|
benztropine 2 mg Tab [HMC]
|
Facility
|
OP
|
$7.10
|
|
|
Service Code
|
NDC 00904678961
|
| Hospital Charge Code |
3807051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: Humana Medicare Advantage |
$2.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.84
|
| Rate for Payer: WPPA Medicare Advantage |
$4.26
|
|
|
benztropine 2 mg Tab [HMC]
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
NDC 60687037901
|
| Hospital Charge Code |
3807051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.66
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Bermuda Grass (G2) IgE QST
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
LAB1003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Bermuda Grass (G2) IgE QST
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
LAB1003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$15.51
|
| Rate for Payer: Humana Medicare Advantage |
$11.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.22
|
| Rate for Payer: WPPA Medicare Advantage |
$16.20
|
|
|
Beta 2 GPI Ab (IgG,IgA,IgM) QST
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3556391
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Beta 2 GPI Ab (IgG,IgA,IgM) QST
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
3556391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Aetna Commercial |
$139.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$56.77
|
| Rate for Payer: Humana Medicare Advantage |
$65.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$147.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.45
|
| Rate for Payer: WPPA Medicare Advantage |
$93.00
|
|
|
Beta 2 Microglobulin QST
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
3556406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$42.33
|
| Rate for Payer: Humana Medicare Advantage |
$34.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.18
|
| Rate for Payer: WPPA Medicare Advantage |
$48.60
|
|
|
Beta 2 Microglobulin QST
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
3556406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Beta 2 Transferrin QST
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3558633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$64.18
|
| Rate for Payer: Humana Medicare Advantage |
$246.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$556.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.35
|
| Rate for Payer: WPPA Medicare Advantage |
$351.60
|
|
|
Beta 2 Transferrin QST
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3558633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$527.40 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$556.70
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Beta hCG Quantitative
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3551260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$60.36
|
| Rate for Payer: Humana Medicare Advantage |
$84.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.79
|
| Rate for Payer: WPPA Medicare Advantage |
$120.00
|
|
|
Beta hCG Quantitative
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3551260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$190.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Beta Hydroxybutyrate
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3557054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$29.06
|
| Rate for Payer: Humana Medicare Advantage |
$43.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: WPPA Medicare Advantage |
$61.80
|
|
|
Beta Hydroxybutyrate
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3557054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.85
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Beta Lactamase
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3553015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Beta Lactamase
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3553015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$18.54
|
| Rate for Payer: Humana Medicare Advantage |
$25.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.75
|
| Rate for Payer: WPPA Medicare Advantage |
$36.60
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL [HMC]
|
Facility
|
OP
|
$101.56
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
3800709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$96.48 |
| Rate for Payer: Aetna Commercial |
$91.40
|
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$8.75
|
| Rate for Payer: Humana Medicare Advantage |
$42.66
|
| Rate for Payer: Humana Medicare Advantage |
$32.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$96.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.91
|
| Rate for Payer: WPPA Medicare Advantage |
$60.94
|
| Rate for Payer: WPPA Medicare Advantage |
$46.42
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL [HMC]
|
Facility
|
IP
|
$101.56
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
3800709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$91.40
|
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$96.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$73.49
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
IP
|
$72.31
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.08 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.69
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
IP
|
$95.87
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.28 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.08
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
OP
|
$95.87
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Humana Medicare Advantage |
$40.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.35
|
| Rate for Payer: WPPA Medicare Advantage |
$57.52
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
IP
|
$48.46
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.04
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
OP
|
$48.46
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Humana Medicare Advantage |
$20.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$46.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.38
|
| Rate for Payer: WPPA Medicare Advantage |
$29.08
|
|
|
betamethasone-clotrimazole Top 0.05%-1% Crm [HMC]
|
Facility
|
OP
|
$72.31
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
3807333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$68.69 |
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Humana Medicare Advantage |
$30.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.92
|
| Rate for Payer: WPPA Medicare Advantage |
$43.39
|
|
|
betaxolol 10 mg Tab [HMC]
|
Facility
|
IP
|
$8.73
|
|
|
Service Code
|
NDC 10702001301
|
| Hospital Charge Code |
3804537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.29
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
