|
Fentanyl citrate injection
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
Px0636J301001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.55 |
| 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 |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| 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 |
$53.55
|
| Rate for Payer: Provider Network of America Commercial |
$57.12
|
|
|
ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial
|
Facility
|
OP
|
$6,494.12
|
|
|
Service Code
|
HCPCS J1439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,701.65 |
| Max. Negotiated Rate |
$6,494.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,578.35
|
| Rate for Payer: Aetna Workers' Compensation |
$4,578.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,500.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,500.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,000.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,117.37
|
| Rate for Payer: Cash Price |
$6,494.12
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Cigna Medicare Advantage |
$3,701.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,091.30
|
| Rate for Payer: Home State Health Plan Exchange |
$3,701.65
|
| Rate for Payer: Humana Medicare |
$4,870.59
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,870.59
|
| Rate for Payer: Provider Network of America Commercial |
$5,195.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,286.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,494.12
|
|
|
ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial
|
Facility
|
OP
|
$6,494.12
|
|
|
Service Code
|
NDC 00517065001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,701.65 |
| Max. Negotiated Rate |
$6,494.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,578.35
|
| Rate for Payer: Aetna Workers' Compensation |
$4,578.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,500.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,500.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,117.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,000.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,117.37
|
| Rate for Payer: Cash Price |
$6,494.12
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Cigna Medicare Advantage |
$3,701.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,091.30
|
| Rate for Payer: Home State Health Plan Exchange |
$3,701.65
|
| Rate for Payer: Humana Medicare |
$4,870.59
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,870.59
|
| Rate for Payer: Provider Network of America Commercial |
$5,195.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,286.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,494.12
|
|
|
ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial
|
Facility
|
IP
|
$6,494.12
|
|
|
Service Code
|
HCPCS J1439
|
|
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 |
$6,494.12
|
| Rate for Payer: Cash Price |
$6,494.12
|
| 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 |
$4,870.59
|
| Rate for Payer: Provider Network of America Commercial |
$5,195.30
|
|
|
ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial
|
Facility
|
IP
|
$6,494.12
|
|
|
Service Code
|
NDC 00517065001
|
|
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 |
$6,494.12
|
| Rate for Payer: Cash Price |
$6,494.12
|
| 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 |
$4,870.59
|
| Rate for Payer: Provider Network of America Commercial |
$5,195.30
|
|
|
ferric subsulfate 0.2 to 0.22 gram/mL solution with applicator 8 mL Bottle
|
Facility
|
IP
|
$58.34
|
|
|
Service Code
|
NDC 48783011208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.76 |
| 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 |
$58.34
|
| Rate for Payer: Cash Price |
$58.34
|
| 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 |
$43.76
|
| Rate for Payer: Provider Network of America Commercial |
$46.67
|
|
|
ferric subsulfate 0.2 to 0.22 gram/mL solution with applicator 8 mL Bottle
|
Facility
|
OP
|
$58.34
|
|
|
Service Code
|
NDC 48783011208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$58.34 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$41.13
|
| Rate for Payer: Aetna Workers' Compensation |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.97
|
| Rate for Payer: Cash Price |
$58.34
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: Cigna Medicare Advantage |
$33.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.75
|
| Rate for Payer: Home State Health Plan Exchange |
$33.25
|
| Rate for Payer: Humana Medicare |
$43.76
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.76
|
| Rate for Payer: Provider Network of America Commercial |
$46.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$58.34
|
|
|
ferrous sulfate 325 mg (65 mg iron) tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904759161
|
|
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
|
|
|
ferrous sulfate 325 mg (65 mg iron) tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904759161
|
|
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
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
OP
|
$4,774.48
|
|
|
Service Code
|
NDC 59338077501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,721.45 |
| Max. Negotiated Rate |
$4,774.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3,366.01
|
| Rate for Payer: Aetna Workers' Compensation |
$3,366.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,676.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,762.29
|
| Rate for Payer: Cash Price |
$4,774.48
|
| Rate for Payer: Cigna Commercial |
$2,921.98
|
| Rate for Payer: Cigna Medicare Advantage |
$2,721.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,007.92
|
| Rate for Payer: Home State Health Plan Exchange |
$2,721.45
|
| Rate for Payer: Humana Medicare |
$3,580.86
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,580.86
|
| Rate for Payer: Provider Network of America Commercial |
$3,819.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,151.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,774.48
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
OP
|
$2,955.08
|
|
|
Service Code
|
HCPCS Q0139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,684.40 |
| Max. Negotiated Rate |
$2,955.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,083.33
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3,366.01
|
| Rate for Payer: Aetna Workers' Compensation |
$2,083.33
|
| Rate for Payer: Aetna Workers' Compensation |
$3,366.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,047.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,047.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,275.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,676.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,762.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,328.60
|
| Rate for Payer: Cash Price |
$4,774.48
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cigna Commercial |
$1,808.51
|
| Rate for Payer: Cigna Commercial |
$2,921.98
|
| Rate for Payer: Cigna Medicare Advantage |
$1,684.40
|
| Rate for Payer: Cigna Medicare Advantage |
$2,721.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,861.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,007.92
|
| Rate for Payer: Home State Health Plan Exchange |
$1,684.40
|
| Rate for Payer: Home State Health Plan Exchange |
$2,721.45
|
| Rate for Payer: Humana Medicare |
$2,216.31
|
| Rate for Payer: Humana Medicare |
$3,580.86
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,216.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,580.86
|
| Rate for Payer: Provider Network of America Commercial |
$2,364.06
|
| Rate for Payer: Provider Network of America Commercial |
$3,819.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,950.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,151.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,955.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,774.48
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
OP
|
$2,955.08
|
|
|
Service Code
|
NDC 00781315401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,684.40 |
| Max. Negotiated Rate |
$2,955.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,083.33
|
| Rate for Payer: Aetna Workers' Compensation |
$2,083.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,047.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,047.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,328.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,275.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,328.60
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cigna Commercial |
$1,808.51
|
| Rate for Payer: Cigna Medicare Advantage |
$1,684.40
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,861.70
|
| Rate for Payer: Home State Health Plan Exchange |
$1,684.40
|
| Rate for Payer: Humana Medicare |
$2,216.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,216.31
|
| Rate for Payer: Provider Network of America Commercial |
$2,364.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,950.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,955.08
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
IP
|
$4,774.48
|
|
|
Service Code
|
NDC 59338077501
|
|
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 |
$4,774.48
|
| Rate for Payer: Cash Price |
$4,774.48
|
| 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 |
$3,580.86
|
| Rate for Payer: Provider Network of America Commercial |
$3,819.58
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
IP
|
$2,955.08
|
|
|
Service Code
|
NDC 00781315401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,216.31
|
| Rate for Payer: Provider Network of America Commercial |
$2,364.06
|
|
|
ferumoxytol 510 mg/17 mL (30 mg/mL) solution 17 mL Vial
|
Facility
|
IP
|
$4,774.48
|
|
|
Service Code
|
HCPCS Q0139
|
|
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 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 |
$4,774.48
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cash Price |
$2,955.08
|
| Rate for Payer: Cash Price |
$4,774.48
|
| 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 |
$2,216.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,580.86
|
| Rate for Payer: Provider Network of America Commercial |
$2,364.06
|
| Rate for Payer: Provider Network of America Commercial |
$3,819.58
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$15,308.19
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$15,308.19 |
| 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 |
$15,308.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$15,308.19
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$15,308.19
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15,308.19
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$6,760.08
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,760.08 |
| 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 |
$6,760.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,760.08
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,760.08
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,760.08
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$9,352.43
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$9,352.43 |
| 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 |
$9,352.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$9,352.43
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,352.43
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,352.43
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 7221
|
| 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 |
$4,643.86
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,643.86
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,643.86
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,643.86
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 864
|
| 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 |
$4,172.19
|
|
|
filgrastim 300 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$1,334.80
|
|
|
Service Code
|
NDC 55513092491
|
|
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 |
$1,334.80
|
| Rate for Payer: Cash Price |
$1,334.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,001.10
|
| Rate for Payer: Provider Network of America Commercial |
$1,067.84
|
|
|
filgrastim 300 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$1,334.80
|
|
|
Service Code
|
HCPCS J1442
|
|
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 |
$1,334.80
|
| Rate for Payer: Cash Price |
$1,334.80
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,001.10
|
| Rate for Payer: Provider Network of America Commercial |
$1,067.84
|
|
|
filgrastim 300 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$1,334.80
|
|
|
Service Code
|
NDC 55513092491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$760.84 |
| Max. Negotiated Rate |
$1,334.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$941.03
|
| Rate for Payer: Aetna Workers' Compensation |
$941.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,027.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,051.82
|
| Rate for Payer: Cash Price |
$1,334.80
|
| Rate for Payer: Cigna Commercial |
$816.90
|
| Rate for Payer: Cigna Medicare Advantage |
$760.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$840.92
|
| Rate for Payer: Home State Health Plan Exchange |
$760.84
|
| Rate for Payer: Humana Medicare |
$1,001.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,001.10
|
| Rate for Payer: Provider Network of America Commercial |
$1,067.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$880.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,334.80
|
|
|
filgrastim 300 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$1,334.80
|
|
|
Service Code
|
HCPCS J1442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$760.84 |
| Max. Negotiated Rate |
$1,334.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$941.03
|
| Rate for Payer: Aetna Workers' Compensation |
$941.03
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,051.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,027.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,051.82
|
| Rate for Payer: Cash Price |
$1,334.80
|
| Rate for Payer: Cigna Commercial |
$816.90
|
| Rate for Payer: Cigna Medicare Advantage |
$760.84
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$840.92
|
| Rate for Payer: Home State Health Plan Exchange |
$760.84
|
| Rate for Payer: Humana Medicare |
$1,001.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,001.10
|
| Rate for Payer: Provider Network of America Commercial |
$1,067.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$880.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,334.80
|
|
|
filgrastim 480 mcg/0.8 mL syringe 0.8 mL Syringe
|
Facility
|
OP
|
$2,125.72
|
|
|
Service Code
|
HCPCS J1442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,211.66 |
| Max. Negotiated Rate |
$2,125.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,498.63
|
| Rate for Payer: Aetna Workers' Compensation |
$1,498.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,473.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,473.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,675.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,675.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,675.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,636.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,675.07
|
| Rate for Payer: Cash Price |
$2,125.72
|
| Rate for Payer: Cigna Commercial |
$1,300.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1,211.66
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,339.20
|
| Rate for Payer: Home State Health Plan Exchange |
$1,211.66
|
| Rate for Payer: Humana Medicare |
$1,594.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,594.29
|
| Rate for Payer: Provider Network of America Commercial |
$1,700.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,402.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,125.72
|
|
