|
Methylprednisolone 80 Mg Inj
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
Px0636J104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$79.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.89
|
| Rate for Payer: Aetna Workers' Compensation |
$55.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.47
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cigna Commercial |
$48.52
|
| Rate for Payer: Cigna Medicare Advantage |
$45.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.95
|
| Rate for Payer: Home State Health Plan Exchange |
$45.19
|
| Rate for Payer: Humana Medicare |
$59.46
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.46
|
| Rate for Payer: Provider Network of America Commercial |
$63.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.28
|
|
|
methylPREDNISolone acetate 40 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$45.44
|
|
|
Service Code
|
NDC 00009307301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.08 |
| 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 |
$45.44
|
| Rate for Payer: Cash Price |
$45.44
|
| 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 |
$34.08
|
| Rate for Payer: Provider Network of America Commercial |
$36.35
|
|
|
methylPREDNISolone acetate 40 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$45.44
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.08 |
| 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 |
$45.44
|
| Rate for Payer: Cash Price |
$45.44
|
| 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 |
$34.08
|
| Rate for Payer: Provider Network of America Commercial |
$36.35
|
|
|
methylPREDNISolone acetate 40 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$45.44
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$45.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$32.04
|
| Rate for Payer: Aetna Workers' Compensation |
$32.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.81
|
| Rate for Payer: Cash Price |
$45.44
|
| Rate for Payer: Cigna Commercial |
$27.81
|
| Rate for Payer: Cigna Medicare Advantage |
$25.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.63
|
| Rate for Payer: Home State Health Plan Exchange |
$25.90
|
| Rate for Payer: Humana Medicare |
$34.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$34.08
|
| Rate for Payer: Provider Network of America Commercial |
$36.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.44
|
|
|
methylPREDNISolone acetate 40 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$45.44
|
|
|
Service Code
|
NDC 00009307301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$45.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$32.04
|
| Rate for Payer: Aetna Workers' Compensation |
$32.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.81
|
| Rate for Payer: Cash Price |
$45.44
|
| Rate for Payer: Cigna Commercial |
$27.81
|
| Rate for Payer: Cigna Medicare Advantage |
$25.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.63
|
| Rate for Payer: Home State Health Plan Exchange |
$25.90
|
| Rate for Payer: Humana Medicare |
$34.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$34.08
|
| Rate for Payer: Provider Network of America Commercial |
$36.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.44
|
|
|
methylPREDNISolone acetate 80 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$46.02
|
| Rate for Payer: Aetna Workers' Compensation |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.44
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: Cigna Medicare Advantage |
$37.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.13
|
| Rate for Payer: Home State Health Plan Exchange |
$37.21
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.96
|
| Rate for Payer: Provider Network of America Commercial |
$52.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.28
|
|
|
methylPREDNISolone acetate 80 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.96 |
| 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 |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| 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 |
$48.96
|
| Rate for Payer: Provider Network of America Commercial |
$52.22
|
|
|
methylPREDNISolone acetate 80 mg/mL suspension 1 mL Vial
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
NDC 70121157401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$46.02
|
| Rate for Payer: Aetna Workers' Compensation |
$46.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.44
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cigna Commercial |
$39.95
|
| Rate for Payer: Cigna Medicare Advantage |
$37.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$41.13
|
| Rate for Payer: Home State Health Plan Exchange |
$37.21
|
| Rate for Payer: Humana Medicare |
$48.96
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.96
|
| Rate for Payer: Provider Network of America Commercial |
$52.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$43.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.28
|
|
|
methylPREDNISolone acetate 80 mg/mL suspension 1 mL Vial
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
NDC 70121157401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.96 |
| 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 |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| 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 |
$48.96
|
| Rate for Payer: Provider Network of America Commercial |
$52.22
|
|
|
Methylprednisolone Injection
|
Facility
|
OP
|
$76.13
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
Px0636J293001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$76.13 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.67
|
| Rate for Payer: Aetna Workers' Compensation |
$53.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.99
|
| Rate for Payer: Cash Price |
$76.13
|
| Rate for Payer: Cigna Commercial |
$46.59
|
| Rate for Payer: Cigna Medicare Advantage |
$43.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.96
|
| Rate for Payer: Home State Health Plan Exchange |
$43.39
|
| Rate for Payer: Humana Medicare |
$57.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.10
|
| Rate for Payer: Provider Network of America Commercial |
$60.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.13
|
|
|
Methylprednisolone Injection
|
Facility
|
IP
|
$76.13
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
Px0636J293001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.10 |
| 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 |
$76.13
|
| Rate for Payer: Cash Price |
$76.13
|
| 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 |
$57.10
|
| Rate for Payer: Provider Network of America Commercial |
$60.90
|
|
|
methylPREDNISolone sodium succinate (PF) 1,000 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$91.65
|
| Rate for Payer: Aetna Workers' Compensation |
$91.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$100.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$102.44
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$79.56
|
| Rate for Payer: Cigna Medicare Advantage |
$74.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$81.90
|
| Rate for Payer: Home State Health Plan Exchange |
$74.10
|
| Rate for Payer: Humana Medicare |
$97.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Provider Network of America Commercial |
$104.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$130.00
|
|
|
methylPREDNISolone sodium succinate (PF) 1,000 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
NDC 43598013074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$91.65
|
| Rate for Payer: Aetna Workers' Compensation |
$91.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$100.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$102.44
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$79.56
|
| Rate for Payer: Cigna Medicare Advantage |
$74.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$81.90
|
| Rate for Payer: Home State Health Plan Exchange |
$74.10
|
| Rate for Payer: Humana Medicare |
$97.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Provider Network of America Commercial |
$104.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$130.00
|
|
|
methylPREDNISolone sodium succinate (PF) 1,000 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
NDC 43598013074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.50 |
| 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 |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| 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 |
$97.50
|
| Rate for Payer: Provider Network of America Commercial |
$104.00
|
|
|
methylPREDNISolone sodium succinate (PF) 1,000 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.50 |
| 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 |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| 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 |
$97.50
|
| Rate for Payer: Provider Network of America Commercial |
$104.00
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 1 Each Vial
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$29.38
|
| Rate for Payer: Aetna Workers' Compensation |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$32.84
|
| Rate for Payer: Cash Price |
$41.67
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: Cigna Medicare Advantage |
$23.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$26.25
|
| Rate for Payer: Home State Health Plan Exchange |
$23.75
|
| Rate for Payer: Humana Medicare |
$31.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$31.25
|
| Rate for Payer: Provider Network of America Commercial |
$33.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$41.67
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 1 Each Vial
|
Facility
|
IP
|
$41.67
|
|
|
Service Code
|
NDC 00009004722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.25 |
| 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 |
$41.67
|
| Rate for Payer: Cash Price |
$41.67
|
| 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 |
$31.25
|
| Rate for Payer: Provider Network of America Commercial |
$33.34
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 1 Each Vial
|
Facility
|
IP
|
$41.67
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.25 |
| 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 |
$41.67
|
| Rate for Payer: Cash Price |
$41.67
|
| 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 |
$31.25
|
| Rate for Payer: Provider Network of America Commercial |
$33.34
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 1 Each Vial
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
NDC 00009004722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$29.38
|
| Rate for Payer: Aetna Workers' Compensation |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$28.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$32.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$32.84
|
| Rate for Payer: Cash Price |
$41.67
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: Cigna Medicare Advantage |
$23.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$26.25
|
| Rate for Payer: Home State Health Plan Exchange |
$23.75
|
| Rate for Payer: Humana Medicare |
$31.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$31.25
|
| Rate for Payer: Provider Network of America Commercial |
$33.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$41.67
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 2 mL Vial
|
Facility
|
IP
|
$83.34
|
|
|
Service Code
|
NDC 00009004725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.51 |
| 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 |
$83.34
|
| Rate for Payer: Cash Price |
$83.34
|
| 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 |
$62.51
|
| Rate for Payer: Provider Network of America Commercial |
$66.67
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 2 mL Vial
|
Facility
|
OP
|
$83.34
|
|
|
Service Code
|
NDC 00009004725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$58.75
|
| Rate for Payer: Aetna Workers' Compensation |
$58.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$64.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$65.67
|
| Rate for Payer: Cash Price |
$83.34
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: Cigna Medicare Advantage |
$47.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$52.50
|
| Rate for Payer: Home State Health Plan Exchange |
$47.50
|
| Rate for Payer: Humana Medicare |
$62.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$62.51
|
| Rate for Payer: Provider Network of America Commercial |
$66.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$83.34
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 2 mL Vial
|
Facility
|
IP
|
$83.34
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.51 |
| 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 |
$83.34
|
| Rate for Payer: Cash Price |
$83.34
|
| 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 |
$62.51
|
| Rate for Payer: Provider Network of America Commercial |
$66.67
|
|
|
methylPREDNISolone sod suc(PF) 125 mg/2 mL recon soln 2 mL Vial
|
Facility
|
OP
|
$83.34
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$58.75
|
| Rate for Payer: Aetna Workers' Compensation |
$58.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$65.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$64.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$65.67
|
| Rate for Payer: Cash Price |
$83.34
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: Cigna Medicare Advantage |
$47.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$52.50
|
| Rate for Payer: Home State Health Plan Exchange |
$47.50
|
| Rate for Payer: Humana Medicare |
$62.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$62.51
|
| Rate for Payer: Provider Network of America Commercial |
$66.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$83.34
|
|
|
methylPREDNISolone sod suc(PF) 40 mg/mL recon soln 1 Each Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00009003930
|
|
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
|
|
|
methylPREDNISolone sod suc(PF) 40 mg/mL recon soln 1 Each Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00009003928
|
|
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
|
|
