|
Gastric Emptying Imag Study
|
Facility
|
IP
|
$141.96
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
Px09727826401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$106.47 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| 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 |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
|
|
Gastric Emptying Imag Study
|
Facility
|
OP
|
$141.96
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
Px09727826401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.92 |
| Max. Negotiated Rate |
$544.89 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$100.08
|
| Rate for Payer: Aetna Workers' Compensation |
$100.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$109.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$111.86
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cash Price |
$141.96
|
| Rate for Payer: Cigna Commercial |
$86.88
|
| Rate for Payer: Cigna Medicare Advantage |
$80.92
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$89.43
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$80.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$106.47
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$106.47
|
| Rate for Payer: Provider Network of America Commercial |
$113.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$93.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$141.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 378
|
| 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 |
$4,609.29
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$8,591.60
|
|
|
Service Code
|
MSDRG 377
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,591.60 |
| 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 |
$8,591.60
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 379
|
| 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 |
$2,962.88
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 389
|
| 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 |
$3,712.06
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$6,940.96
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,940.96 |
| 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 |
$6,940.96
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 390
|
| 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 |
$2,556.80
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$20,686.11
|
|
|
Service Code
|
APR-DRG 2464
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$20,686.11 |
| 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 |
$20,686.11
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$20,686.11
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$20,686.11
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20,686.11
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$6,258.99
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,258.99 |
| 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 |
$6,258.99
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6,258.99
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$6,258.99
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6,258.99
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$12,385.78
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,385.78 |
| 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 |
$12,385.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,385.78
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,385.78
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,385.78
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$8,196.79
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,196.79 |
| 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 |
$8,196.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,196.79
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,196.79
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,196.79
|
|
|
Gefitinib oral
|
Facility
|
IP
|
$79.71
|
|
|
Service Code
|
HCPCS J8565
|
| Hospital Charge Code |
Px0636J856501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.78 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Provider Network of America Commercial |
$63.77
|
|
|
Gefitinib oral
|
Facility
|
OP
|
$79.71
|
|
|
Service Code
|
HCPCS J8565
|
| Hospital Charge Code |
Px0636J856501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$79.71 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.20
|
| Rate for Payer: Aetna Workers' Compensation |
$56.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.81
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cigna Commercial |
$48.78
|
| Rate for Payer: Cigna Medicare Advantage |
$45.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.22
|
| Rate for Payer: Home State Health Plan Exchange |
$45.43
|
| Rate for Payer: Humana Medicare |
$59.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Provider Network of America Commercial |
$63.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$79.71
|
|
|
Gelsyn-3 16.8 mg/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
NDC 89130311101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$884.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,094.16
|
| Rate for Payer: Aetna Workers' Compensation |
$1,094.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,075.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,075.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,195.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,222.98
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cigna Commercial |
$949.82
|
| Rate for Payer: Cigna Medicare Advantage |
$884.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$977.76
|
| Rate for Payer: Home State Health Plan Exchange |
$884.64
|
| Rate for Payer: Humana Medicare |
$1,164.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,241.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,024.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,552.00
|
|
|
Gelsyn-3 16.8 mg/2 mL syringe 2 mL Syringe
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS J7328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$884.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,094.16
|
| Rate for Payer: Aetna Workers' Compensation |
$1,094.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,075.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,075.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,222.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,195.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,222.98
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cigna Commercial |
$949.82
|
| Rate for Payer: Cigna Medicare Advantage |
$884.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$977.76
|
| Rate for Payer: Home State Health Plan Exchange |
$884.64
|
| Rate for Payer: Humana Medicare |
$1,164.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,241.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,024.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,552.00
|
|
|
Gelsyn-3 16.8 mg/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS J7328
|
|
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 |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,241.60
|
|
|
Gelsyn-3 16.8 mg/2 mL syringe 2 mL Syringe
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
NDC 89130311101
|
|
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 |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,241.60
|
|
|
gemcitabine 1 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$203.12
|
|
|
Service Code
|
HCPCS J9201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.78 |
| Max. Negotiated Rate |
$203.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$143.20
|
| Rate for Payer: Aetna Workers' Compensation |
$143.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$160.06
|
| Rate for Payer: Cash Price |
$203.12
|
| Rate for Payer: Cigna Commercial |
$124.31
|
| Rate for Payer: Cigna Medicare Advantage |
$115.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.97
|
| Rate for Payer: Home State Health Plan Exchange |
$115.78
|
| Rate for Payer: Humana Medicare |
$152.34
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$152.34
|
| Rate for Payer: Provider Network of America Commercial |
$162.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$134.06
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$203.12
|
|
|
gemcitabine 1 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$203.12
|
|
|
Service Code
|
HCPCS J9201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.34 |
| 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 |
$203.12
|
| Rate for Payer: Cash Price |
$203.12
|
| 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 |
$152.34
|
| Rate for Payer: Provider Network of America Commercial |
$162.50
|
|
|
gemcitabine 1 gram recon soln 1 Each Vial
|
Facility
|
IP
|
$203.12
|
|
|
Service Code
|
NDC 00409018601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.34 |
| 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 |
$203.12
|
| Rate for Payer: Cash Price |
$203.12
|
| 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 |
$152.34
|
| Rate for Payer: Provider Network of America Commercial |
$162.50
|
|
|
gemcitabine 1 gram recon soln 1 Each Vial
|
Facility
|
OP
|
$203.12
|
|
|
Service Code
|
NDC 00409018601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.78 |
| Max. Negotiated Rate |
$203.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$143.20
|
| Rate for Payer: Aetna Workers' Compensation |
$143.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$140.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$156.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$160.06
|
| Rate for Payer: Cash Price |
$203.12
|
| Rate for Payer: Cigna Commercial |
$124.31
|
| Rate for Payer: Cigna Medicare Advantage |
$115.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$127.97
|
| Rate for Payer: Home State Health Plan Exchange |
$115.78
|
| Rate for Payer: Humana Medicare |
$152.34
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$152.34
|
| Rate for Payer: Provider Network of America Commercial |
$162.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$134.06
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$203.12
|
|
|
gemcitabine 200 mg/5.26 mL (38 mg/mL) solution 5.26 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J9201
|
|
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
|
|
|
gemcitabine 200 mg/5.26 mL (38 mg/mL) solution 5.26 mL Vial
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 00409018301
|
|
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
|
|
|
gemcitabine 200 mg/5.26 mL (38 mg/mL) solution 5.26 mL Vial
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J9201
|
|
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
|
|
