|
amino acids-protein hydrolys 15 gram- 100 kcal/30 mL liquid in packet 30 mL Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 26974041017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.75 |
| 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 |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
|
|
Aminophyllin 250 mg inj
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
Px0636J028001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.69 |
| 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 |
$26.25
|
| Rate for Payer: Cash Price |
$26.25
|
| 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 |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
|
|
Aminophyllin 250 mg inj
|
Facility
|
OP
|
$26.25
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
Px0636J028001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$18.51
|
| Rate for Payer: Aetna Workers' Compensation |
$18.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$20.68
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Cigna Commercial |
$16.07
|
| Rate for Payer: Cigna Medicare Advantage |
$14.96
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$16.54
|
| Rate for Payer: Home State Health Plan Exchange |
$14.96
|
| Rate for Payer: Humana Medicare |
$19.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.69
|
| Rate for Payer: Provider Network of America Commercial |
$21.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$26.25
|
|
|
aminophylline per 250 mg
|
Facility
|
OP
|
$56.62
|
|
|
Service Code
|
NDC 00409592216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$39.92
|
| Rate for Payer: Aetna Workers' Compensation |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$44.62
|
| Rate for Payer: Cash Price |
$56.62
|
| Rate for Payer: Cigna Commercial |
$34.65
|
| Rate for Payer: Cigna Medicare Advantage |
$32.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$35.67
|
| Rate for Payer: Home State Health Plan Exchange |
$32.27
|
| Rate for Payer: Humana Medicare |
$42.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$42.47
|
| Rate for Payer: Provider Network of America Commercial |
$45.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$56.62
|
|
|
aminophylline per 250 mg
|
Facility
|
OP
|
$56.62
|
|
|
Service Code
|
HCPCS J0280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.27 |
| Max. Negotiated Rate |
$56.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$39.92
|
| Rate for Payer: Aetna Workers' Compensation |
$39.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$43.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$44.62
|
| Rate for Payer: Cash Price |
$56.62
|
| Rate for Payer: Cigna Commercial |
$34.65
|
| Rate for Payer: Cigna Medicare Advantage |
$32.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$35.67
|
| Rate for Payer: Home State Health Plan Exchange |
$32.27
|
| Rate for Payer: Humana Medicare |
$42.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$42.47
|
| Rate for Payer: Provider Network of America Commercial |
$45.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$56.62
|
|
|
aminophylline per 250 mg
|
Facility
|
IP
|
$56.62
|
|
|
Service Code
|
NDC 00409592216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.47 |
| 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 |
$56.62
|
| Rate for Payer: Cash Price |
$56.62
|
| 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 |
$42.47
|
| Rate for Payer: Provider Network of America Commercial |
$45.30
|
|
|
aminophylline per 250 mg
|
Facility
|
IP
|
$56.62
|
|
|
Service Code
|
HCPCS J0280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.47 |
| 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 |
$56.62
|
| Rate for Payer: Cash Price |
$56.62
|
| 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 |
$42.47
|
| Rate for Payer: Provider Network of America Commercial |
$45.30
|
|
|
amiodarone 150 mg/100 mL (1.5 mg/mL) solution 100 mL Bag
|
Facility
|
IP
|
$138.76
|
|
|
Service Code
|
NDC 43066015010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.07
|
| Rate for Payer: Provider Network of America Commercial |
$111.01
|
|
|
amiodarone 150 mg/100 mL (1.5 mg/mL) solution 100 mL Bag
|
Facility
|
OP
|
$138.76
|
|
|
Service Code
|
NDC 43066015010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$138.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$97.83
|
| Rate for Payer: Aetna Workers' Compensation |
$97.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$96.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$96.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$109.34
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Commercial |
$84.92
|
| Rate for Payer: Cigna Medicare Advantage |
$79.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$87.42
|
| Rate for Payer: Home State Health Plan Exchange |
$79.09
|
| Rate for Payer: Humana Medicare |
$104.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.07
|
| Rate for Payer: Provider Network of America Commercial |
$111.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$138.76
|
|
|
amiodarone 150 mg/100 mL (1.5 mg/mL) solution 100 mL Bag
|
Facility
|
IP
|
$138.76
|
|
|
Service Code
|
HCPCS J0283
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.07
|
| Rate for Payer: Provider Network of America Commercial |
$111.01
|
|
|
amiodarone 150 mg/100 mL (1.5 mg/mL) solution 100 mL Bag
|
Facility
|
OP
|
$138.76
|
|
|
Service Code
|
HCPCS J0283
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$138.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$97.83
|
| Rate for Payer: Aetna Workers' Compensation |
$97.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$96.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$96.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$109.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$106.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$109.34
|
| Rate for Payer: Cash Price |
$138.76
|
| Rate for Payer: Cigna Commercial |
$84.92
|
| Rate for Payer: Cigna Medicare Advantage |
$79.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$87.42
|
| Rate for Payer: Home State Health Plan Exchange |
$79.09
|
| Rate for Payer: Humana Medicare |
$104.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$104.07
|
| Rate for Payer: Provider Network of America Commercial |
$111.01
|
| Rate for Payer: UnitedHealthcare Commercial |
$91.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$138.76
|
|
|
amiodarone 200 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904699361
|
|
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
|
|
|
amiodarone 200 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904699361
|
|
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
|
|
|
amiodarone 360 mg/200 mL (1.8 mg/mL) solution 200 mL Bag
|
Facility
|
OP
|
$184.56
|
|
|
Service Code
|
HCPCS J0283
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$184.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$130.11
|
| Rate for Payer: Aetna Workers' Compensation |
$130.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$127.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$127.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$142.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$145.43
|
| Rate for Payer: Cash Price |
$184.56
|
| Rate for Payer: Cigna Commercial |
$112.95
|
| Rate for Payer: Cigna Medicare Advantage |
$105.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$116.27
|
| Rate for Payer: Home State Health Plan Exchange |
$105.20
|
| Rate for Payer: Humana Medicare |
$138.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$138.42
|
| Rate for Payer: Provider Network of America Commercial |
$147.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$121.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$184.56
|
|
|
amiodarone 360 mg/200 mL (1.8 mg/mL) solution 200 mL Bag
|
Facility
|
IP
|
$184.56
|
|
|
Service Code
|
NDC 43066036020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$138.42 |
| 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 |
$184.56
|
| Rate for Payer: Cash Price |
$184.56
|
| 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 |
$138.42
|
| Rate for Payer: Provider Network of America Commercial |
$147.65
|
|
|
amiodarone 360 mg/200 mL (1.8 mg/mL) solution 200 mL Bag
|
Facility
|
OP
|
$184.56
|
|
|
Service Code
|
NDC 43066036020
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$184.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$130.11
|
| Rate for Payer: Aetna Workers' Compensation |
$130.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$127.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$127.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$145.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$142.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$145.43
|
| Rate for Payer: Cash Price |
$184.56
|
| Rate for Payer: Cigna Commercial |
$112.95
|
| Rate for Payer: Cigna Medicare Advantage |
$105.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$116.27
|
| Rate for Payer: Home State Health Plan Exchange |
$105.20
|
| Rate for Payer: Humana Medicare |
$138.42
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$138.42
|
| Rate for Payer: Provider Network of America Commercial |
$147.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$121.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$184.56
|
|
|
amiodarone 360 mg/200 mL (1.8 mg/mL) solution 200 mL Bag
|
Facility
|
IP
|
$184.56
|
|
|
Service Code
|
HCPCS J0283
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$138.42 |
| 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 |
$184.56
|
| Rate for Payer: Cash Price |
$184.56
|
| 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 |
$138.42
|
| Rate for Payer: Provider Network of America Commercial |
$147.65
|
|
|
amiodarone 50 mg/mL solution 3 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 00143987501
|
|
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
|
|
|
amiodarone 50 mg/mL solution 3 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J0282
|
|
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
|
|
|
amiodarone 50 mg/mL solution 3 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J0282
|
|
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
|
|
|
amiodarone 50 mg/mL solution 3 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 00143987501
|
|
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
|
|
|
amLODIPine 5 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904637061
|
|
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
|
|
|
amLODIPine 5 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904637061
|
|
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
|
|
|
ammonia 15 % (w/v) solution 1 Each AMPUL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ammonia 15 % (w/v) solution 1 Each AMPUL
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J7699
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
