|
Tobramycin sulfate injection
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
Px0636J326001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$18.51
|
| Rate for Payer: Aetna Workers' Compensation |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$20.68
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$14.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$16.54
|
| Rate for Payer: Home State Health Plan Exchange |
$14.96
|
| Rate for Payer: Humana Medicare |
$19.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$26.25
|
|
|
Tobramycin sulfate injection
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
Px0636J326001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| 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 |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
|
|
tocilizumab 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$10,623.28
|
|
|
Service Code
|
NDC 50242013701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,055.27 |
| Max. Negotiated Rate |
$10,623.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7,489.41
|
| Rate for Payer: Aetna Workers' Compensation |
$7,489.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8,179.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$8,371.14
|
| Rate for Payer: Cash Price |
$10,623.28
|
| Rate for Payer: Cigna Commercial |
$6,501.45
|
| Rate for Payer: Cigna Medicare Advantage |
$6,055.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6,692.67
|
| Rate for Payer: Home State Health Plan Exchange |
$6,055.27
|
| Rate for Payer: Humana Medicare |
$7,967.46
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,967.46
|
| Rate for Payer: Provider Network of America Commercial |
$8,498.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,011.36
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10,623.28
|
|
|
tocilizumab 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$10,623.28
|
|
|
Service Code
|
NDC 50242013701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,498.62 |
| 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 |
$10,623.28
|
| Rate for Payer: Cash Price |
$10,623.28
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,967.46
|
| Rate for Payer: Provider Network of America Commercial |
$8,498.62
|
|
|
tocilizumab 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$10,623.28
|
|
|
Service Code
|
HCPCS J3262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,498.62 |
| 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 |
$10,623.28
|
| Rate for Payer: Cash Price |
$10,623.28
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,967.46
|
| Rate for Payer: Provider Network of America Commercial |
$8,498.62
|
|
|
tocilizumab 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$10,623.28
|
|
|
Service Code
|
HCPCS J3262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,055.27 |
| Max. Negotiated Rate |
$10,623.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$7,489.41
|
| Rate for Payer: Aetna Workers' Compensation |
$7,489.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$8,371.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8,179.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$8,371.14
|
| Rate for Payer: Cash Price |
$10,623.28
|
| Rate for Payer: Cigna Commercial |
$6,501.45
|
| Rate for Payer: Cigna Medicare Advantage |
$6,055.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6,692.67
|
| Rate for Payer: Home State Health Plan Exchange |
$6,055.27
|
| Rate for Payer: Humana Medicare |
$7,967.46
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7,967.46
|
| Rate for Payer: Provider Network of America Commercial |
$8,498.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,011.36
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10,623.28
|
|
|
tocilizumab 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$2,124.64
|
|
|
Service Code
|
NDC 50242013501
|
|
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 |
$2,124.64
|
| Rate for Payer: Cash Price |
$2,124.64
|
| 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 |
$1,593.48
|
| Rate for Payer: Provider Network of America Commercial |
$1,699.71
|
|
|
tocilizumab 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$2,124.64
|
|
|
Service Code
|
HCPCS J3262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,211.04 |
| Max. Negotiated Rate |
$2,124.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,497.87
|
| Rate for Payer: Aetna Workers' Compensation |
$1,497.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,472.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,472.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,635.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,674.22
|
| Rate for Payer: Cash Price |
$2,124.64
|
| Rate for Payer: Cigna Commercial |
$1,300.28
|
| Rate for Payer: Cigna Medicare Advantage |
$1,211.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,338.52
|
| Rate for Payer: Home State Health Plan Exchange |
$1,211.04
|
| Rate for Payer: Humana Medicare |
$1,593.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,593.48
|
| Rate for Payer: Provider Network of America Commercial |
$1,699.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,402.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,124.64
|
|
|
tocilizumab 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$2,124.64
|
|
|
Service Code
|
NDC 50242013501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,211.04 |
| Max. Negotiated Rate |
$2,124.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,497.87
|
| Rate for Payer: Aetna Workers' Compensation |
$1,497.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,472.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,472.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,674.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,635.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,674.22
|
| Rate for Payer: Cash Price |
$2,124.64
|
| Rate for Payer: Cigna Commercial |
$1,300.28
|
| Rate for Payer: Cigna Medicare Advantage |
$1,211.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,338.52
|
| Rate for Payer: Home State Health Plan Exchange |
$1,211.04
|
| Rate for Payer: Humana Medicare |
$1,593.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,593.48
|
| Rate for Payer: Provider Network of America Commercial |
$1,699.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,402.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,124.64
|
|
|
tocilizumab 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$2,124.64
|
|
|
Service Code
|
HCPCS J3262
|
|
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 |
$2,124.64
|
| Rate for Payer: Cash Price |
$2,124.64
|
| 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 |
$1,593.48
|
| Rate for Payer: Provider Network of America Commercial |
$1,699.71
|
|
|
tocilizumab-aazg 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
OP
|
$3,916.80
|
|
|
Service Code
|
NDC 65219059210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,232.58 |
| Max. Negotiated Rate |
$3,916.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,761.34
|
| Rate for Payer: Aetna Workers' Compensation |
$2,761.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,714.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,714.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,015.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,086.44
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cigna Commercial |
$2,397.08
|
| Rate for Payer: Cigna Medicare Advantage |
$2,232.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,467.58
|
| Rate for Payer: Home State Health Plan Exchange |
$2,232.58
|
| Rate for Payer: Humana Medicare |
$2,937.60
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,937.60
|
| Rate for Payer: Provider Network of America Commercial |
$3,133.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,585.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,916.80
|
|
|
tocilizumab-aazg 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
OP
|
$3,916.80
|
|
|
Service Code
|
HCPCS Q5135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,232.58 |
| Max. Negotiated Rate |
$3,916.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,761.34
|
| Rate for Payer: Aetna Workers' Compensation |
$2,761.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,714.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,714.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,086.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,015.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,086.44
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cigna Commercial |
$2,397.08
|
| Rate for Payer: Cigna Medicare Advantage |
$2,232.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,467.58
|
| Rate for Payer: Home State Health Plan Exchange |
$2,232.58
|
| Rate for Payer: Humana Medicare |
$2,937.60
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,937.60
|
| Rate for Payer: Provider Network of America Commercial |
$3,133.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,585.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,916.80
|
|
|
tocilizumab-aazg 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
IP
|
$3,916.80
|
|
|
Service Code
|
NDC 65219059210
|
|
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 |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,937.60
|
| Rate for Payer: Provider Network of America Commercial |
$3,133.44
|
|
|
tocilizumab-aazg 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
IP
|
$3,916.80
|
|
|
Service Code
|
HCPCS Q5135
|
|
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 |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,937.60
|
| Rate for Payer: Provider Network of America Commercial |
$3,133.44
|
|
|
tocilizumab-aazg 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$7,833.60
|
|
|
Service Code
|
NDC 65219059420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,266.88 |
| 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 |
$7,833.60
|
| Rate for Payer: Cash Price |
$7,833.60
|
| 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 |
$5,875.20
|
| Rate for Payer: Provider Network of America Commercial |
$6,266.88
|
|
|
tocilizumab-aazg 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$7,833.60
|
|
|
Service Code
|
NDC 65219059420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,465.15 |
| Max. Negotiated Rate |
$7,833.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,522.69
|
| Rate for Payer: Aetna Workers' Compensation |
$5,522.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,428.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,428.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,031.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,172.88
|
| Rate for Payer: Cash Price |
$7,833.60
|
| Rate for Payer: Cigna Commercial |
$4,794.16
|
| Rate for Payer: Cigna Medicare Advantage |
$4,465.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,935.17
|
| Rate for Payer: Home State Health Plan Exchange |
$4,465.15
|
| Rate for Payer: Humana Medicare |
$5,875.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,875.20
|
| Rate for Payer: Provider Network of America Commercial |
$6,266.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,170.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,833.60
|
|
|
tocilizumab-aazg 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$7,833.60
|
|
|
Service Code
|
HCPCS Q5135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,266.88 |
| 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 |
$7,833.60
|
| Rate for Payer: Cash Price |
$7,833.60
|
| 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 |
$5,875.20
|
| Rate for Payer: Provider Network of America Commercial |
$6,266.88
|
|
|
tocilizumab-aazg 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$7,833.60
|
|
|
Service Code
|
HCPCS Q5135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,465.15 |
| Max. Negotiated Rate |
$7,833.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,522.69
|
| Rate for Payer: Aetna Workers' Compensation |
$5,522.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,428.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,428.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,172.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,031.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,172.88
|
| Rate for Payer: Cash Price |
$7,833.60
|
| Rate for Payer: Cigna Commercial |
$4,794.16
|
| Rate for Payer: Cigna Medicare Advantage |
$4,465.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,935.17
|
| Rate for Payer: Home State Health Plan Exchange |
$4,465.15
|
| Rate for Payer: Humana Medicare |
$5,875.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,875.20
|
| Rate for Payer: Provider Network of America Commercial |
$6,266.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,170.18
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,833.60
|
|
|
tocilizumab-aazg 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$1,566.72
|
|
|
Service Code
|
HCPCS Q5135
|
|
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 |
$1,566.72
|
| Rate for Payer: Cash Price |
$1,566.72
|
| 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 |
$1,175.04
|
| Rate for Payer: Provider Network of America Commercial |
$1,253.38
|
|
|
tocilizumab-aazg 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$1,566.72
|
|
|
Service Code
|
NDC 65219059004
|
|
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 |
$1,566.72
|
| Rate for Payer: Cash Price |
$1,566.72
|
| 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 |
$1,175.04
|
| Rate for Payer: Provider Network of America Commercial |
$1,253.38
|
|
|
tocilizumab-aazg 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$1,566.72
|
|
|
Service Code
|
NDC 65219059004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$893.03 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,104.54
|
| Rate for Payer: Aetna Workers' Compensation |
$1,104.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,206.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,234.58
|
| Rate for Payer: Cash Price |
$1,566.72
|
| Rate for Payer: Cigna Commercial |
$958.83
|
| Rate for Payer: Cigna Medicare Advantage |
$893.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$987.03
|
| Rate for Payer: Home State Health Plan Exchange |
$893.03
|
| Rate for Payer: Humana Medicare |
$1,175.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,175.04
|
| Rate for Payer: Provider Network of America Commercial |
$1,253.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,034.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,566.72
|
|
|
tocilizumab-aazg 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$1,566.72
|
|
|
Service Code
|
HCPCS Q5135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$893.03 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,104.54
|
| Rate for Payer: Aetna Workers' Compensation |
$1,104.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,234.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,206.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,234.58
|
| Rate for Payer: Cash Price |
$1,566.72
|
| Rate for Payer: Cigna Commercial |
$958.83
|
| Rate for Payer: Cigna Medicare Advantage |
$893.03
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$987.03
|
| Rate for Payer: Home State Health Plan Exchange |
$893.03
|
| Rate for Payer: Humana Medicare |
$1,175.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,175.04
|
| Rate for Payer: Provider Network of America Commercial |
$1,253.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,034.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,566.72
|
|
|
tocilizumab-anoh 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
OP
|
$3,452.56
|
|
|
Service Code
|
NDC 72606004301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,967.96 |
| Max. Negotiated Rate |
$3,452.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,434.05
|
| Rate for Payer: Aetna Workers' Compensation |
$2,434.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,392.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,392.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,658.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,720.62
|
| Rate for Payer: Cash Price |
$3,452.56
|
| Rate for Payer: Cigna Commercial |
$2,112.97
|
| Rate for Payer: Cigna Medicare Advantage |
$1,967.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,175.11
|
| Rate for Payer: Home State Health Plan Exchange |
$1,967.96
|
| Rate for Payer: Humana Medicare |
$2,589.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,589.42
|
| Rate for Payer: Provider Network of America Commercial |
$2,762.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,278.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,452.56
|
|
|
tocilizumab-anoh 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
IP
|
$3,452.56
|
|
|
Service Code
|
NDC 72606004301
|
|
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 |
$3,452.56
|
| Rate for Payer: Cash Price |
$3,452.56
|
| 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 |
$2,589.42
|
| Rate for Payer: Provider Network of America Commercial |
$2,762.05
|
|
|
tocilizumab-anoh 200 mg/10 mL (20 mg/mL) solution 10 mL Vial
|
Facility
|
OP
|
$3,452.56
|
|
|
Service Code
|
HCPCS Q5156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,967.96 |
| Max. Negotiated Rate |
$3,452.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,434.05
|
| Rate for Payer: Aetna Workers' Compensation |
$2,434.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,392.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,392.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,658.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,720.62
|
| Rate for Payer: Cash Price |
$3,452.56
|
| Rate for Payer: Cigna Commercial |
$2,112.97
|
| Rate for Payer: Cigna Medicare Advantage |
$1,967.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,175.11
|
| Rate for Payer: Home State Health Plan Exchange |
$1,967.96
|
| Rate for Payer: Humana Medicare |
$2,589.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,589.42
|
| Rate for Payer: Provider Network of America Commercial |
$2,762.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,278.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,452.56
|
|
