|
Airway King LTS-D Supraglottic Yellow Size 3
|
Facility
|
OP
|
$149.80
|
|
| Hospital Charge Code |
3257705
|
|
Hospital Revenue Code
|
541
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$142.31 |
| Rate for Payer: Aetna Commercial |
$134.82
|
| Rate for Payer: Humana Medicare Advantage |
$62.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$142.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.92
|
| Rate for Payer: WPPA Medicare Advantage |
$89.88
|
|
|
Alanine Aminotransferase
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3550734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$11.36
|
| Rate for Payer: Humana Medicare Advantage |
$31.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.30
|
| Rate for Payer: WPPA Medicare Advantage |
$44.40
|
|
|
Alanine Aminotransferase
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3550734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albumin human 25% IV Sol 100 mL [HMC]
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
3805077
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.92 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$69.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$69.92
|
| Rate for Payer: Humana Medicare Advantage |
$81.48
|
| Rate for Payer: Humana Medicare Advantage |
$121.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$77.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.00
|
| Rate for Payer: WPPA Medicare Advantage |
$116.40
|
| Rate for Payer: WPPA Medicare Advantage |
$174.00
|
|
|
albumin human 25% IV Sol 100 mL [HMC]
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
3805077
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.50
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albumin human 25% Sol 50 mL [HMC]
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
3805077
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$69.92
|
| Rate for Payer: Humana Medicare Advantage |
$65.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.00
|
| Rate for Payer: WPPA Medicare Advantage |
$93.00
|
|
|
albumin human 25% Sol 50 mL [HMC]
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
3805077
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albumin human 5% IV Sol 250 mL [HMC]
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3800487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.30 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Aetna Commercial |
$119.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$125.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albumin human 5% IV Sol 250 mL [HMC]
|
Facility
|
OP
|
$132.50
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3800487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$125.88 |
| Rate for Payer: Aetna Commercial |
$119.25
|
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Commercial |
$106.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$66.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$66.36
|
| Rate for Payer: Humana Medicare Advantage |
$55.65
|
| Rate for Payer: Humana Medicare Advantage |
$49.72
|
| Rate for Payer: Humana Medicare Advantage |
$44.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$125.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.80
|
| Rate for Payer: WPPA Medicare Advantage |
$64.20
|
| Rate for Payer: WPPA Medicare Advantage |
$71.02
|
| Rate for Payer: WPPA Medicare Advantage |
$79.50
|
|
|
Albumin Level
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3550023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Albumin Level
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3550023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$10.63
|
| Rate for Payer: Humana Medicare Advantage |
$31.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.95
|
| Rate for Payer: WPPA Medicare Advantage |
$44.40
|
|
|
Albumin, Pericardial Fluid QSTS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
3552042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$25.51
|
| Rate for Payer: Humana Medicare Advantage |
$23.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.61
|
| Rate for Payer: WPPA Medicare Advantage |
$33.00
|
|
|
Albumin, Pericardial Fluid QSTS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
3552042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$0.31
|
| Rate for Payer: Humana Medicare Advantage |
$5.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.33
|
| Rate for Payer: WPPA Medicare Advantage |
$7.99
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 00378705752
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 00378699152
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 00378705752
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.33
|
| Rate for Payer: WPPA Medicare Advantage |
$7.99
|
|
|
albuterol 0.021% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 00378699152
|
| Hospital Charge Code |
3808975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.33
|
| Rate for Payer: WPPA Medicare Advantage |
$7.99
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$12.66
|
|
|
Service Code
|
NDC 76204020030
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: WPPA Medicare Advantage |
$7.60
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$12.66
|
|
|
Service Code
|
NDC 47335070352
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: WPPA Medicare Advantage |
$7.60
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
IP
|
$12.66
|
|
|
Service Code
|
NDC 47335070352
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$0.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$0.31
|
| Rate for Payer: Humana Medicare Advantage |
$5.32
|
| Rate for Payer: Humana Medicare Advantage |
$4.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: WPPA Medicare Advantage |
$7.60
|
| Rate for Payer: WPPA Medicare Advantage |
$6.96
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
OP
|
$12.66
|
|
|
Service Code
|
NDC 65862085825
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: WPPA Medicare Advantage |
$7.60
|
|
|
albuterol 0.083% Inh Sol 3 mL [HMC]
|
Facility
|
IP
|
$12.66
|
|
|
Service Code
|
NDC 65862085825
|
| Hospital Charge Code |
3804362
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.03
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
