|
PACLitaxel 6 mg/mL concentrate 16.7 mL Vial
|
Facility
|
IP
|
$112.76
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.57 |
| 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 |
$112.76
|
| Rate for Payer: Cash Price |
$112.76
|
| 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 |
$84.57
|
| Rate for Payer: Provider Network of America Commercial |
$90.21
|
|
|
PACLitaxel 6 mg/mL concentrate 16.7 mL Vial
|
Facility
|
OP
|
$112.76
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$79.50
|
| Rate for Payer: Aetna Workers' Compensation |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$86.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$88.85
|
| Rate for Payer: Cash Price |
$112.76
|
| Rate for Payer: Cigna Commercial |
$69.01
|
| Rate for Payer: Cigna Medicare Advantage |
$64.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$71.04
|
| Rate for Payer: Home State Health Plan Exchange |
$64.27
|
| Rate for Payer: Humana Medicare |
$84.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.57
|
| Rate for Payer: Provider Network of America Commercial |
$90.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$112.76
|
|
|
PACLitaxel 6 mg/mL concentrate 16.7 mL Vial
|
Facility
|
IP
|
$112.76
|
|
|
Service Code
|
NDC 70860020017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.57 |
| 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 |
$112.76
|
| Rate for Payer: Cash Price |
$112.76
|
| 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 |
$84.57
|
| Rate for Payer: Provider Network of America Commercial |
$90.21
|
|
|
PACLitaxel 6 mg/mL concentrate 16.7 mL Vial
|
Facility
|
OP
|
$112.76
|
|
|
Service Code
|
NDC 70860020017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$112.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$79.50
|
| Rate for Payer: Aetna Workers' Compensation |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$78.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$88.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$86.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$88.85
|
| Rate for Payer: Cash Price |
$112.76
|
| Rate for Payer: Cigna Commercial |
$69.01
|
| Rate for Payer: Cigna Medicare Advantage |
$64.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$71.04
|
| Rate for Payer: Home State Health Plan Exchange |
$64.27
|
| Rate for Payer: Humana Medicare |
$84.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$84.57
|
| Rate for Payer: Provider Network of America Commercial |
$90.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$74.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$112.76
|
|
|
PACLitaxel 6 mg/mL concentrate 50 mL Vial
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
NDC 70860020050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$169.20
|
| Rate for Payer: Aetna Workers' Compensation |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$189.12
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$146.88
|
| Rate for Payer: Cigna Medicare Advantage |
$136.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$151.20
|
| Rate for Payer: Home State Health Plan Exchange |
$136.80
|
| Rate for Payer: Humana Medicare |
$180.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$180.00
|
| Rate for Payer: Provider Network of America Commercial |
$192.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$158.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$240.00
|
|
|
PACLitaxel 6 mg/mL concentrate 50 mL Vial
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
NDC 70860020050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.00 |
| 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 |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| 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 |
$180.00
|
| Rate for Payer: Provider Network of America Commercial |
$192.00
|
|
|
PACLitaxel 6 mg/mL concentrate 50 mL Vial
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$169.20
|
| Rate for Payer: Aetna Workers' Compensation |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$166.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$189.12
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$146.88
|
| Rate for Payer: Cigna Medicare Advantage |
$136.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$151.20
|
| Rate for Payer: Home State Health Plan Exchange |
$136.80
|
| Rate for Payer: Humana Medicare |
$180.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$180.00
|
| Rate for Payer: Provider Network of America Commercial |
$192.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$158.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$240.00
|
|
|
PACLitaxel 6 mg/mL concentrate 50 mL Vial
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.00 |
| 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 |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| 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 |
$180.00
|
| Rate for Payer: Provider Network of America Commercial |
$192.00
|
|
|
PACLitaxel 6 mg/mL concentrate 5 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 70860020005
|
|
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
|
|
|
PACLitaxel 6 mg/mL concentrate 5 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J9267
|
|
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
|
|
|
PACLitaxel 6 mg/mL concentrate 5 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 70860020005
|
|
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
|
|
|
PACLitaxel 6 mg/mL concentrate 5 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J9267
|
|
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
|
|
|
Paclitaxel injection
|
Facility
|
OP
|
$106.72
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
Px0636J926701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.83 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.24
|
| Rate for Payer: Aetna Workers' Compensation |
$75.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.10
|
| Rate for Payer: Cash Price |
$106.72
|
| Rate for Payer: Cigna Commercial |
$65.31
|
| Rate for Payer: Cigna Medicare Advantage |
$60.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.23
|
| Rate for Payer: Home State Health Plan Exchange |
$60.83
|
| Rate for Payer: Humana Medicare |
$80.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.04
|
| Rate for Payer: Provider Network of America Commercial |
$85.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$106.72
|
|
|
Paclitaxel injection
|
Facility
|
IP
|
$106.72
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
Px0636J926701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.04 |
| 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 |
$106.72
|
| Rate for Payer: Cash Price |
$106.72
|
| 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 |
$80.04
|
| Rate for Payer: Provider Network of America Commercial |
$85.38
|
|
|
palonosetron 0.25 mg/5 mL solution 5 mL Vial
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.00 |
| 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 |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| 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 |
$105.00
|
| Rate for Payer: Provider Network of America Commercial |
$112.00
|
|
|
palonosetron 0.25 mg/5 mL solution 5 mL Vial
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
NDC 00781331275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$98.70
|
| Rate for Payer: Aetna Workers' Compensation |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$110.32
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$85.68
|
| Rate for Payer: Cigna Medicare Advantage |
$79.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$88.20
|
| Rate for Payer: Home State Health Plan Exchange |
$79.80
|
| Rate for Payer: Humana Medicare |
$105.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Provider Network of America Commercial |
$112.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$92.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$140.00
|
|
|
palonosetron 0.25 mg/5 mL solution 5 mL Vial
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 00781331275
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.00 |
| 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 |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| 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 |
$105.00
|
| Rate for Payer: Provider Network of America Commercial |
$112.00
|
|
|
palonosetron 0.25 mg/5 mL solution 5 mL Vial
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$98.70
|
| Rate for Payer: Aetna Workers' Compensation |
$98.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$110.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$110.32
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$85.68
|
| Rate for Payer: Cigna Medicare Advantage |
$79.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$88.20
|
| Rate for Payer: Home State Health Plan Exchange |
$79.80
|
| Rate for Payer: Humana Medicare |
$105.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Provider Network of America Commercial |
$112.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$92.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$140.00
|
|
|
Palonosetron hcl
|
Facility
|
OP
|
$28.54
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
Px0636J246901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$28.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$20.12
|
| Rate for Payer: Aetna Workers' Compensation |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$22.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$22.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$22.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$21.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$22.49
|
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Cigna Commercial |
$17.47
|
| Rate for Payer: Cigna Medicare Advantage |
$16.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$17.98
|
| Rate for Payer: Home State Health Plan Exchange |
$16.27
|
| Rate for Payer: Humana Medicare |
$21.41
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$21.41
|
| Rate for Payer: Provider Network of America Commercial |
$22.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.84
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$28.54
|
|
|
Palonosetron hcl
|
Facility
|
IP
|
$28.54
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
Px0636J246901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.41 |
| 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 |
$28.54
|
| Rate for Payer: Cash Price |
$28.54
|
| 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 |
$21.41
|
| Rate for Payer: Provider Network of America Commercial |
$22.83
|
|
|
Pamidronate disodium /30 mg
|
Facility
|
OP
|
$1,014.83
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
Px0636J243001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$578.45 |
| Max. Negotiated Rate |
$1,014.83 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$715.46
|
| Rate for Payer: Aetna Workers' Compensation |
$715.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$703.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$703.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$799.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$799.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$799.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$781.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$799.69
|
| Rate for Payer: Cash Price |
$1,014.83
|
| Rate for Payer: Cigna Commercial |
$621.08
|
| Rate for Payer: Cigna Medicare Advantage |
$578.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$639.34
|
| Rate for Payer: Home State Health Plan Exchange |
$578.45
|
| Rate for Payer: Humana Medicare |
$761.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$761.12
|
| Rate for Payer: Provider Network of America Commercial |
$811.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$669.79
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,014.83
|
|
|
Pamidronate disodium /30 mg
|
Facility
|
IP
|
$1,014.83
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
Px0636J243001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$761.12 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$1,014.83
|
| Rate for Payer: Cash Price |
$1,014.83
|
| 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 |
$761.12
|
| Rate for Payer: Provider Network of America Commercial |
$811.86
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$13,630.94
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,630.94 |
| 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 |
$13,630.94
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$25,711.35
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$25,711.35 |
| 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 |
$25,711.35
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$10,432.12
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,432.12 |
| 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 |
$10,432.12
|
|
