Commercial |
$367.36
|
|
|
albumin human 25 % parenteral solution 50 mL Glass Cont
|
Facility
|
OP
|
$459.20
|
|
|
Service Code
|
NDC 68982064301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$261.74 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$323.74
|
| Rate for Payer: Aetna Workers' Compensation |
$323.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$318.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$361.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$361.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$361.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$353.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$361.85
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cigna Commercial |
$281.03
|
| Rate for Payer: Cigna Medicare Advantage |
$261.74
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$289.30
|
| Rate for Payer: Home State Health Plan Exchange |
$261.74
|
| Rate for Payer: Humana Medicare |
$344.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$344.40
|
| Rate for Payer: Provider Network of America Commercial |
$367.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$303.07
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$459.20
|
|
|
albumin human 5 % parenteral solution 250 mL Vial
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS P9045
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$253.80
|
| Rate for Payer: Aetna Workers' Compensation |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$283.68
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cigna Medicare Advantage |
$205.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$226.80
|
| Rate for Payer: Home State Health Plan Exchange |
$205.20
|
| Rate for Payer: Humana Medicare |
$270.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$270.00
|
| Rate for Payer: Provider Network of America Commercial |
$288.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$237.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$360.00
|
|
|
albumin human 5 % parenteral solution 250 mL Vial
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 44206031090
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$253.80
|
| Rate for Payer: Aetna Workers' Compensation |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$283.68
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cigna Medicare Advantage |
$205.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$226.80
|
| Rate for Payer: Home State Health Plan Exchange |
$205.20
|
| Rate for Payer: Humana Medicare |
$270.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$270.00
|
| Rate for Payer: Provider Network of America Commercial |
$288.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$237.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$360.00
|
|
|
albumin human 5 % parenteral solution 250 mL Vial
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS P9045
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$270.00 |
| 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 |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| 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 |
$270.00
|
| Rate for Payer: Provider Network of America Commercial |
$288.00
|
|
|
albumin human 5 % parenteral solution 250 mL Vial
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 44206031090
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$270.00 |
| 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 |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| 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 |
$270.00
|
| Rate for Payer: Provider Network of America Commercial |
$288.00
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687039583
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 76204020001
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687039583
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 76204020001
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
albuterol HFA 90 mcg/actuation HFA aerosol inhaler 6.7 g CANISTER
|
Facility
|
IP
|
$143.92
|
|
|
Service Code
|
NDC 00781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.94 |
| 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 |
$143.92
|
| Rate for Payer: Cash Price |
$143.92
|
| 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 |
$107.94
|
| Rate for Payer: Provider Network of America Commercial |
$115.14
|
|
|
albuterol HFA 90 mcg/actuation HFA aerosol inhaler 6.7 g CANISTER
|
Facility
|
OP
|
$143.92
|
|
|
Service Code
|
NDC 00781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$101.46
|
| Rate for Payer: Aetna Workers' Compensation |
$101.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$110.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$113.41
|
| Rate for Payer: Cash Price |
$143.92
|
| Rate for Payer: Cigna Commercial |
$88.08
|
| Rate for Payer: Cigna Medicare Advantage |
$82.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$90.67
|
| Rate for Payer: Home State Health Plan Exchange |
$82.03
|
| Rate for Payer: Humana Medicare |
$107.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$107.94
|
| Rate for Payer: Provider Network of America Commercial |
$115.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$94.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$143.92
|
|
|
albuterol HFA 90 mcg/actuation HFA aerosol inhaler 6.7 g CANISTER
|
Facility
|
OP
|
$143.92
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$143.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$101.46
|
| Rate for Payer: Aetna Workers' Compensation |
$101.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$113.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$110.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$113.41
|
| Rate for Payer: Cash Price |
$143.92
|
| Rate for Payer: Cigna Commercial |
$88.08
|
| Rate for Payer: Cigna Medicare Advantage |
$82.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$90.67
|
| Rate for Payer: Home State Health Plan Exchange |
$82.03
|
| Rate for Payer: Humana Medicare |
$107.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$107.94
|
| Rate for Payer: Provider Network of America Commercial |
$115.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$94.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$143.92
|
|
|
albuterol HFA 90 mcg/actuation HFA aerosol inhaler 6.7 g CANISTER
|
Facility
|
IP
|
$143.92
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.94 |
| 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 |
$143.92
|
| Rate for Payer: Cash Price |
$143.92
|
| 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 |
$107.94
|
| Rate for Payer: Provider Network of America Commercial |
$115.14
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$4,161.26
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,161.26
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,161.26
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,161.26
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$26,745.41
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,745.41 |
| 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 |
$26,745.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$26,745.41
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$26,745.41
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26,745.41
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$6,336.65
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,336.65 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$6,336.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,336.65
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,336.65
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,336.65
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,467.73
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,467.73 |
| 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 |
$11,467.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,467.73
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,467.73
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,467.73
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
|
|
ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
|
