|
ziprasidone 20 mg capsule 40 Each BLIST PACK
|
Facility
|
OP
|
$19.30
|
|
|
Service Code
|
NDC 00904626908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$13.61
|
| Rate for Payer: Aetna Workers' Compensation |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$13.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$13.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$15.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$15.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$15.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$15.21
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cigna Commercial |
$11.81
|
| Rate for Payer: Cigna Medicare Advantage |
$11.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$12.16
|
| Rate for Payer: Home State Health Plan Exchange |
$11.00
|
| Rate for Payer: Humana Medicare |
$14.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$14.47
|
| Rate for Payer: Provider Network of America Commercial |
$15.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$19.30
|
|
|
ziprasidone 20 mg capsule 40 Each BLIST PACK
|
Facility
|
IP
|
$19.30
|
|
|
Service Code
|
NDC 00904626908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.47 |
| 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 |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| 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 |
$14.47
|
| Rate for Payer: Provider Network of America Commercial |
$15.44
|
|
|
ziprasidone 20 mg/mL (final conc.) recon soln 1 Each Vial
|
Facility
|
OP
|
$79.64
|
|
|
Service Code
|
NDC 72266016042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$79.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.15
|
| Rate for Payer: Aetna Workers' Compensation |
$56.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$79.64
|
| Rate for Payer: Cigna Commercial |
$48.74
|
| Rate for Payer: Cigna Medicare Advantage |
$45.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.17
|
| Rate for Payer: Home State Health Plan Exchange |
$45.39
|
| Rate for Payer: Humana Medicare |
$59.73
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.73
|
| Rate for Payer: Provider Network of America Commercial |
$63.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.64
|
|
|
ziprasidone 20 mg/mL (final conc.) recon soln 1 Each Vial
|
Facility
|
IP
|
$79.64
|
|
|
Service Code
|
HCPCS J3486
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$79.64
|
| Rate for Payer: Cash Price |
$79.64
|
| 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 |
$59.73
|
| Rate for Payer: Provider Network of America Commercial |
$63.71
|
|
|
ziprasidone 20 mg/mL (final conc.) recon soln 1 Each Vial
|
Facility
|
IP
|
$79.64
|
|
|
Service Code
|
NDC 72266016042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$79.64
|
| Rate for Payer: Cash Price |
$79.64
|
| 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 |
$59.73
|
| Rate for Payer: Provider Network of America Commercial |
$63.71
|
|
|
ziprasidone 20 mg/mL (final conc.) recon soln 1 Each Vial
|
Facility
|
OP
|
$79.64
|
|
|
Service Code
|
HCPCS J3486
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$79.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.15
|
| Rate for Payer: Aetna Workers' Compensation |
$56.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$79.64
|
| Rate for Payer: Cigna Commercial |
$48.74
|
| Rate for Payer: Cigna Medicare Advantage |
$45.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.17
|
| Rate for Payer: Home State Health Plan Exchange |
$45.39
|
| Rate for Payer: Humana Medicare |
$59.73
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.73
|
| Rate for Payer: Provider Network of America Commercial |
$63.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.64
|
|
|
Ziprasidone mesylate
|
Facility
|
IP
|
$35.83
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
Px0636J348601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.87 |
| 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 |
$35.83
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.87
|
| Rate for Payer: Provider Network of America Commercial |
$28.66
|
|
|
Ziprasidone mesylate
|
Facility
|
OP
|
$35.83
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
Px0636J348601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$35.83 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.26
|
| Rate for Payer: Aetna Workers' Compensation |
$25.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$27.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.23
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cigna Commercial |
$21.93
|
| Rate for Payer: Cigna Medicare Advantage |
$20.42
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.57
|
| Rate for Payer: Home State Health Plan Exchange |
$20.42
|
| Rate for Payer: Humana Medicare |
$26.87
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.87
|
| Rate for Payer: Provider Network of America Commercial |
$28.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.65
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.83
|
|
|
Zoledronic acid 1mg
|
Facility
|
OP
|
$107.60
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
Px0636J348901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.86
|
| Rate for Payer: Aetna Workers' Compensation |
$75.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$74.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$74.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.79
|
| Rate for Payer: Cash Price |
$107.60
|
| Rate for Payer: Cigna Commercial |
$65.85
|
| Rate for Payer: Cigna Medicare Advantage |
$61.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.79
|
| Rate for Payer: Home State Health Plan Exchange |
$61.33
|
| Rate for Payer: Humana Medicare |
$80.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.70
|
| Rate for Payer: Provider Network of America Commercial |
$86.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$71.02
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$107.60
|
|
|
Zoledronic acid 1mg
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
Px0636J348901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.70 |
| 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 |
$107.60
|
| Rate for Payer: Cash Price |
$107.60
|
| 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 |
$80.70
|
| Rate for Payer: Provider Network of America Commercial |
$86.08
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
NDC 67457079410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$310.20
|
| Rate for Payer: Aetna Workers' Compensation |
$310.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$338.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$346.72
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$269.28
|
| Rate for Payer: Cigna Medicare Advantage |
$250.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$277.20
|
| Rate for Payer: Home State Health Plan Exchange |
$250.80
|
| Rate for Payer: Humana Medicare |
$330.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$330.00
|
| Rate for Payer: Provider Network of America Commercial |
$352.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$440.00
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
NDC 25021083082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$987.00
|
| Rate for Payer: Aetna Workers' Compensation |
$987.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Cigna Medicare Advantage |
$798.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$882.00
|
| Rate for Payer: Home State Health Plan Exchange |
$798.00
|
| Rate for Payer: Humana Medicare |
$1,050.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$924.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,400.00
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
NDC 25021083082
|
|
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 |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| 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 |
$1,050.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,120.00
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
NDC 67457079410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$330.00 |
| 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 |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| 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 |
$330.00
|
| Rate for Payer: Provider Network of America Commercial |
$352.00
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$330.00 |
| 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 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 |
$440.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$440.00
|
| 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 |
$1,050.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$330.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,120.00
|
| Rate for Payer: Provider Network of America Commercial |
$352.00
|
|
|
zoledronic acid 5 mg/100 mL piggyback 100 mL Bag
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS J3489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$987.00
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$310.20
|
| Rate for Payer: Aetna Workers' Compensation |
$987.00
|
| Rate for Payer: Aetna Workers' Compensation |
$310.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$304.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,103.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$338.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$346.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,103.20
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$856.80
|
| Rate for Payer: Cigna Commercial |
$269.28
|
| Rate for Payer: Cigna Medicare Advantage |
$798.00
|
| Rate for Payer: Cigna Medicare Advantage |
$250.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$882.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$277.20
|
| Rate for Payer: Home State Health Plan Exchange |
$798.00
|
| Rate for Payer: Home State Health Plan Exchange |
$250.80
|
| Rate for Payer: Humana Medicare |
$1,050.00
|
| Rate for Payer: Humana Medicare |
$330.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$330.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,120.00
|
| Rate for Payer: Provider Network of America Commercial |
$352.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$924.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,400.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$440.00
|
|
|
zolpidem 5 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904608261
|
|
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
|
|
|
zolpidem 5 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904608261
|
|
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
|
|
|
zolpidem 5 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687083811
|
|
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
|
|
|
zolpidem 5 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687083811
|
|
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
|
|
