|
methotrexate 2.5 mg tablet 20 Each BLIST PACK
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00904714110
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
methotrexate 2.5 mg tablet 20 Each BLIST PACK
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$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
|
|
|
methotrexate 2.5 mg tablet 20 Each BLIST PACK
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00904714110
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
methotrexate 2.5 mg tablet 20 Each BLIST PACK
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
methotrexate PF 25 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
methotrexate PF 25 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
methotrexate PF 25 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 00143951910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
methotrexate PF 25 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 00143951910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL AMPUL
|
Facility
|
IP
|
$79.04
|
|
|
Service Code
|
NDC 51991014417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.28 |
| 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 |
$79.04
|
| Rate for Payer: Cash Price |
$79.04
|
| 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 |
$59.28
|
| Rate for Payer: Provider Network of America Commercial |
$63.23
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL AMPUL
|
Facility
|
OP
|
$79.04
|
|
|
Service Code
|
NDC 51991014417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Workers' Compensation |
$55.72
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.28
|
| Rate for Payer: Cash Price |
$79.04
|
| Rate for Payer: Cigna Commercial |
$48.37
|
| Rate for Payer: Cigna Medicare Advantage |
$45.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.80
|
| Rate for Payer: Home State Health Plan Exchange |
$45.05
|
| Rate for Payer: Humana Medicare |
$59.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.28
|
| Rate for Payer: Provider Network of America Commercial |
$63.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.17
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.04
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL AMPUL
|
Facility
|
OP
|
$79.04
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.72
|
| Rate for Payer: Aetna Workers' Compensation |
$55.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.28
|
| Rate for Payer: Cash Price |
$79.04
|
| Rate for Payer: Cigna Commercial |
$48.37
|
| Rate for Payer: Cigna Medicare Advantage |
$45.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.80
|
| Rate for Payer: Home State Health Plan Exchange |
$45.05
|
| Rate for Payer: Humana Medicare |
$59.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.28
|
| Rate for Payer: Provider Network of America Commercial |
$63.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.17
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.04
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL AMPUL
|
Facility
|
IP
|
$79.04
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.28 |
| 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 |
$79.04
|
| Rate for Payer: Cash Price |
$79.04
|
| 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 |
$59.28
|
| Rate for Payer: Provider Network of America Commercial |
$63.23
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
OP
|
$127.04
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$89.56
|
| Rate for Payer: Aetna Workers' Compensation |
$89.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$88.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$88.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$100.11
|
| Rate for Payer: Cash Price |
$127.04
|
| Rate for Payer: Cigna Commercial |
$77.75
|
| Rate for Payer: Cigna Medicare Advantage |
$72.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$80.04
|
| Rate for Payer: Home State Health Plan Exchange |
$72.41
|
| Rate for Payer: Humana Medicare |
$95.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$95.28
|
| Rate for Payer: Provider Network of America Commercial |
$101.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$127.04
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
IP
|
$127.04
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.28 |
| 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 |
$127.04
|
| Rate for Payer: Cash Price |
$127.04
|
| 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 |
$95.28
|
| Rate for Payer: Provider Network of America Commercial |
$101.63
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
IP
|
$127.04
|
|
|
Service Code
|
NDC 00517074020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.28 |
| 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 |
$127.04
|
| Rate for Payer: Cash Price |
$127.04
|
| 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 |
$95.28
|
| Rate for Payer: Provider Network of America Commercial |
$101.63
|
|
|
methylergonovine 0.2 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
OP
|
$127.04
|
|
|
Service Code
|
NDC 00517074020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$127.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$89.56
|
| Rate for Payer: Aetna Workers' Compensation |
$89.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$88.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$88.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$100.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$100.11
|
| Rate for Payer: Cash Price |
$127.04
|
| Rate for Payer: Cigna Commercial |
$77.75
|
| Rate for Payer: Cigna Medicare Advantage |
$72.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$80.04
|
| Rate for Payer: Home State Health Plan Exchange |
$72.41
|
| Rate for Payer: Humana Medicare |
$95.28
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$95.28
|
| Rate for Payer: Provider Network of America Commercial |
$101.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$127.04
|
|
|
Methylergonovin maleate inj
|
Facility
|
IP
|
$46.96
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
Px0636J221001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| 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 |
$46.96
|
| Rate for Payer: Cash Price |
$46.96
|
| 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 |
$35.22
|
| Rate for Payer: Provider Network of America Commercial |
$37.57
|
|
|
Methylergonovin maleate inj
|
Facility
|
OP
|
$46.96
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
Px0636J221001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$46.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$33.11
|
| Rate for Payer: Aetna Workers' Compensation |
$33.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$32.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$32.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$37.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$37.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$37.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$36.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$37.00
|
| Rate for Payer: Cash Price |
$46.96
|
| Rate for Payer: Cigna Commercial |
$28.74
|
| Rate for Payer: Cigna Medicare Advantage |
$26.77
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$29.58
|
| Rate for Payer: Home State Health Plan Exchange |
$26.77
|
| Rate for Payer: Humana Medicare |
$35.22
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$35.22
|
| Rate for Payer: Provider Network of America Commercial |
$37.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$46.96
|
|
|
methylnaltrexone 12 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
IP
|
$820.96
|
|
|
Service Code
|
NDC 65649055107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$615.72 |
| 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 |
$820.96
|
| Rate for Payer: Cash Price |
$820.96
|
| 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 |
$615.72
|
| Rate for Payer: Provider Network of America Commercial |
$656.77
|
|
|
methylnaltrexone 12 mg/0.6 mL syringe 0.6 mL Syringe
|
Facility
|
OP
|
$820.96
|
|
|
Service Code
|
NDC 65649055107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$467.95 |
| Max. Negotiated Rate |
$820.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$578.78
|
| Rate for Payer: Aetna Workers' Compensation |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$568.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$568.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$646.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$646.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$646.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$632.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$646.92
|
| Rate for Payer: Cash Price |
$820.96
|
| Rate for Payer: Cigna Commercial |
$502.43
|
| Rate for Payer: Cigna Medicare Advantage |
$467.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$517.20
|
| Rate for Payer: Home State Health Plan Exchange |
$467.95
|
| Rate for Payer: Humana Medicare |
$615.72
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$615.72
|
| Rate for Payer: Provider Network of America Commercial |
$656.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$541.83
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$820.96
|
|
|
methylPREDNISolone 4 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$7.42
|
|
|
Service Code
|
HCPCS J7509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.57 |
| 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 |
$7.42
|
| Rate for Payer: Cash Price |
$7.42
|
| 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 |
$5.57
|
| Rate for Payer: Provider Network of America Commercial |
$5.94
|
|
|
methylPREDNISolone 4 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$7.42
|
|
|
Service Code
|
HCPCS J7509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.23
|
| Rate for Payer: Aetna Workers' Compensation |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5.85
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cigna Commercial |
$4.54
|
| Rate for Payer: Cigna Medicare Advantage |
$4.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4.67
|
| Rate for Payer: Home State Health Plan Exchange |
$4.23
|
| Rate for Payer: Humana Medicare |
$5.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5.57
|
| Rate for Payer: Provider Network of America Commercial |
$5.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7.42
|
|
|
methylPREDNISolone 4 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$7.42
|
|
|
Service Code
|
NDC 00904691461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.57 |
| 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 |
$7.42
|
| Rate for Payer: Cash Price |
$7.42
|
| 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 |
$5.57
|
| Rate for Payer: Provider Network of America Commercial |
$5.94
|
|
|
methylPREDNISolone 4 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$7.42
|
|
|
Service Code
|
NDC 00904691461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.23
|
| Rate for Payer: Aetna Workers' Compensation |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5.85
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cigna Commercial |
$4.54
|
| Rate for Payer: Cigna Medicare Advantage |
$4.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4.67
|
| Rate for Payer: Home State Health Plan Exchange |
$4.23
|
| Rate for Payer: Humana Medicare |
$5.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5.57
|
| Rate for Payer: Provider Network of America Commercial |
$5.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7.42
|
|
|
Methylprednisolone 80 Mg Inj
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
Px0636J104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.46 |
| 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 |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| 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 |
$59.46
|
| Rate for Payer: Provider Network of America Commercial |
$63.42
|
|
