|
electrolytes-dextrose solution 1,000 mL Bottle
|
Facility
|
IP
|
$17.56
|
|
|
Service Code
|
NDC 80681001400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.17 |
| 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 |
$17.56
|
| Rate for Payer: Cash Price |
$17.56
|
| 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 |
$13.17
|
| Rate for Payer: Provider Network of America Commercial |
$14.05
|
|
|
empagliflozin 10 mg tablet 30 Each BLIST PACK
|
Facility
|
OP
|
$46.67
|
|
|
Service Code
|
NDC 00597015237
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$32.90
|
| Rate for Payer: Aetna Workers' Compensation |
$32.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$36.78
|
| Rate for Payer: Cash Price |
$46.67
|
| Rate for Payer: Cigna Commercial |
$28.56
|
| Rate for Payer: Cigna Medicare Advantage |
$26.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$29.40
|
| Rate for Payer: Home State Health Plan Exchange |
$26.60
|
| Rate for Payer: Humana Medicare |
$35.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$46.67
|
|
|
empagliflozin 10 mg tablet 30 Each BLIST PACK
|
Facility
|
OP
|
$46.67
|
|
|
Service Code
|
HCPCS J8499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$32.90
|
| Rate for Payer: Aetna Workers' Compensation |
$32.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$36.78
|
| Rate for Payer: Cash Price |
$46.67
|
| Rate for Payer: Cigna Commercial |
$28.56
|
| Rate for Payer: Cigna Medicare Advantage |
$26.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$29.40
|
| Rate for Payer: Home State Health Plan Exchange |
$26.60
|
| Rate for Payer: Humana Medicare |
$35.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$46.67
|
|
|
empagliflozin 10 mg tablet 30 Each BLIST PACK
|
Facility
|
IP
|
$46.67
|
|
|
Service Code
|
HCPCS J8499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.00 |
| 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 |
$46.67
|
| Rate for Payer: Cash Price |
$46.67
|
| 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 |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
|
|
empagliflozin 10 mg tablet 30 Each BLIST PACK
|
Facility
|
IP
|
$46.67
|
|
|
Service Code
|
NDC 00597015237
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.00 |
| 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 |
$46.67
|
| Rate for Payer: Cash Price |
$46.67
|
| 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 |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
|
|
empagliflozin 25 mg tablet 30 Each Bottle
|
Facility
|
IP
|
$46.67
|
|
|
Service Code
|
NDC 00597015330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.00 |
| 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 |
$46.67
|
| Rate for Payer: Cash Price |
$46.67
|
| 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 |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
|
|
empagliflozin 25 mg tablet 30 Each Bottle
|
Facility
|
OP
|
$46.67
|
|
|
Service Code
|
NDC 00597015330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$32.90
|
| Rate for Payer: Aetna Workers' Compensation |
$32.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$36.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$36.78
|
| Rate for Payer: Cash Price |
$46.67
|
| Rate for Payer: Cigna Commercial |
$28.56
|
| Rate for Payer: Cigna Medicare Advantage |
$26.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$29.40
|
| Rate for Payer: Home State Health Plan Exchange |
$26.60
|
| Rate for Payer: Humana Medicare |
$35.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$35.00
|
| Rate for Payer: Provider Network of America Commercial |
$37.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$46.67
|
|
|
Employee Lipid Panel - Bundled Charge
|
Facility
|
IP
|
$204.75
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
Px03018006102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.56 |
| 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 |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| 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 |
$153.56
|
| Rate for Payer: Provider Network of America Commercial |
$163.80
|
|
|
Employee Lipid Panel - Bundled Charge
|
Facility
|
OP
|
$204.75
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
Px03018006102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$144.35
|
| Rate for Payer: Aetna Workers' Compensation |
$144.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$141.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$141.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$161.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$157.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$161.34
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna Commercial |
$107.29
|
| Rate for Payer: Cigna Medicare Advantage |
$116.71
|
| Rate for Payer: Family Health Partners Medicaid |
$16.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$128.99
|
| Rate for Payer: Healthy Blue Medicaid |
$18.22
|
| Rate for Payer: Home State Health Plan Exchange |
$116.71
|
| Rate for Payer: Home State Health Plan Medicaid |
$16.87
|
| Rate for Payer: Humana Medicare |
$153.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16.87
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$153.56
|
| Rate for Payer: Provider Network of America Commercial |
$163.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$135.13
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.70
|
|
|
emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 42385095330
|
|
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
|
|
|
emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 42385095330
|
|
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
|
|
|
emtricitabine-tenofovir (TDF) 200-300 mg tablet 5 Each Disp Pack
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 99999131801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
emtricitabine-tenofovir (TDF) 200-300 mg tablet 5 Each Disp Pack
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 99999131801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,817.50
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$7,736.67
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,736.67 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$7,736.67
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 645
|
| 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 |
$3,611.01
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$26,822.43
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,822.43 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$26,822.43
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$28,803.48
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$28,803.48 |
| 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 |
$28,803.48
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$22,375.76
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,375.76 |
| 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 |
$22,375.76
|
|
|
enoxaparin 100 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$37.28
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.96 |
| 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 |
$37.28
|
| Rate for Payer: Cash Price |
$37.28
|
| 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 |
$27.96
|
| Rate for Payer: Provider Network of America Commercial |
$29.82
|
|
|
enoxaparin 100 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$37.28
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.28
|
| Rate for Payer: Aetna Workers' Compensation |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.38
|
| Rate for Payer: Cash Price |
$37.28
|
| Rate for Payer: Cigna Commercial |
$22.82
|
| Rate for Payer: Cigna Medicare Advantage |
$21.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.49
|
| Rate for Payer: Home State Health Plan Exchange |
$21.25
|
| Rate for Payer: Humana Medicare |
$27.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.96
|
| Rate for Payer: Provider Network of America Commercial |
$29.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.28
|
|
|
enoxaparin 100 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$37.28
|
|
|
Service Code
|
NDC 63323058621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.96 |
| 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 |
$37.28
|
| Rate for Payer: Cash Price |
$37.28
|
| 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 |
$27.96
|
| Rate for Payer: Provider Network of America Commercial |
$29.82
|
|
|
enoxaparin 100 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$37.28
|
|
|
Service Code
|
NDC 63323058621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.28
|
| Rate for Payer: Aetna Workers' Compensation |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.38
|
| Rate for Payer: Cash Price |
$37.28
|
| Rate for Payer: Cigna Commercial |
$22.82
|
| Rate for Payer: Cigna Medicare Advantage |
$21.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.49
|
| Rate for Payer: Home State Health Plan Exchange |
$21.25
|
| Rate for Payer: Humana Medicare |
$27.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.96
|
| Rate for Payer: Provider Network of America Commercial |
$29.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.28
|
|
|
enoxaparin 30 mg/0.3 mL syringe 0.3 mL Syringe
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 63323055963
|
|
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
|
|
|
enoxaparin 30 mg/0.3 mL syringe 0.3 mL Syringe
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 63323055963
|
|
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
|
|
