|
RADIOTHERAPY
|
Facility
|
IP
|
$38,045.81
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$38,045.81 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$38,045.81
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$38,045.81
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$38,045.81
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$38,045.81
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$12,734.65
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,734.65 |
| 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 |
$12,734.65
|
|
|
raloxifene 60 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 50268069411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| 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 |
$12.43
|
| Rate for Payer: Cash Price |
$12.43
|
| 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 |
$9.32
|
| Rate for Payer: Provider Network of America Commercial |
$9.94
|
|
|
raloxifene 60 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
NDC 50268069411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$8.76
|
| Rate for Payer: Aetna Workers' Compensation |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$9.79
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: Cigna Medicare Advantage |
$7.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$7.83
|
| Rate for Payer: Home State Health Plan Exchange |
$7.09
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9.32
|
| Rate for Payer: Provider Network of America Commercial |
$9.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12.43
|
|
|
raloxifene 60 mg tablet 30 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69097082502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
|
|
raloxifene 60 mg tablet 30 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 69097082502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.82
|
| Rate for Payer: Aetna Workers' Compensation |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$2.45
|
| Rate for Payer: Cigna Medicare Advantage |
$2.28
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.52
|
| Rate for Payer: Home State Health Plan Exchange |
$2.28
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Provider Network of America Commercial |
$3.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.00
|
|
|
raloxifene 60 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
NDC 50268069415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$8.76
|
| Rate for Payer: Aetna Workers' Compensation |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$9.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$9.79
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: Cigna Medicare Advantage |
$7.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$7.83
|
| Rate for Payer: Home State Health Plan Exchange |
$7.09
|
| Rate for Payer: Humana Medicare |
$9.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9.32
|
| Rate for Payer: Provider Network of America Commercial |
$9.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12.43
|
|
|
raloxifene 60 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 50268069415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| 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 |
$12.43
|
| Rate for Payer: Cash Price |
$12.43
|
| 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 |
$9.32
|
| Rate for Payer: Provider Network of America Commercial |
$9.94
|
|
|
raltegravir 400 mg tablet 10 Each Disp Pack
|
Facility
|
OP
|
$138.88
|
|
|
Service Code
|
NDC 99999131701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.16 |
| Max. Negotiated Rate |
$138.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$97.91
|
| Rate for Payer: Aetna Workers' Compensation |
$97.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$96.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$96.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$109.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$109.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$109.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$106.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$109.44
|
| Rate for Payer: Cash Price |
$138.88
|
| Rate for Payer: Cigna Commercial |
$84.99
|
| Rate for Payer: Cigna Medicare Advantage |
$79.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$87.49
|
| Rate for Payer: Home State Health Plan Exchange |
$79.16
|
| Rate for Payer: Humana Medicare |
$104.16
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.16
|
| Rate for Payer: Provider Network of America Commercial |
$111.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$138.88
|
|
|
raltegravir 400 mg tablet 10 Each Disp Pack
|
Facility
|
IP
|
$138.88
|
|
|
Service Code
|
NDC 99999131701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.16 |
| 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 |
$138.88
|
| Rate for Payer: Cash Price |
$138.88
|
| 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 |
$104.16
|
| Rate for Payer: Provider Network of America Commercial |
$111.10
|
|
|
raltegravir 400 mg tablet 60 Each Bottle
|
Facility
|
IP
|
$142.08
|
|
|
Service Code
|
NDC 00006022761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.56 |
| 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 |
$142.08
|
| Rate for Payer: Cash Price |
$142.08
|
| 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 |
$106.56
|
| Rate for Payer: Provider Network of America Commercial |
$113.66
|
|
|
raltegravir 400 mg tablet 60 Each Bottle
|
Facility
|
OP
|
$142.08
|
|
|
Service Code
|
NDC 00006022761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.17
|
| Rate for Payer: Aetna Workers' Compensation |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.96
|
| Rate for Payer: Cash Price |
$142.08
|
| Rate for Payer: Cigna Commercial |
$86.95
|
| Rate for Payer: Cigna Medicare Advantage |
$80.99
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.51
|
| Rate for Payer: Home State Health Plan Exchange |
$80.99
|
| Rate for Payer: Humana Medicare |
$106.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.56
|
| Rate for Payer: Provider Network of America Commercial |
$113.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$142.08
|
|
|
ramucirumab per 5 mg
|
Facility
|
IP
|
$30,465.96
|
|
|
Service Code
|
HCPCS J9308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,372.77 |
| 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 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 |
$6,093.20
|
| Rate for Payer: Cash Price |
$6,093.20
|
| Rate for Payer: Cash Price |
$30,465.96
|
| Rate for Payer: Cash Price |
$30,465.96
|
| 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 |
$4,569.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22,849.47
|
| Rate for Payer: Provider Network of America Commercial |
$24,372.77
|
| Rate for Payer: Provider Network of America Commercial |
$4,874.56
|
|
|
ramucirumab per 5 mg
|
Facility
|
OP
|
$30,465.96
|
|
|
Service Code
|
NDC 00002767801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17,365.60 |
| Max. Negotiated Rate |
$30,465.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21,478.50
|
| Rate for Payer: Aetna Workers' Compensation |
$21,478.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$21,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$21,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23,458.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$24,007.18
|
| Rate for Payer: Cash Price |
$30,465.96
|
| Rate for Payer: Cigna Commercial |
$18,645.17
|
| Rate for Payer: Cigna Medicare Advantage |
$17,365.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$19,193.55
|
| Rate for Payer: Home State Health Plan Exchange |
$17,365.60
|
| Rate for Payer: Humana Medicare |
$22,849.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22,849.47
|
| Rate for Payer: Provider Network of America Commercial |
$24,372.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,107.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30,465.96
|
|
|
ramucirumab per 5 mg
|
Facility
|
IP
|
$6,093.20
|
|
|
Service Code
|
NDC 00002766901
|
|
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 |
$6,093.20
|
| Rate for Payer: Cash Price |
$6,093.20
|
| 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 |
$4,569.90
|
| Rate for Payer: Provider Network of America Commercial |
$4,874.56
|
|
|
ramucirumab per 5 mg
|
Facility
|
OP
|
$30,465.96
|
|
|
Service Code
|
HCPCS J9308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17,365.60 |
| Max. Negotiated Rate |
$30,465.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21,478.50
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,295.71
|
| Rate for Payer: Aetna Workers' Compensation |
$21,478.50
|
| Rate for Payer: Aetna Workers' Compensation |
$4,295.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$21,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,222.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$21,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,222.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$24,007.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23,458.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,691.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$24,007.18
|
| Rate for Payer: Cash Price |
$6,093.20
|
| Rate for Payer: Cash Price |
$30,465.96
|
| Rate for Payer: Cigna Commercial |
$18,645.17
|
| Rate for Payer: Cigna Commercial |
$3,729.04
|
| Rate for Payer: Cigna Medicare Advantage |
$17,365.60
|
| Rate for Payer: Cigna Medicare Advantage |
$3,473.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$19,193.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,838.72
|
| Rate for Payer: Home State Health Plan Exchange |
$17,365.60
|
| Rate for Payer: Home State Health Plan Exchange |
$3,473.12
|
| Rate for Payer: Humana Medicare |
$22,849.47
|
| Rate for Payer: Humana Medicare |
$4,569.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22,849.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,569.90
|
| Rate for Payer: Provider Network of America Commercial |
$24,372.77
|
| Rate for Payer: Provider Network of America Commercial |
$4,874.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$20,107.53
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,021.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30,465.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,093.20
|
|
|
ramucirumab per 5 mg
|
Facility
|
OP
|
$6,093.20
|
|
|
Service Code
|
NDC 00002766901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,473.12 |
| Max. Negotiated Rate |
$6,093.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,295.71
|
| Rate for Payer: Aetna Workers' Compensation |
$4,295.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,222.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,222.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,801.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,691.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,801.44
|
| Rate for Payer: Cash Price |
$6,093.20
|
| Rate for Payer: Cigna Commercial |
$3,729.04
|
| Rate for Payer: Cigna Medicare Advantage |
$3,473.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,838.72
|
| Rate for Payer: Home State Health Plan Exchange |
$3,473.12
|
| Rate for Payer: Humana Medicare |
$4,569.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,569.90
|
| Rate for Payer: Provider Network of America Commercial |
$4,874.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,021.51
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,093.20
|
|
|
ramucirumab per 5 mg
|
Facility
|
IP
|
$30,465.96
|
|
|
Service Code
|
NDC 00002767801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$24,372.77 |
| 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: Cash Price |
$30,465.96
|
| Rate for Payer: Cash Price |
$30,465.96
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22,849.47
|
| Rate for Payer: Provider Network of America Commercial |
$24,372.77
|
|
|
Ranitidine hydrochloride inj
|
Facility
|
IP
|
$67.20
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
Px0636J278001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.40 |
| 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 |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| 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 |
$50.40
|
| Rate for Payer: Provider Network of America Commercial |
$53.76
|
|
|
Ranitidine hydrochloride inj
|
Facility
|
OP
|
$67.20
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
Px0636J278001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.30 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$47.38
|
| Rate for Payer: Aetna Workers' Compensation |
$47.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$52.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$52.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$52.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$51.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$52.95
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$41.13
|
| Rate for Payer: Cigna Medicare Advantage |
$38.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$42.34
|
| Rate for Payer: Home State Health Plan Exchange |
$38.30
|
| Rate for Payer: Humana Medicare |
$50.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$50.40
|
| Rate for Payer: Provider Network of America Commercial |
$53.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$67.20
|
|
|
ranolazine 500 mg tablet extended release 12 hr 1 Each BLIST PACK
|
Facility
|
IP
|
$6.31
|
|
|
Service Code
|
NDC 50268072211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.73 |
| 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 |
$6.31
|
| Rate for Payer: Cash Price |
$6.31
|
| 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 |
$4.73
|
| Rate for Payer: Provider Network of America Commercial |
$5.05
|
|
|
ranolazine 500 mg tablet extended release 12 hr 1 Each BLIST PACK
|
Facility
|
OP
|
$5.60
|
|
|
Service Code
|
NDC 60687054911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.95
|
| Rate for Payer: Aetna Workers' Compensation |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.41
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$3.43
|
| Rate for Payer: Cigna Medicare Advantage |
$3.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.53
|
| Rate for Payer: Home State Health Plan Exchange |
$3.19
|
| Rate for Payer: Humana Medicare |
$4.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.20
|
| Rate for Payer: Provider Network of America Commercial |
$4.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.60
|
|
|
ranolazine 500 mg tablet extended release 12 hr 1 Each BLIST PACK
|
Facility
|
IP
|
$5.60
|
|
|
Service Code
|
NDC 60687054911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| 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 |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| 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 |
$4.20
|
| Rate for Payer: Provider Network of America Commercial |
$4.48
|
|
|
ranolazine 500 mg tablet extended release 12 hr 1 Each BLIST PACK
|
Facility
|
OP
|
$6.31
|
|
|
Service Code
|
NDC 50268072211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.45
|
| Rate for Payer: Aetna Workers' Compensation |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.97
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: Cigna Medicare Advantage |
$3.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.98
|
| Rate for Payer: Home State Health Plan Exchange |
$3.60
|
| Rate for Payer: Humana Medicare |
$4.73
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.73
|
| Rate for Payer: Provider Network of America Commercial |
$5.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.31
|
|
|
Recmpl Wnd Head,Fac,Hand 1.1-2.5 Cm
|
Facility
|
OP
|
$584.85
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
Px03601313101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.36 |
| Max. Negotiated Rate |
$584.85 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$405.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$405.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$460.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$460.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$460.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$450.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$460.86
|
| Rate for Payer: Cash Price |
$584.85
|
| Rate for Payer: Cash Price |
$584.85
|
| Rate for Payer: Cigna Commercial |
$387.76
|
| Rate for Payer: Cigna Medicare Advantage |
$333.36
|
| Rate for Payer: Family Health Partners Medicaid |
$513.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$368.46
|
| Rate for Payer: Healthy Blue Medicaid |
$554.07
|
| Rate for Payer: Home State Health Plan Exchange |
$333.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$513.03
|
| Rate for Payer: Humana Medicare |
$438.64
|
| Rate for Payer: Mercy CarePlus Medicaid |
$513.03
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$438.64
|
| Rate for Payer: Provider Network of America Commercial |
$467.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$386.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$584.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.24
|
|
