|
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 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$6,905.12
|
|
|
Service Code
|
HCPCS Q5156
|
|
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 |
$6,905.12
|
| Rate for Payer: Cash Price |
$6,905.12
|
| 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 |
$5,178.84
|
| Rate for Payer: Provider Network of America Commercial |
$5,524.10
|
|
|
tocilizumab-anoh 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$6,905.12
|
|
|
Service Code
|
HCPCS Q5156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,935.92 |
| Max. Negotiated Rate |
$6,905.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,868.11
|
| Rate for Payer: Aetna Workers' Compensation |
$4,868.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,785.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,785.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,316.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,441.23
|
| Rate for Payer: Cash Price |
$6,905.12
|
| Rate for Payer: Cigna Commercial |
$4,225.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,935.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,350.23
|
| Rate for Payer: Home State Health Plan Exchange |
$3,935.92
|
| Rate for Payer: Humana Medicare |
$5,178.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,178.84
|
| Rate for Payer: Provider Network of America Commercial |
$5,524.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,557.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,905.12
|
|
|
tocilizumab-anoh 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
IP
|
$6,905.12
|
|
|
Service Code
|
NDC 72606004401
|
|
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 |
$6,905.12
|
| Rate for Payer: Cash Price |
$6,905.12
|
| 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 |
$5,178.84
|
| Rate for Payer: Provider Network of America Commercial |
$5,524.10
|
|
|
tocilizumab-anoh 400 mg/20 mL (20 mg/mL) solution 20 mL Vial
|
Facility
|
OP
|
$6,905.12
|
|
|
Service Code
|
NDC 72606004401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,935.92 |
| Max. Negotiated Rate |
$6,905.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,868.11
|
| Rate for Payer: Aetna Workers' Compensation |
$4,868.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,785.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,785.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,441.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,316.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,441.23
|
| Rate for Payer: Cash Price |
$6,905.12
|
| Rate for Payer: Cigna Commercial |
$4,225.93
|
| Rate for Payer: Cigna Medicare Advantage |
$3,935.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,350.23
|
| Rate for Payer: Home State Health Plan Exchange |
$3,935.92
|
| Rate for Payer: Humana Medicare |
$5,178.84
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,178.84
|
| Rate for Payer: Provider Network of America Commercial |
$5,524.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,557.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,905.12
|
|
|
tocilizumab-anoh 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
HCPCS Q5156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$1,381.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$973.61
|
| Rate for Payer: Aetna Workers' Compensation |
$973.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$957.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$957.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,063.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,088.23
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cigna Commercial |
$845.17
|
| Rate for Payer: Cigna Medicare Advantage |
$787.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$870.03
|
| Rate for Payer: Home State Health Plan Exchange |
$787.17
|
| Rate for Payer: Humana Medicare |
$1,035.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,035.75
|
| Rate for Payer: Provider Network of America Commercial |
$1,104.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$911.46
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,381.00
|
|
|
tocilizumab-anoh 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
HCPCS Q5156
|
|
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 |
$1,381.00
|
| Rate for Payer: Cash Price |
$1,381.00
|
| 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 |
$1,035.75
|
| Rate for Payer: Provider Network of America Commercial |
$1,104.80
|
|
|
tocilizumab-anoh 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
NDC 72606004201
|
|
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 |
$1,381.00
|
| Rate for Payer: Cash Price |
$1,381.00
|
| 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 |
$1,035.75
|
| Rate for Payer: Provider Network of America Commercial |
$1,104.80
|
|
|
tocilizumab-anoh 80 mg/4 mL (20 mg/mL) solution 4 mL Vial
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
NDC 72606004201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$1,381.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$911.46
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$973.61
|
| Rate for Payer: Aetna Workers' Compensation |
$973.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$957.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$957.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,088.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,063.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,088.23
|
| Rate for Payer: Cash Price |
$1,381.00
|
| Rate for Payer: Cigna Commercial |
$845.17
|
| Rate for Payer: Cigna Medicare Advantage |
$787.17
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$870.03
|
| Rate for Payer: Home State Health Plan Exchange |
$787.17
|
| Rate for Payer: Humana Medicare |
$1,035.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,035.75
|
| Rate for Payer: Provider Network of America Commercial |
$1,104.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,381.00
|
|
|
Tocilizumab injection
|
Facility
|
IP
|
$8,156.67
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
Px0636J326201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,525.34 |
| 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 |
$8,156.67
|
| Rate for Payer: Cash Price |
$8,156.67
|
| 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 |
$6,117.50
|
| Rate for Payer: Provider Network of America Commercial |
$6,525.34
|
|
|
Tocilizumab injection
|
Facility
|
OP
|
$8,156.67
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
Px0636J326201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,649.30 |
| Max. Negotiated Rate |
$8,156.67 |
| Rate for Payer: Humana Medicare |
$6,117.50
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,750.45
|
| Rate for Payer: Aetna Workers' Compensation |
$5,750.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,652.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,652.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,427.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,427.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,427.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,280.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$8,156.67
|
| Rate for Payer: Cigna Commercial |
$4,991.88
|
| Rate for Payer: Cigna Medicare Advantage |
$4,649.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5,138.70
|
| Rate for Payer: Home State Health Plan Exchange |
$4,649.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6,117.50
|
| Rate for Payer: Provider Network of America Commercial |
$6,525.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,383.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8,156.67
|
|
|
Tomosynthesis Mam Unilat or Bilat Diagnostic
|
Facility
|
IP
|
$218.40
|
|
|
Service Code
|
HCPCS G0279
|
| Hospital Charge Code |
Px0972G027901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$163.80 |
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| 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 |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
|
|
Tomosynthesis Mam Unilat or Bilat Diagnostic
|
Facility
|
OP
|
$218.40
|
|
|
Service Code
|
HCPCS G0279
|
| Hospital Charge Code |
Px0972G027901
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$153.97
|
| Rate for Payer: Aetna Workers' Compensation |
$153.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$151.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$172.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$168.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$172.10
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$133.66
|
| Rate for Payer: Cigna Medicare Advantage |
$124.49
|
| Rate for Payer: Family Health Partners Medicaid |
$49.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$137.59
|
| Rate for Payer: Healthy Blue Medicaid |
$53.71
|
| Rate for Payer: Home State Health Plan Exchange |
$124.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$49.73
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Mercy CarePlus Medicaid |
$49.73
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Provider Network of America Commercial |
$174.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$144.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$218.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.44
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$6,694.44
|
|
|
Service Code
|
APR-DRG 0971
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,694.44 |
| 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 |
$6,694.44
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,694.44
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,694.44
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,694.44
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$11,235.68
|
|
|
Service Code
|
APR-DRG 0972
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,235.68 |
| 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 |
$11,235.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$11,235.68
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$11,235.68
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11,235.68
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$18,500.55
|
|
|
Service Code
|
APR-DRG 0973
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$18,500.55 |
| 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 |
$18,500.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$18,500.55
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$18,500.55
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$18,500.55
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$33,596.10
|
|
|
Service Code
|
APR-DRG 0974
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$33,596.10 |
| 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 |
$33,596.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$33,596.10
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$33,596.10
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$33,596.10
|
|
|
topiramate 25 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904692861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$2.64
|
| 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 Individual Exchange |
$4.00
|
|
|
topiramate 25 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904692861
|
|
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
|
|
|
Topotecan injection
|
Facility
|
IP
|
$76.04
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
Px0636J935101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.03 |
| 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 |
$76.04
|
| Rate for Payer: Cash Price |
$76.04
|
| 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 |
$57.03
|
| Rate for Payer: Provider Network of America Commercial |
$60.83
|
|
|
Topotecan injection
|
Facility
|
OP
|
$76.04
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
Px0636J935101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$76.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.61
|
| Rate for Payer: Aetna Workers' Compensation |
$53.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$59.92
|
| Rate for Payer: Cash Price |
$76.04
|
| Rate for Payer: Cigna Commercial |
$46.54
|
| Rate for Payer: Cigna Medicare Advantage |
$43.34
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$47.91
|
| Rate for Payer: Home State Health Plan Exchange |
$43.34
|
| Rate for Payer: Humana Medicare |
$57.03
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.03
|
| Rate for Payer: Provider Network of America Commercial |
$60.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.04
|
|
|
torsemide 20 mg tablet 50 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904728306
|
|
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
|
|
|
torsemide 20 mg tablet 50 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904728306
|
|
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
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 8161
|
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$4,960.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,960.04
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,960.04
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,960.04
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$13,194.74
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$13,194.74 |
| 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 |
$13,194.74
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$13,194.74
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$13,194.74
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13,194.74
|
|
