|
Darbepoetin alfa, non-esrd
|
Facility
|
IP
|
$3,734.33
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
Px0636J088101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| 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 |
$3,734.33
|
| Rate for Payer: Cash Price |
$3,734.33
|
| 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 |
$2,800.75
|
| Rate for Payer: Provider Network of America Commercial |
$2,987.46
|
|
|
Darbepoetin alfa, non-esrd
|
Facility
|
OP
|
$3,734.33
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
Px0636J088101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,128.57 |
| Max. Negotiated Rate |
$3,734.33 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,632.70
|
| Rate for Payer: Aetna Workers' Compensation |
$2,632.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,587.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,587.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,942.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,942.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,942.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,875.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,942.65
|
| Rate for Payer: Cash Price |
$3,734.33
|
| Rate for Payer: Cigna Commercial |
$2,285.41
|
| Rate for Payer: Cigna Medicare Advantage |
$2,128.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,352.63
|
| Rate for Payer: Home State Health Plan Exchange |
$2,128.57
|
| Rate for Payer: Humana Medicare |
$2,800.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,800.75
|
| Rate for Payer: Provider Network of America Commercial |
$2,987.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,464.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,734.33
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$9,630.77
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,630.77 |
| 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 |
$9,630.77
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$875.00 |
| 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 Freedom Network |
$4,846.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,846.00
|
| 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 |
$5,346.25
|
|
|
Debridement, Infected Skin, Up to 10% Bsa
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
Px07611100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.25 |
| 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 |
$1,163.00
|
| Rate for Payer: Cash Price |
$1,163.00
|
| 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 |
$872.25
|
| Rate for Payer: Provider Network of America Commercial |
$930.40
|
|
|
Debridement, Infected Skin, Up to 10% Bsa
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
Px07611100001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.24 |
| Max. Negotiated Rate |
$1,163.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$819.91
|
| Rate for Payer: Aetna Workers' Compensation |
$819.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$805.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$805.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$916.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$916.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$916.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$895.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$916.44
|
| Rate for Payer: Cash Price |
$1,163.00
|
| Rate for Payer: Cash Price |
$1,163.00
|
| Rate for Payer: Cigna Commercial |
$711.76
|
| Rate for Payer: Cigna Medicare Advantage |
$662.91
|
| Rate for Payer: Family Health Partners Medicaid |
$513.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$732.69
|
| Rate for Payer: Healthy Blue Medicaid |
$554.07
|
| Rate for Payer: Home State Health Plan Exchange |
$662.91
|
| Rate for Payer: Home State Health Plan Medicaid |
$513.03
|
| Rate for Payer: Humana Medicare |
$872.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$513.03
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$872.25
|
| Rate for Payer: Provider Network of America Commercial |
$930.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$767.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,163.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.24
|
|
|
Debridement Mastoidectomy Cavity Simple
|
Facility
|
OP
|
$131.25
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
Px09826922001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$74.81 |
| Max. Negotiated Rate |
$273.46 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$92.53
|
| Rate for Payer: Aetna Workers' Compensation |
$92.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$90.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$90.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$103.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$103.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$103.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$101.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$103.42
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Cigna Commercial |
$80.33
|
| Rate for Payer: Cigna Medicare Advantage |
$74.81
|
| Rate for Payer: Family Health Partners Medicaid |
$253.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$82.69
|
| Rate for Payer: Healthy Blue Medicaid |
$273.46
|
| Rate for Payer: Home State Health Plan Exchange |
$74.81
|
| Rate for Payer: Home State Health Plan Medicaid |
$253.20
|
| Rate for Payer: Humana Medicare |
$98.44
|
| Rate for Payer: Mercy CarePlus Medicaid |
$253.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$98.44
|
| Rate for Payer: Provider Network of America Commercial |
$105.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$86.62
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$131.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.63
|
|
|
Debridement Mastoidectomy Cavity Simple
|
Facility
|
IP
|
$131.25
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
Px09826922001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$98.44 |
| 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 |
$131.25
|
| Rate for Payer: Cash Price |
$131.25
|
| 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 |
$98.44
|
| Rate for Payer: Provider Network of America Commercial |
$105.00
|
|
|
Debridement, Skin, Sub-Q Tissue,=<20 Sq Cm
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
Px07611104201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| 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 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 |
$1,307.25
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$1,307.25
|
| 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 |
$720.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$980.44
|
| Rate for Payer: Provider Network of America Commercial |
$768.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,045.80
|
|
|
Debridement, Skin, Sub-Q Tissue,=<20 Sq Cm
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
Px07611104201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.24 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$676.80
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$921.61
|
| Rate for Payer: Aetna Workers' Compensation |
$676.80
|
| Rate for Payer: Aetna Workers' Compensation |
$921.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$665.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$905.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$665.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$905.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$756.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,030.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$756.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,030.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,030.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$756.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,006.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$739.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$756.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,030.11
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cash Price |
$1,307.25
|
| Rate for Payer: Cigna Commercial |
$587.52
|
| Rate for Payer: Cigna Commercial |
$800.04
|
| Rate for Payer: Cigna Medicare Advantage |
$745.13
|
| Rate for Payer: Cigna Medicare Advantage |
$547.20
|
| Rate for Payer: Family Health Partners Medicaid |
$513.03
|
| Rate for Payer: Family Health Partners Medicaid |
$513.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$604.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$823.57
|
| Rate for Payer: Healthy Blue Medicaid |
$554.07
|
| Rate for Payer: Healthy Blue Medicaid |
$554.07
|
| Rate for Payer: Home State Health Plan Exchange |
$547.20
|
| Rate for Payer: Home State Health Plan Exchange |
$745.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$513.03
|
| Rate for Payer: Home State Health Plan Medicaid |
$513.03
|
| Rate for Payer: Humana Medicare |
$980.44
|
| Rate for Payer: Humana Medicare |
$720.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$513.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$513.03
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$980.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$720.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,045.80
|
| Rate for Payer: Provider Network of America Commercial |
$768.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$862.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$633.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,307.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$960.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.24
|
|
|
Decitabine injection
|
Facility
|
OP
|
$5,408.55
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
Px0636J089401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,082.87 |
| Max. Negotiated Rate |
$5,408.55 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3,813.03
|
| Rate for Payer: Aetna Workers' Compensation |
$3,813.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,748.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,748.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,261.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,261.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,261.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,164.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,261.94
|
| Rate for Payer: Cash Price |
$5,408.55
|
| Rate for Payer: Cigna Commercial |
$3,310.03
|
| Rate for Payer: Cigna Medicare Advantage |
$3,082.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,407.39
|
| Rate for Payer: Home State Health Plan Exchange |
$3,082.87
|
| Rate for Payer: Humana Medicare |
$4,056.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,056.41
|
| Rate for Payer: Provider Network of America Commercial |
$4,326.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,569.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,408.55
|
|
|
Decitabine injection
|
Facility
|
IP
|
$5,408.55
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
Px0636J089401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| 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 |
$5,408.55
|
| Rate for Payer: Cash Price |
$5,408.55
|
| 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 |
$4,056.41
|
| Rate for Payer: Provider Network of America Commercial |
$4,326.84
|
|
|
decitabine per 1 mg
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS J0894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$594.00 |
| 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 |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| 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 |
$594.00
|
| Rate for Payer: Provider Network of America Commercial |
$633.60
|
|
|
decitabine per 1 mg
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS J0894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$558.36
|
| Rate for Payer: Aetna Workers' Compensation |
$558.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$548.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$548.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$609.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$624.10
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$484.70
|
| Rate for Payer: Cigna Medicare Advantage |
$451.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$498.96
|
| Rate for Payer: Home State Health Plan Exchange |
$451.44
|
| Rate for Payer: Humana Medicare |
$594.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Provider Network of America Commercial |
$633.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$522.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$792.00
|
|
|
decitabine per 1 mg
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
NDC 72205003601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$594.00 |
| 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 |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| 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 |
$594.00
|
| Rate for Payer: Provider Network of America Commercial |
$633.60
|
|
|
decitabine per 1 mg
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
NDC 72205003601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$558.36
|
| Rate for Payer: Aetna Workers' Compensation |
$558.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$548.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$548.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$624.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$609.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$624.10
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$484.70
|
| Rate for Payer: Cigna Medicare Advantage |
$451.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$498.96
|
| Rate for Payer: Home State Health Plan Exchange |
$451.44
|
| Rate for Payer: Humana Medicare |
$594.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Provider Network of America Commercial |
$633.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$522.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$792.00
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$48,344.95
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$48,344.95 |
| 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 |
$48,344.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$48,344.95
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$48,344.95
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$48,344.95
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$39,101.61
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$39,101.61 |
| 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 |
$39,101.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$39,101.61
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$39,101.61
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$39,101.61
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$63,457.14
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$63,457.14 |
| 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 |
$63,457.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$63,457.14
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$63,457.14
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$63,457.14
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$32,999.78
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$32,999.78 |
| 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 |
$32,999.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$32,999.78
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$32,999.78
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32,999.78
|
|
|
degarelix 80 mg recon soln 1 Each KIT
|
Facility
|
OP
|
$1,953.80
|
|
|
Service Code
|
HCPCS J9155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,113.67 |
| Max. Negotiated Rate |
$1,953.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,377.43
|
| Rate for Payer: Aetna Workers' Compensation |
$1,377.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,353.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,353.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,504.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,539.59
|
| Rate for Payer: Cash Price |
$1,953.80
|
| Rate for Payer: Cigna Commercial |
$1,195.73
|
| Rate for Payer: Cigna Medicare Advantage |
$1,113.67
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,230.89
|
| Rate for Payer: Home State Health Plan Exchange |
$1,113.67
|
| Rate for Payer: Humana Medicare |
$1,465.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,465.35
|
| Rate for Payer: Provider Network of America Commercial |
$1,563.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,289.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,953.80
|
|
|
degarelix 80 mg recon soln 1 Each KIT
|
Facility
|
IP
|
$1,953.80
|
|
|
Service Code
|
HCPCS J9155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| 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 |
$1,953.80
|
| Rate for Payer: Cash Price |
$1,953.80
|
| 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 |
$1,465.35
|
| Rate for Payer: Provider Network of America Commercial |
$1,563.04
|
|
|
degarelix 80 mg recon soln 1 Each KIT
|
Facility
|
OP
|
$1,953.80
|
|
|
Service Code
|
NDC 55566830301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,113.67 |
| Max. Negotiated Rate |
$1,953.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,377.43
|
| Rate for Payer: Aetna Workers' Compensation |
$1,377.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,353.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,353.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,539.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,504.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,539.59
|
| Rate for Payer: Cash Price |
$1,953.80
|
| Rate for Payer: Cigna Commercial |
$1,195.73
|
| Rate for Payer: Cigna Medicare Advantage |
$1,113.67
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,230.89
|
| Rate for Payer: Home State Health Plan Exchange |
$1,113.67
|
| Rate for Payer: Humana Medicare |
$1,465.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,465.35
|
| Rate for Payer: Provider Network of America Commercial |
$1,563.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,289.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,953.80
|
|
|
degarelix 80 mg recon soln 1 Each KIT
|
Facility
|
IP
|
$1,953.80
|
|
|
Service Code
|
NDC 55566830301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| 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 |
$1,953.80
|
| Rate for Payer: Cash Price |
$1,953.80
|
| 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 |
$1,465.35
|
| Rate for Payer: Provider Network of America Commercial |
$1,563.04
|
|
|
Degarelix injection
|
Facility
|
OP
|
$2,324.07
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
Px0636J915501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.72 |
| Max. Negotiated Rate |
$2,324.07 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,638.47
|
| Rate for Payer: Aetna Workers' Compensation |
$1,638.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,610.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,610.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,789.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,831.37
|
| Rate for Payer: Cash Price |
$2,324.07
|
| Rate for Payer: Cigna Commercial |
$1,422.33
|
| Rate for Payer: Cigna Medicare Advantage |
$1,324.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,464.16
|
| Rate for Payer: Home State Health Plan Exchange |
$1,324.72
|
| Rate for Payer: Humana Medicare |
$1,743.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,743.05
|
| Rate for Payer: Provider Network of America Commercial |
$1,859.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,533.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,324.07
|
|
