|
tbo-filgrastim 300 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$999.44
|
|
|
Service Code
|
NDC 63459091001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$569.68 |
| Max. Negotiated Rate |
$999.44 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$704.61
|
| Rate for Payer: Aetna Workers' Compensation |
$704.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$692.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$692.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$787.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$787.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$787.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$769.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$787.56
|
| Rate for Payer: Cash Price |
$999.44
|
| Rate for Payer: Cigna Commercial |
$611.66
|
| Rate for Payer: Cigna Medicare Advantage |
$569.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$629.65
|
| Rate for Payer: Home State Health Plan Exchange |
$569.68
|
| Rate for Payer: Humana Medicare |
$749.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$749.58
|
| Rate for Payer: Provider Network of America Commercial |
$799.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$659.63
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$999.44
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
IP
|
$1,599.56
|
|
|
Service Code
|
HCPCS J1447
|
|
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 |
$1,599.56
|
| Rate for Payer: Cash Price |
$1,599.56
|
| 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 |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
IP
|
$1,599.56
|
|
|
Service Code
|
NDC 63459091211
|
|
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 |
$1,599.56
|
| Rate for Payer: Cash Price |
$1,599.56
|
| 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 |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
OP
|
$1,599.56
|
|
|
Service Code
|
NDC 63459091201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$911.75 |
| Max. Negotiated Rate |
$1,599.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,127.69
|
| Rate for Payer: Aetna Workers' Compensation |
$1,127.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,231.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,599.56
|
| Rate for Payer: Cigna Commercial |
$978.93
|
| Rate for Payer: Cigna Medicare Advantage |
$911.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,007.72
|
| Rate for Payer: Home State Health Plan Exchange |
$911.75
|
| Rate for Payer: Humana Medicare |
$1,199.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,055.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,599.56
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
OP
|
$1,599.56
|
|
|
Service Code
|
NDC 63459091211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$911.75 |
| Max. Negotiated Rate |
$1,599.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,127.69
|
| Rate for Payer: Aetna Workers' Compensation |
$1,127.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,231.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,599.56
|
| Rate for Payer: Cigna Commercial |
$978.93
|
| Rate for Payer: Cigna Medicare Advantage |
$911.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,007.72
|
| Rate for Payer: Home State Health Plan Exchange |
$911.75
|
| Rate for Payer: Humana Medicare |
$1,199.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,055.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,599.56
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
IP
|
$1,599.56
|
|
|
Service Code
|
NDC 63459091201
|
|
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 |
$1,599.56
|
| Rate for Payer: Cash Price |
$1,599.56
|
| 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 |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
|
|
tbo-filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
OP
|
$1,599.56
|
|
|
Service Code
|
HCPCS J1447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$911.75 |
| Max. Negotiated Rate |
$1,599.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,127.69
|
| Rate for Payer: Aetna Workers' Compensation |
$1,127.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,108.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,260.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,231.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,260.45
|
| Rate for Payer: Cash Price |
$1,599.56
|
| Rate for Payer: Cigna Commercial |
$978.93
|
| Rate for Payer: Cigna Medicare Advantage |
$911.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,007.72
|
| Rate for Payer: Home State Health Plan Exchange |
$911.75
|
| Rate for Payer: Humana Medicare |
$1,199.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,199.67
|
| Rate for Payer: Provider Network of America Commercial |
$1,279.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,055.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,599.56
|
|
|
Tdap Vaccine >7 Yo, Im
|
Facility
|
OP
|
$132.04
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
Px06369071501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$93.09
|
| Rate for Payer: Aetna Workers' Compensation |
$93.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$104.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$104.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$104.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$101.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$104.05
|
| Rate for Payer: Cash Price |
$132.04
|
| Rate for Payer: Cash Price |
$132.04
|
| Rate for Payer: Cigna Commercial |
$80.81
|
| Rate for Payer: Cigna Medicare Advantage |
$75.26
|
| Rate for Payer: Family Health Partners Medicaid |
$33.88
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$83.19
|
| Rate for Payer: Healthy Blue Medicaid |
$36.59
|
| Rate for Payer: Home State Health Plan Exchange |
$75.26
|
| Rate for Payer: Home State Health Plan Medicaid |
$33.88
|
| Rate for Payer: Humana Medicare |
$99.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$33.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$99.03
|
| Rate for Payer: Provider Network of America Commercial |
$105.63
|
| Rate for Payer: UnitedHealthcare Commercial |
$87.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$132.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.51
|
|
|
Tdap Vaccine >7 Yo, Im
|
Facility
|
IP
|
$132.04
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
Px06369071501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.03 |
| 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 |
$132.04
|
| Rate for Payer: Cash Price |
$132.04
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$99.03
|
| Rate for Payer: Provider Network of America Commercial |
$105.63
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$195.31
|
|
|
Service Code
|
NDC 49281040020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$137.69
|
| Rate for Payer: Aetna Workers' Compensation |
$137.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$153.90
|
| Rate for Payer: Cash Price |
$195.31
|
| Rate for Payer: Cigna Commercial |
$119.53
|
| Rate for Payer: Cigna Medicare Advantage |
$111.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$123.05
|
| Rate for Payer: Home State Health Plan Exchange |
$111.33
|
| Rate for Payer: Humana Medicare |
$146.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$146.48
|
| Rate for Payer: Provider Network of America Commercial |
$156.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$128.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$195.31
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$195.32
|
|
|
Service Code
|
NDC 49281040089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.49 |
| 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 |
$195.32
|
| Rate for Payer: Cash Price |
$195.32
|
| 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 |
$146.49
|
| Rate for Payer: Provider Network of America Commercial |
$156.26
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$195.32
|
|
|
Service Code
|
NDC 49281040089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.33 |
| Max. Negotiated Rate |
$195.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$137.70
|
| Rate for Payer: Aetna Workers' Compensation |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$153.91
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cigna Commercial |
$119.54
|
| Rate for Payer: Cigna Medicare Advantage |
$111.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$123.05
|
| Rate for Payer: Home State Health Plan Exchange |
$111.33
|
| Rate for Payer: Humana Medicare |
$146.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$146.49
|
| Rate for Payer: Provider Network of America Commercial |
$156.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$128.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$195.32
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$195.31
|
|
|
Service Code
|
NDC 49281040020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.48 |
| 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 |
$195.31
|
| Rate for Payer: Cash Price |
$195.31
|
| 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 |
$146.48
|
| Rate for Payer: Provider Network of America Commercial |
$156.25
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$195.31
|
|
|
Service Code
|
CPT 90715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.48 |
| 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 |
$195.32
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cash Price |
$195.31
|
| Rate for Payer: Cash Price |
$195.31
|
| 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 |
$146.49
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$146.48
|
| Rate for Payer: Provider Network of America Commercial |
$156.25
|
| Rate for Payer: Provider Network of America Commercial |
$156.26
|
|
|
Tdap vaccine (PF) 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$195.31
|
|
|
Service Code
|
CPT 90715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$137.69
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$137.70
|
| Rate for Payer: Aetna Workers' Compensation |
$137.70
|
| Rate for Payer: Aetna Workers' Compensation |
$137.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$135.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$135.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$153.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$153.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$153.91
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cash Price |
$195.31
|
| Rate for Payer: Cash Price |
$195.31
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cigna Commercial |
$119.54
|
| Rate for Payer: Cigna Commercial |
$119.53
|
| Rate for Payer: Cigna Medicare Advantage |
$111.33
|
| Rate for Payer: Cigna Medicare Advantage |
$111.33
|
| Rate for Payer: Family Health Partners Medicaid |
$33.88
|
| Rate for Payer: Family Health Partners Medicaid |
$33.88
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$123.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$123.05
|
| Rate for Payer: Healthy Blue Medicaid |
$36.59
|
| Rate for Payer: Healthy Blue Medicaid |
$36.59
|
| Rate for Payer: Home State Health Plan Exchange |
$111.33
|
| Rate for Payer: Home State Health Plan Exchange |
$111.33
|
| Rate for Payer: Home State Health Plan Medicaid |
$33.88
|
| Rate for Payer: Home State Health Plan Medicaid |
$33.88
|
| Rate for Payer: Humana Medicare |
$146.48
|
| Rate for Payer: Humana Medicare |
$146.49
|
| Rate for Payer: Mercy CarePlus Medicaid |
$33.88
|
| Rate for Payer: Mercy CarePlus Medicaid |
$33.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$146.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$146.49
|
| Rate for Payer: Provider Network of America Commercial |
$156.25
|
| Rate for Payer: Provider Network of America Commercial |
$156.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$128.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$128.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$195.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$195.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.51
|
|
|
Td Vaccine Prsrv Free 7 Yrs or Older for Im Use
|
Facility
|
IP
|
$101.49
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
Px06369071401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.12 |
| 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 |
$101.49
|
| Rate for Payer: Cash Price |
$101.49
|
| 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 |
$76.12
|
| Rate for Payer: Provider Network of America Commercial |
$81.19
|
|
|
Td Vaccine Prsrv Free 7 Yrs or Older for Im Use
|
Facility
|
OP
|
$101.49
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
Px06369071401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$101.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$71.55
|
| Rate for Payer: Aetna Workers' Compensation |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$70.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$70.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$79.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$79.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$79.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$78.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$79.97
|
| Rate for Payer: Cash Price |
$101.49
|
| Rate for Payer: Cash Price |
$101.49
|
| Rate for Payer: Cigna Commercial |
$62.11
|
| Rate for Payer: Cigna Medicare Advantage |
$57.85
|
| Rate for Payer: Family Health Partners Medicaid |
$22.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$63.94
|
| Rate for Payer: Healthy Blue Medicaid |
$24.39
|
| Rate for Payer: Home State Health Plan Exchange |
$57.85
|
| Rate for Payer: Home State Health Plan Medicaid |
$22.58
|
| Rate for Payer: Humana Medicare |
$76.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$76.12
|
| Rate for Payer: Provider Network of America Commercial |
$81.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$66.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$101.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.00
|
|
|
technicium Tc-99m-mebrofenin 45 mg recon soln 5 Each Vial
|
Facility
|
IP
|
$211.68
|
|
|
Service Code
|
NDC 45567045501
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$158.76 |
| 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 |
$211.68
|
| Rate for Payer: Cash Price |
$211.68
|
| 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 |
$158.76
|
| Rate for Payer: Provider Network of America Commercial |
$169.34
|
|
|
technicium Tc-99m-mebrofenin 45 mg recon soln 5 Each Vial
|
Facility
|
OP
|
$211.68
|
|
|
Service Code
|
HCPCS A9537
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.23
|
| Rate for Payer: Aetna Workers' Compensation |
$149.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$166.80
|
| Rate for Payer: Cash Price |
$211.68
|
| Rate for Payer: Cigna Commercial |
$129.55
|
| Rate for Payer: Cigna Medicare Advantage |
$120.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.36
|
| Rate for Payer: Home State Health Plan Exchange |
$120.66
|
| Rate for Payer: Humana Medicare |
$158.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$158.76
|
| Rate for Payer: Provider Network of America Commercial |
$169.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$211.68
|
|
|
technicium Tc-99m-mebrofenin 45 mg recon soln 5 Each Vial
|
Facility
|
IP
|
$211.68
|
|
|
Service Code
|
HCPCS A9537
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$158.76 |
| 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 |
$211.68
|
| Rate for Payer: Cash Price |
$211.68
|
| 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 |
$158.76
|
| Rate for Payer: Provider Network of America Commercial |
$169.34
|
|
|
technicium Tc-99m-mebrofenin 45 mg recon soln 5 Each Vial
|
Facility
|
OP
|
$211.68
|
|
|
Service Code
|
NDC 45567045501
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.23
|
| Rate for Payer: Aetna Workers' Compensation |
$149.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$166.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$166.80
|
| Rate for Payer: Cash Price |
$211.68
|
| Rate for Payer: Cigna Commercial |
$129.55
|
| Rate for Payer: Cigna Medicare Advantage |
$120.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.36
|
| Rate for Payer: Home State Health Plan Exchange |
$120.66
|
| Rate for Payer: Humana Medicare |
$158.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$158.76
|
| Rate for Payer: Provider Network of America Commercial |
$169.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$211.68
|
|
|
Tee w or w/o fol w/cont, mon
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS C8927
|
| Hospital Charge Code |
Px000000C8927
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$617.40
|
|
|
Tee W or W/O Fol W/Cont, Mon
|
Facility
|
OP
|
$1,764.00
|
|
|
Service Code
|
HCPCS C8927
|
| Hospital Charge Code |
Px0483C892701
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$744.82 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,243.62
|
| Rate for Payer: Aetna Workers' Compensation |
$1,243.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,222.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,222.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,390.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,390.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,390.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,358.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,390.03
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$1,079.57
|
| Rate for Payer: Cigna Medicare Advantage |
$1,005.48
|
| Rate for Payer: Family Health Partners Medicaid |
$989.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,111.32
|
| Rate for Payer: Healthy Blue Medicaid |
$1,068.47
|
| Rate for Payer: Home State Health Plan Exchange |
$1,005.48
|
| Rate for Payer: Home State Health Plan Medicaid |
$989.32
|
| Rate for Payer: Humana Medicare |
$1,323.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$989.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,323.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,411.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,164.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,764.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$744.82
|
|
|
Tee W or W/O Fol W/Cont, Mon
|
Facility
|
IP
|
$1,764.00
|
|
|
Service Code
|
HCPCS C8927
|
| Hospital Charge Code |
Px0483C892701
|
|
Hospital Revenue Code
|
483
|
| 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 |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| 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 |
$1,323.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,411.20
|
|
|
Tegaderm 4x4
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02720000060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
