|
folic acid 1 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904722461
|
|
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
|
|
|
folic acid 1 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904722461
|
|
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
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$20,448.51
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,448.51 |
| 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 |
$20,448.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,448.51
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,448.51
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,448.51
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$13,546.98
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,546.98 |
| 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 |
$13,546.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,546.98
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,546.98
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,546.98
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$33,202.25
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$33,202.25 |
| 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 |
$33,202.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$33,202.25
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$33,202.25
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$33,202.25
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$10,118.86
|
|
|
Service Code
|
APR-DRG 3141
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,118.86 |
| 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 |
$10,118.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,118.86
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,118.86
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,118.86
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$8,785.24
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,785.24 |
| 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 |
$8,785.24
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$13,118.17
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,118.17 |
| 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 |
$13,118.17
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$8,426.16
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,426.16 |
| 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 |
$8,426.16
|
|
|
Fo Pip Dip W Joint Spring Prefab Ots Pr90
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
Px0274L392501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.44
|
| Rate for Payer: Aetna Workers' Compensation |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.32
|
| Rate for Payer: Cash Price |
$34.67
|
| Rate for Payer: Cigna Commercial |
$21.22
|
| Rate for Payer: Cigna Medicare Advantage |
$19.76
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$21.84
|
| Rate for Payer: Home State Health Plan Exchange |
$19.76
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.00
|
| Rate for Payer: Provider Network of America Commercial |
$27.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.88
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$34.67
|
|
|
Fo Pip Dip W Joint Spring Prefab Ots Pr90
|
Facility
|
IP
|
$34.67
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
Px0274L392501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.00 |
| 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 |
$34.67
|
| Rate for Payer: Cash Price |
$34.67
|
| 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 |
$26.00
|
| Rate for Payer: Provider Network of America Commercial |
$27.74
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
IP
|
$25.33
|
|
|
Service Code
|
NDC 43598077811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| 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 |
$25.33
|
| Rate for Payer: Cash Price |
$25.33
|
| 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 |
$19.00
|
| Rate for Payer: Provider Network of America Commercial |
$20.26
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
IP
|
$64.25
|
|
|
Service Code
|
NDC 62332065530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.19 |
| 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 |
$64.25
|
| Rate for Payer: Cash Price |
$64.25
|
| 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 |
$48.19
|
| Rate for Payer: Provider Network of America Commercial |
$51.40
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
OP
|
$64.25
|
|
|
Service Code
|
NDC 62332065530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$64.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.30
|
| Rate for Payer: Aetna Workers' Compensation |
$45.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$49.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.63
|
| Rate for Payer: Cash Price |
$64.25
|
| Rate for Payer: Cigna Commercial |
$39.32
|
| Rate for Payer: Cigna Medicare Advantage |
$36.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.48
|
| Rate for Payer: Home State Health Plan Exchange |
$36.62
|
| Rate for Payer: Humana Medicare |
$48.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.19
|
| Rate for Payer: Provider Network of America Commercial |
$51.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.41
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$64.25
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
IP
|
$25.33
|
|
|
Service Code
|
HCPCS J7606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| 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 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 |
$64.25
|
| Rate for Payer: Cash Price |
$64.25
|
| Rate for Payer: Cash Price |
$25.33
|
| Rate for Payer: Cash Price |
$25.33
|
| 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 |
$19.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.19
|
| Rate for Payer: Provider Network of America Commercial |
$51.40
|
| Rate for Payer: Provider Network of America Commercial |
$20.26
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
OP
|
$25.33
|
|
|
Service Code
|
NDC 43598077811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$25.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$17.86
|
| Rate for Payer: Aetna Workers' Compensation |
$17.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$19.96
|
| Rate for Payer: Cash Price |
$25.33
|
| Rate for Payer: Cigna Commercial |
$15.50
|
| Rate for Payer: Cigna Medicare Advantage |
$14.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15.96
|
| Rate for Payer: Home State Health Plan Exchange |
$14.44
|
| Rate for Payer: Humana Medicare |
$19.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.00
|
| Rate for Payer: Provider Network of America Commercial |
$20.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.33
|
|
|
formoterol fumarate 20 mcg/2 mL solution for nebulization 2 mL Vial
|
Facility
|
OP
|
$25.33
|
|
|
Service Code
|
HCPCS J7606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$25.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$17.86
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.30
|
| Rate for Payer: Aetna Workers' Compensation |
$17.86
|
| Rate for Payer: Aetna Workers' Compensation |
$45.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$19.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$19.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$49.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$19.96
|
| Rate for Payer: Cash Price |
$64.25
|
| Rate for Payer: Cash Price |
$25.33
|
| Rate for Payer: Cigna Commercial |
$15.50
|
| Rate for Payer: Cigna Commercial |
$39.32
|
| Rate for Payer: Cigna Medicare Advantage |
$14.44
|
| Rate for Payer: Cigna Medicare Advantage |
$36.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$15.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.48
|
| Rate for Payer: Home State Health Plan Exchange |
$14.44
|
| Rate for Payer: Home State Health Plan Exchange |
$36.62
|
| Rate for Payer: Humana Medicare |
$19.00
|
| Rate for Payer: Humana Medicare |
$48.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.19
|
| Rate for Payer: Provider Network of America Commercial |
$20.26
|
| Rate for Payer: Provider Network of America Commercial |
$51.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.41
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.33
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$64.25
|
|
|
fosfomycin 3 gram packet 1 Each Packet
|
Facility
|
IP
|
$321.28
|
|
|
Service Code
|
NDC 70700026894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.96 |
| 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 |
$321.28
|
| Rate for Payer: Cash Price |
$321.28
|
| 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 |
$240.96
|
| Rate for Payer: Provider Network of America Commercial |
$257.02
|
|
|
fosfomycin 3 gram packet 1 Each Packet
|
Facility
|
OP
|
$321.28
|
|
|
Service Code
|
NDC 70700026894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.13 |
| Max. Negotiated Rate |
$321.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$226.50
|
| Rate for Payer: Aetna Workers' Compensation |
$226.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$222.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$222.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$253.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$253.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$253.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$247.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$253.17
|
| Rate for Payer: Cash Price |
$321.28
|
| Rate for Payer: Cigna Commercial |
$196.62
|
| Rate for Payer: Cigna Medicare Advantage |
$183.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$202.41
|
| Rate for Payer: Home State Health Plan Exchange |
$183.13
|
| Rate for Payer: Humana Medicare |
$240.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$240.96
|
| Rate for Payer: Provider Network of America Commercial |
$257.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$212.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$321.28
|
|
|
fosphenytoin 100 mg PE/2 mL solution 2 mL Vial
|
Facility
|
IP
|
$161.73
|
|
|
Service Code
|
NDC 00069600125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.30 |
| 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 |
$161.73
|
| Rate for Payer: Cash Price |
$161.73
|
| 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 |
$121.30
|
| Rate for Payer: Provider Network of America Commercial |
$129.38
|
|
|
fosphenytoin 100 mg PE/2 mL solution 2 mL Vial
|
Facility
|
OP
|
$161.73
|
|
|
Service Code
|
NDC 00069600125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.19 |
| Max. Negotiated Rate |
$161.73 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$114.02
|
| Rate for Payer: Aetna Workers' Compensation |
$114.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$112.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$112.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$127.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$127.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$127.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$124.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$127.44
|
| Rate for Payer: Cash Price |
$161.73
|
| Rate for Payer: Cigna Commercial |
$98.98
|
| Rate for Payer: Cigna Medicare Advantage |
$92.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$101.89
|
| Rate for Payer: Home State Health Plan Exchange |
$92.19
|
| Rate for Payer: Humana Medicare |
$121.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$121.30
|
| Rate for Payer: Provider Network of America Commercial |
$129.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$106.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$161.73
|
|
|
fosphenytoin 500 mg PE/10 mL solution 10 mL Vial
|
Facility
|
OP
|
$485.18
|
|
|
Service Code
|
NDC 00069600121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$276.55 |
| Max. Negotiated Rate |
$485.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$342.05
|
| Rate for Payer: Aetna Workers' Compensation |
$342.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$382.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$382.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$382.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$373.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$382.32
|
| Rate for Payer: Cash Price |
$485.18
|
| Rate for Payer: Cigna Commercial |
$296.93
|
| Rate for Payer: Cigna Medicare Advantage |
$276.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$305.66
|
| Rate for Payer: Home State Health Plan Exchange |
$276.55
|
| Rate for Payer: Humana Medicare |
$363.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$363.88
|
| Rate for Payer: Provider Network of America Commercial |
$388.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$320.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$485.18
|
|
|
fosphenytoin 500 mg PE/10 mL solution 10 mL Vial
|
Facility
|
IP
|
$485.18
|
|
|
Service Code
|
NDC 00069600121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$363.88 |
| 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 |
$485.18
|
| Rate for Payer: Cash Price |
$485.18
|
| 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 |
$363.88
|
| Rate for Payer: Provider Network of America Commercial |
$388.14
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$7,047.61
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$7,047.61 |
| 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 |
$7,047.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$7,047.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$7,047.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$7,047.61
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 3401
|
| 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 |
$5,369.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$5,369.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$5,369.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$5,369.61
|
|
