|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$39,991.92
|
|
|
Service Code
|
APR-DRG 3031
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$39,991.92 |
| 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 |
$39,991.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$39,991.92
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$39,991.92
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$39,991.92
|
|
|
DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK
|
Facility
|
IP
|
$98,344.78
|
|
|
Service Code
|
APR-DRG 3034
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$98,344.78 |
| 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 |
$98,344.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$98,344.78
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$98,344.78
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$98,344.78
|
|
|
doxazosin 2 mg tablet 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60505009400
|
|
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
|
|
|
doxazosin 2 mg tablet 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60505009400
|
|
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
|
|
|
doxazosin 2 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68084085195
|
|
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
|
|
|
doxazosin 2 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68084085195
|
|
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
|
|
|
DOXOrubicin 50 mg/25 mL solution 25 mL Vial
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.09
|
| Rate for Payer: Aetna Workers' Compensation |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.22
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$59.98
|
| Rate for Payer: Cigna Medicare Advantage |
$55.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$61.74
|
| Rate for Payer: Home State Health Plan Exchange |
$55.86
|
| Rate for Payer: Humana Medicare |
$73.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Provider Network of America Commercial |
$78.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$64.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.00
|
|
|
DOXOrubicin 50 mg/25 mL solution 25 mL Vial
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS J9000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.50 |
| 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 |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| 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 |
$73.50
|
| Rate for Payer: Provider Network of America Commercial |
$78.40
|
|
|
DOXOrubicin 50 mg/25 mL solution 25 mL Vial
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
NDC 25021020725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.50 |
| 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 |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| 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 |
$73.50
|
| Rate for Payer: Provider Network of America Commercial |
$78.40
|
|
|
DOXOrubicin 50 mg/25 mL solution 25 mL Vial
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
NDC 25021020725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.09
|
| Rate for Payer: Aetna Workers' Compensation |
$69.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$77.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.22
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$59.98
|
| Rate for Payer: Cigna Medicare Advantage |
$55.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$61.74
|
| Rate for Payer: Home State Health Plan Exchange |
$55.86
|
| Rate for Payer: Humana Medicare |
$73.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Provider Network of America Commercial |
$78.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$64.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.00
|
|
|
Doxorubicin hcl injection
|
Facility
|
OP
|
$358.76
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
Px0636J900001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.49 |
| Max. Negotiated Rate |
$358.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$252.93
|
| Rate for Payer: Aetna Workers' Compensation |
$252.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$248.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$282.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$282.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$282.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$276.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$282.70
|
| Rate for Payer: Cash Price |
$358.76
|
| Rate for Payer: Cigna Commercial |
$219.56
|
| Rate for Payer: Cigna Medicare Advantage |
$204.49
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$226.02
|
| Rate for Payer: Home State Health Plan Exchange |
$204.49
|
| Rate for Payer: Humana Medicare |
$269.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$269.07
|
| Rate for Payer: Provider Network of America Commercial |
$287.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$236.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$358.76
|
|
|
Doxorubicin hcl injection
|
Facility
|
IP
|
$358.76
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
Px0636J900001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.07 |
| 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 |
$358.76
|
| Rate for Payer: Cash Price |
$358.76
|
| 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 |
$269.07
|
| Rate for Payer: Provider Network of America Commercial |
$287.01
|
|
|
doxycycline 100 mg capsule 1 Each BLIST PACK
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 60687071611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| 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 |
$3.20
|
| Rate for Payer: Provider Network of America Commercial |
$3.42
|
|
|
doxycycline 100 mg capsule 1 Each BLIST PACK
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 60687071611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.01
|
| Rate for Payer: Aetna Workers' Compensation |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna Commercial |
$2.61
|
| Rate for Payer: Cigna Medicare Advantage |
$2.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.69
|
| Rate for Payer: Home State Health Plan Exchange |
$2.43
|
| Rate for Payer: Humana Medicare |
$3.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.20
|
| Rate for Payer: Provider Network of America Commercial |
$3.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.27
|
|
|
doxycycline 100 mg capsule 30 Each BLIST PACK
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 60687071621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.01
|
| Rate for Payer: Aetna Workers' Compensation |
$3.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cigna Commercial |
$2.61
|
| Rate for Payer: Cigna Medicare Advantage |
$2.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.69
|
| Rate for Payer: Home State Health Plan Exchange |
$2.43
|
| Rate for Payer: Humana Medicare |
$3.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.20
|
| Rate for Payer: Provider Network of America Commercial |
$3.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.27
|
|
|
doxycycline 100 mg capsule 30 Each BLIST PACK
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 60687071621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| 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 |
$3.20
|
| Rate for Payer: Provider Network of America Commercial |
$3.42
|
|
|
doxycycline 100 mg capsule 50 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68180065208
|
|
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
|
|
|
doxycycline 100 mg capsule 50 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68180065208
|
|
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
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$69.30
|
|
|
Service Code
|
NDC 63323013003
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$48.86
|
| Rate for Payer: Aetna Workers' Compensation |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$54.61
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$42.41
|
| Rate for Payer: Cigna Medicare Advantage |
$39.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$43.66
|
| Rate for Payer: Home State Health Plan Exchange |
$39.50
|
| Rate for Payer: Humana Medicare |
$51.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.98
|
| Rate for Payer: Provider Network of America Commercial |
$55.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$69.30
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 66794023702
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$37.50 |
| 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 |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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 |
$37.50
|
| Rate for Payer: Provider Network of America Commercial |
$40.00
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 66794023702
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$35.25
|
| Rate for Payer: Aetna Workers' Compensation |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$39.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$39.40
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: Cigna Medicare Advantage |
$28.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$31.50
|
| Rate for Payer: Home State Health Plan Exchange |
$28.50
|
| Rate for Payer: Humana Medicare |
$37.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$37.50
|
| Rate for Payer: Provider Network of America Commercial |
$40.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$50.00
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
NDC 71288003020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$48.00 |
| 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 |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| 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 |
$48.00
|
| Rate for Payer: Provider Network of America Commercial |
$51.20
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$96.64
|
|
|
Service Code
|
NDC 68382091001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$96.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$68.13
|
| Rate for Payer: Aetna Workers' Compensation |
$68.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$66.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$76.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$76.15
|
| Rate for Payer: Cash Price |
$96.64
|
| Rate for Payer: Cigna Commercial |
$59.14
|
| Rate for Payer: Cigna Medicare Advantage |
$55.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$60.88
|
| Rate for Payer: Home State Health Plan Exchange |
$55.08
|
| Rate for Payer: Humana Medicare |
$72.48
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$72.48
|
| Rate for Payer: Provider Network of America Commercial |
$77.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$63.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$96.64
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
NDC 71288003020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.12
|
| Rate for Payer: Aetna Workers' Compensation |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$44.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$44.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$50.43
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$39.17
|
| Rate for Payer: Cigna Medicare Advantage |
$36.48
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.32
|
| Rate for Payer: Home State Health Plan Exchange |
$36.48
|
| Rate for Payer: Humana Medicare |
$48.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Provider Network of America Commercial |
$51.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$64.00
|
|
|
doxycycline 100 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$69.30
|
|
|
Service Code
|
NDC 63323013003
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$51.98 |
| 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 |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| 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 |
$51.98
|
| Rate for Payer: Provider Network of America Commercial |
$55.44
|
|
