|
fluconazole in NaCl (iso-osm) 200 mg/100 mL piggyback 100 mL Flex Cont
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J1450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.38
|
| Rate for Payer: Aetna Workers' Compensation |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.37
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$22.03
|
| Rate for Payer: Cigna Medicare Advantage |
$20.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.68
|
| Rate for Payer: Home State Health Plan Exchange |
$20.52
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Provider Network of America Commercial |
$28.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.76
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$36.00
|
|
|
fluconazole in NaCl (iso-osm) 200 mg/100 mL piggyback 100 mL Flex Cont
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
NDC 25021018482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| 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 |
$27.00
|
| Rate for Payer: Provider Network of America Commercial |
$28.80
|
|
|
fluconazole in NaCl (iso-osm) 200 mg/100 mL piggyback 100 mL Flex Cont
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
NDC 25021018482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.38
|
| Rate for Payer: Aetna Workers' Compensation |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$27.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.37
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$22.03
|
| Rate for Payer: Cigna Medicare Advantage |
$20.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.68
|
| Rate for Payer: Home State Health Plan Exchange |
$20.52
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Provider Network of America Commercial |
$28.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.76
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$36.00
|
|
|
fluconazole in NaCl (iso-osm) 200 mg/100 mL piggyback 100 mL Flex Cont
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J1450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| 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 |
$27.00
|
| Rate for Payer: Provider Network of America Commercial |
$28.80
|
|
|
Fludarabine phosphate inj
|
Facility
|
OP
|
$432.18
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
Px0636J918501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.34 |
| Max. Negotiated Rate |
$432.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$304.69
|
| Rate for Payer: Aetna Workers' Compensation |
$304.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$299.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$299.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$332.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$340.56
|
| Rate for Payer: Cash Price |
$432.18
|
| Rate for Payer: Cigna Commercial |
$264.49
|
| Rate for Payer: Cigna Medicare Advantage |
$246.34
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$272.27
|
| Rate for Payer: Home State Health Plan Exchange |
$246.34
|
| Rate for Payer: Humana Medicare |
$324.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$324.13
|
| Rate for Payer: Provider Network of America Commercial |
$345.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$285.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$432.18
|
|
|
Fludarabine phosphate inj
|
Facility
|
IP
|
$432.18
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
Px0636J918501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.13 |
| 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 |
$432.18
|
| Rate for Payer: Cash Price |
$432.18
|
| 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 |
$324.13
|
| Rate for Payer: Provider Network of America Commercial |
$345.74
|
|
|
fludrocortisone 0.1 mg tablet 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268033011
|
|
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
|
|
|
fludrocortisone 0.1 mg tablet 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268033011
|
|
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
|
|
|
flumazenil 0.1 mg/mL solution 5 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 36000014801
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
flumazenil 0.1 mg/mL solution 5 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 36000014801
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
fluorescein 1 mg strip 100 Each Box
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 17238090011
|
|
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
|
|
|
fluorescein 1 mg strip 100 Each Box
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 17238090011
|
|
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
|
|
|
fluorescein 1 mg strip 300 Each Box
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 99999008442
|
|
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
|
|
|
fluorescein 1 mg strip 300 Each Box
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 99999008442
|
|
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
|
|
|
Fluorescent Antibody; Titer - Mglur1 Ab Ifa Titer
|
Facility
|
OP
|
$137.22
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
Px03028625615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$109.78 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$96.74
|
| Rate for Payer: Aetna Workers' Compensation |
$96.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$95.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$108.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$108.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$108.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$105.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$108.13
|
| Rate for Payer: Cash Price |
$137.22
|
| Rate for Payer: Cash Price |
$137.22
|
| Rate for Payer: Cigna Commercial |
$71.90
|
| Rate for Payer: Cigna Medicare Advantage |
$78.22
|
| Rate for Payer: Family Health Partners Medicaid |
$15.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$86.45
|
| Rate for Payer: Healthy Blue Medicaid |
$16.41
|
| Rate for Payer: Home State Health Plan Exchange |
$78.22
|
| Rate for Payer: Home State Health Plan Medicaid |
$15.19
|
| Rate for Payer: Humana Medicare |
$102.92
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$102.92
|
| Rate for Payer: Provider Network of America Commercial |
$109.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
|
|
Fluorescent Antibody; Titer - Mglur1 Ab Ifa Titer
|
Facility
|
IP
|
$137.22
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
Px03028625615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.92 |
| 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 |
$137.22
|
| Rate for Payer: Cash Price |
$137.22
|
| 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 |
$102.92
|
| Rate for Payer: Provider Network of America Commercial |
$109.78
|
|
|
Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
Px09647700201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$176.25
|
| Rate for Payer: Aetna Workers' Compensation |
$176.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$173.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$197.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$192.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$197.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: Cigna Medicare Advantage |
$142.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$157.50
|
| Rate for Payer: Home State Health Plan Exchange |
$142.50
|
| Rate for Payer: Humana Medicare |
$187.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$187.50
|
| Rate for Payer: Provider Network of America Commercial |
$200.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$165.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$250.00
|
|
|
Fluoro Guidance Needle Placement
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
Px09647700201
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$187.50 |
| 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 |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| 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 |
$187.50
|
| Rate for Payer: Provider Network of America Commercial |
$200.00
|
|
|
Fluoroscopic Guidance Needle Placement Add On
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
Px09727700201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Cigna Medicare Advantage |
$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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
Fluoroscopic Guidance Needle Placement Add On
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
Px09727700201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$30.03 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
|
|
fluorouracil 5 gram/100 mL solution 100 mL Vial
|
Facility
|
OP
|
$117.20
|
|
|
Service Code
|
NDC 63323011761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$117.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$82.63
|
| Rate for Payer: Aetna Workers' Compensation |
$82.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$92.35
|
| Rate for Payer: Cash Price |
$117.20
|
| Rate for Payer: Cigna Commercial |
$71.73
|
| Rate for Payer: Cigna Medicare Advantage |
$66.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$73.84
|
| Rate for Payer: Home State Health Plan Exchange |
$66.80
|
| Rate for Payer: Humana Medicare |
$87.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$87.90
|
| Rate for Payer: Provider Network of America Commercial |
$93.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$77.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$117.20
|
|
|
fluorouracil 5 gram/100 mL solution 100 mL Vial
|
Facility
|
OP
|
$117.20
|
|
|
Service Code
|
HCPCS J9190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$117.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$82.63
|
| Rate for Payer: Aetna Workers' Compensation |
$82.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$81.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$92.35
|
| Rate for Payer: Cash Price |
$117.20
|
| Rate for Payer: Cigna Commercial |
$71.73
|
| Rate for Payer: Cigna Medicare Advantage |
$66.80
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$73.84
|
| Rate for Payer: Home State Health Plan Exchange |
$66.80
|
| Rate for Payer: Humana Medicare |
$87.90
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$87.90
|
| Rate for Payer: Provider Network of America Commercial |
$93.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$77.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$117.20
|
|
|
fluorouracil 5 gram/100 mL solution 100 mL Vial
|
Facility
|
IP
|
$117.20
|
|
|
Service Code
|
NDC 63323011761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.90 |
| 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 |
$117.20
|
| Rate for Payer: Cash Price |
$117.20
|
| 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 |
$87.90
|
| Rate for Payer: Provider Network of America Commercial |
$93.76
|
|
|
fluorouracil 5 gram/100 mL solution 100 mL Vial
|
Facility
|
IP
|
$117.20
|
|
|
Service Code
|
HCPCS J9190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.90 |
| 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 |
$117.20
|
| Rate for Payer: Cash Price |
$117.20
|
| 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 |
$87.90
|
| Rate for Payer: Provider Network of America Commercial |
$93.76
|
|
|
Fluorouracil injection
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
Px0636J919001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.88
|
| Rate for Payer: Aetna Workers' Compensation |
$3.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.34
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna Commercial |
$3.37
|
| Rate for Payer: Cigna Medicare Advantage |
$3.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.47
|
| Rate for Payer: Home State Health Plan Exchange |
$3.14
|
| Rate for Payer: Humana Medicare |
$4.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.13
|
| Rate for Payer: Provider Network of America Commercial |
$4.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.51
|
|
