|
atropine 1 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$37.68
|
|
|
Service Code
|
NDC 16729052608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$37.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$26.56
|
| Rate for Payer: Aetna Workers' Compensation |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$26.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$26.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$29.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$29.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$29.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$29.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$29.69
|
| Rate for Payer: Cash Price |
$37.68
|
| Rate for Payer: Cigna Commercial |
$23.06
|
| Rate for Payer: Cigna Medicare Advantage |
$21.48
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.74
|
| Rate for Payer: Home State Health Plan Exchange |
$21.48
|
| Rate for Payer: Humana Medicare |
$28.26
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$28.26
|
| Rate for Payer: Provider Network of America Commercial |
$30.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.87
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$37.68
|
|
|
atropine 1 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 70069064101
|
|
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
|
|
|
Atropine sulfate injection
|
Facility
|
OP
|
$63.13
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
Px0636J046101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$44.51
|
| Rate for Payer: Aetna Workers' Compensation |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$43.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$43.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$48.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$49.75
|
| Rate for Payer: Cash Price |
$63.13
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Cigna Medicare Advantage |
$35.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$39.77
|
| Rate for Payer: Home State Health Plan Exchange |
$35.98
|
| Rate for Payer: Humana Medicare |
$47.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$47.35
|
| Rate for Payer: Provider Network of America Commercial |
$50.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$63.13
|
|
|
Atropine sulfate injection
|
Facility
|
IP
|
$63.13
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
Px0636J046101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.35 |
| 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 |
$63.13
|
| Rate for Payer: Cash Price |
$63.13
|
| 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 |
$47.35
|
| Rate for Payer: Provider Network of America Commercial |
$50.50
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$38,851.99
|
|
|
Service Code
|
APR-DRG 0081
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$38,851.99 |
| 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 |
$38,851.99
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$38,851.99
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$38,851.99
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$38,851.99
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$94,048.54
|
|
|
Service Code
|
APR-DRG 0084
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$94,048.54 |
| 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 |
$94,048.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$94,048.54
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$94,048.54
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$94,048.54
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$56,964.24
|
|
|
Service Code
|
APR-DRG 0083
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$56,964.24 |
| 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: Family Health Partners Medicaid |
$56,964.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$56,964.24
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$56,964.24
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$56,964.24
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$44,027.44
|
|
|
Service Code
|
APR-DRG 0082
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$44,027.44 |
| 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 |
$44,027.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$44,027.44
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$44,027.44
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$44,027.44
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$27,869.59
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,869.59 |
| 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 |
$27,869.59
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$22,740.01
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,740.01 |
| 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 |
$22,740.01
|
|
|
Avulsion Nail Plate Partial/Complete Simple 1
|
Facility
|
IP
|
$418.95
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
Px03601173001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.21 |
| 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 |
$418.95
|
| Rate for Payer: Cash Price |
$418.95
|
| 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 |
$314.21
|
| Rate for Payer: Provider Network of America Commercial |
$335.16
|
|
|
Avulsion Nail Plate Partial/Complete Simple 1
|
Facility
|
OP
|
$418.95
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
Px03601173001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.63 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$290.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$290.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$330.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$330.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$330.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$322.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$330.13
|
| Rate for Payer: Cash Price |
$418.95
|
| Rate for Payer: Cash Price |
$418.95
|
| Rate for Payer: Cigna Commercial |
$277.76
|
| Rate for Payer: Cigna Medicare Advantage |
$238.80
|
| Rate for Payer: Family Health Partners Medicaid |
$253.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$263.94
|
| Rate for Payer: Healthy Blue Medicaid |
$273.46
|
| Rate for Payer: Home State Health Plan Exchange |
$238.80
|
| Rate for Payer: Home State Health Plan Medicaid |
$253.20
|
| Rate for Payer: Humana Medicare |
$314.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$253.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$314.21
|
| Rate for Payer: Provider Network of America Commercial |
$335.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$276.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$418.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.63
|
|
|
Avulsion Nail Plate Partial/Complete Simple Ea Addl
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
Px07611173201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.12 |
| 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 |
$157.50
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$147.00
|
| 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 |
$118.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Provider Network of America Commercial |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$117.60
|
|
|
Avulsion Nail Plate Partial/Complete Simple Ea Addl
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
Px07611173201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$111.04
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$103.64
|
| Rate for Payer: Aetna Workers' Compensation |
$103.64
|
| Rate for Payer: Aetna Workers' Compensation |
$111.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$109.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$109.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$121.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$124.11
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$89.96
|
| Rate for Payer: Cigna Commercial |
$96.39
|
| Rate for Payer: Cigna Medicare Advantage |
$89.78
|
| Rate for Payer: Cigna Medicare Advantage |
$83.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$99.22
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$92.61
|
| Rate for Payer: Home State Health Plan Exchange |
$83.79
|
| Rate for Payer: Home State Health Plan Exchange |
$89.78
|
| Rate for Payer: Humana Medicare |
$118.12
|
| Rate for Payer: Humana Medicare |
$110.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$118.12
|
| Rate for Payer: Provider Network of America Commercial |
$126.00
|
| Rate for Payer: Provider Network of America Commercial |
$117.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.95
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$147.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$157.50
|
|
|
Azacitidine injection
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
Px0636J902501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.28 |
| 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 |
$99.04
|
| Rate for Payer: Cash Price |
$99.04
|
| 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 |
$74.28
|
| Rate for Payer: Provider Network of America Commercial |
$79.23
|
|
|
Azacitidine injection
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
Px0636J902501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.82
|
| Rate for Payer: Aetna Workers' Compensation |
$69.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$68.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$78.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$78.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$78.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$76.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$78.04
|
| Rate for Payer: Cash Price |
$99.04
|
| Rate for Payer: Cigna Commercial |
$60.61
|
| Rate for Payer: Cigna Medicare Advantage |
$56.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.40
|
| Rate for Payer: Home State Health Plan Exchange |
$56.45
|
| Rate for Payer: Humana Medicare |
$74.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.28
|
| Rate for Payer: Provider Network of America Commercial |
$79.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$99.04
|
|
|
azacitidine per 1 mg
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS J9025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.00 |
| 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 |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| 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 |
$117.00
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
|
|
azacitidine per 1 mg
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
NDC 71288015395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$109.98
|
| Rate for Payer: Aetna Workers' Compensation |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$122.93
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$95.47
|
| Rate for Payer: Cigna Medicare Advantage |
$88.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$98.28
|
| Rate for Payer: Home State Health Plan Exchange |
$88.92
|
| Rate for Payer: Humana Medicare |
$117.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$156.00
|
|
|
azacitidine per 1 mg
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS J9025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$109.98
|
| Rate for Payer: Aetna Workers' Compensation |
$109.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$108.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$122.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$120.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$122.93
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$95.47
|
| Rate for Payer: Cigna Medicare Advantage |
$88.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$98.28
|
| Rate for Payer: Home State Health Plan Exchange |
$88.92
|
| Rate for Payer: Humana Medicare |
$117.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$102.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$156.00
|
|
|
azacitidine per 1 mg
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
NDC 71288015395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.00 |
| 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 |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| 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 |
$117.00
|
| Rate for Payer: Provider Network of America Commercial |
$124.80
|
|
|
azaTHIOprine 50 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084022911
|
|
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
|
|
|
azaTHIOprine 50 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J7500
|
|
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
|
|
|
azaTHIOprine 50 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J7500
|
|
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
|
|
|
azaTHIOprine 50 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084022911
|
|
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
|
|
|
Azithromycin
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
Px0636J045601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| 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 |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| 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 |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
|
