|
ePHEDrine 50 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$61.60
|
|
|
Service Code
|
NDC 43598072525
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$61.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$43.43
|
| Rate for Payer: Aetna Workers' Compensation |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$48.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$47.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$48.54
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna Commercial |
$37.70
|
| Rate for Payer: Cigna Medicare Advantage |
$35.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$38.81
|
| Rate for Payer: Home State Health Plan Exchange |
$35.11
|
| Rate for Payer: Humana Medicare |
$46.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$46.20
|
| Rate for Payer: Provider Network of America Commercial |
$49.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$61.60
|
|
|
EPINEPHrine 0.1 mg/mL syringe 10 mL Syringe
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J0168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
EPINEPHrine 0.1 mg/mL syringe 10 mL Syringe
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 76329331801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
EPINEPHrine 0.1 mg/mL syringe 10 mL Syringe
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J0168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
EPINEPHrine 0.1 mg/mL syringe 10 mL Syringe
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 76329331801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 1 Each Syringe
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
NDC 00093598619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$423.00
|
| Rate for Payer: Aetna Workers' Compensation |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$472.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: Cigna Medicare Advantage |
$342.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$378.00
|
| Rate for Payer: Home State Health Plan Exchange |
$342.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$396.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$600.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 1 Each Syringe
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$423.00
|
| Rate for Payer: Aetna Workers' Compensation |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$472.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: Cigna Medicare Advantage |
$342.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$378.00
|
| Rate for Payer: Home State Health Plan Exchange |
$342.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$396.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$600.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 1 Each Syringe
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
NDC 00093598619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 1 Each Syringe
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
NDC 49502010202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$423.00
|
| Rate for Payer: Aetna Workers' Compensation |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$472.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: Cigna Medicare Advantage |
$342.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$378.00
|
| Rate for Payer: Home State Health Plan Exchange |
$342.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$396.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$600.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
NDC 00093598627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$396.00
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$423.00
|
| Rate for Payer: Aetna Workers' Compensation |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$472.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: Cigna Medicare Advantage |
$342.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$378.00
|
| Rate for Payer: Home State Health Plan Exchange |
$342.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$600.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
NDC 49502010202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
NDC 00093598627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
|
|
EPINEPHrine 0.3 mg/0.3 mL auto-injector 2 Each Syringe
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$423.00
|
| Rate for Payer: Aetna Workers' Compensation |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$472.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$462.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$472.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: Cigna Medicare Advantage |
$342.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$378.00
|
| Rate for Payer: Home State Health Plan Exchange |
$342.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Provider Network of America Commercial |
$480.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$396.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$600.00
|
|
|
EPINEPHrine 1 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 42023015901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
EPINEPHrine 1 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 42023015901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
EPINEPHrine 1 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.68
|
| Rate for Payer: Aetna Workers' Compensation |
$24.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$26.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.58
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$21.42
|
| Rate for Payer: Cigna Medicare Advantage |
$19.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.05
|
| Rate for Payer: Home State Health Plan Exchange |
$19.95
|
| Rate for Payer: Humana Medicare |
$26.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.00
|
|
|
EPINEPHrine 1 mg/mL (1 mL) solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.25 |
| 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 |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$26.25
|
| Rate for Payer: Provider Network of America Commercial |
$28.00
|
|
|
EPINEPHrine 1 mg/mL solution 30 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
EPINEPHrine 1 mg/mL solution 30 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J0165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
EPINEPHrine 1 mg/mL solution 30 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 42023016801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: UnitedHealthcare Commercial |
$42.90
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$45.83
|
| Rate for Payer: Aetna Workers' Compensation |
$45.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$51.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$50.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$51.22
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$39.78
|
| Rate for Payer: Cigna Medicare Advantage |
$37.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$40.95
|
| Rate for Payer: Home State Health Plan Exchange |
$37.05
|
| Rate for Payer: Humana Medicare |
$48.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$65.00
|
|
|
EPINEPHrine 1 mg/mL solution 30 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 42023016801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.75 |
| 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 |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| 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 |
$48.75
|
| Rate for Payer: Provider Network of America Commercial |
$52.00
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$6,258.05
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,258.05 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,258.05
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 151
|
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$3,449.80
|
|
