Ray County Hospital

All Charges

Charge

Type

Setting

Price

miSOPROStol 200 mcg tablet 1 Each BLIST PACK

Facility

$9.09

Service Code	NDC 60687074611
Hospital Revenue Code	637
Min. Negotiated Rate	$6.82
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	$9.09
Rate for Payer: Cash Price	$9.09
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	$6.82
Rate for Payer: Provider Network of America Commercial	$7.27

miSOPROStol 200 mcg tablet 1 Each BLIST PACK

Facility

$9.09

Service Code	NDC 60687074611
Hospital Revenue Code	637
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$9.09
Rate for Payer: Aetna Commercial/Medicare Advantage	$6.41
Rate for Payer: Aetna Workers' Compensation	$6.41
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$6.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$6.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$7.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$7.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$7.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$7.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$7.16
Rate for Payer: Cash Price	$9.09
Rate for Payer: Cigna Commercial	$5.56
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Harmony Health CHIP/Medicaid	$5.73
Rate for Payer: Home State Health Plan Exchange	$5.18
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$6.82
Rate for Payer: Provider Network of America Commercial	$7.27
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Individual Exchange	$9.09

miSOPROStol 200 mcg tablet 60 Each Bottle

Facility

$4.00

Service Code	NDC 70954044410
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

miSOPROStol 200 mcg tablet 60 Each Bottle

Facility

$4.00

Service Code	NDC 70954044410
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

Mitoxantrone hydrochl / 5 mg

Facility

$3,101.18

Service Code	HCPCS J9293
Hospital Charge Code	Px0636J929301
Hospital Revenue Code	636
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	$3,101.18
Rate for Payer: Cash Price	$3,101.18
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	$2,325.89
Rate for Payer: Provider Network of America Commercial	$2,480.94

Mitoxantrone hydrochl / 5 mg

Facility

$3,101.18

Service Code	HCPCS J9293
Hospital Charge Code	Px0636J929301
Hospital Revenue Code	636
Min. Negotiated Rate	$1,767.67
Max. Negotiated Rate	$3,101.18
Rate for Payer: Aetna Commercial/Medicare Advantage	$2,186.33
Rate for Payer: Aetna Workers' Compensation	$2,186.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$2,149.12
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$2,149.12
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$2,443.73
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$2,443.73
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$2,443.73
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$2,387.91
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$2,443.73
Rate for Payer: Cash Price	$3,101.18
Rate for Payer: Cigna Commercial	$1,897.92
Rate for Payer: Cigna Medicare Advantage	$1,767.67
Rate for Payer: Harmony Health CHIP/Medicaid	$1,953.74
Rate for Payer: Home State Health Plan Exchange	$1,767.67
Rate for Payer: Humana Medicare	$2,325.89
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$2,325.89
Rate for Payer: Provider Network of America Commercial	$2,480.94
Rate for Payer: UnitedHealthcare Commercial	$2,046.78
Rate for Payer: UnitedHealthcare Individual Exchange	$3,101.18

modafinil 100 mg tablet 30 Each BLIST PACK

Facility

$37.29

Service Code	NDC 00904679104
Hospital Revenue Code	637
Min. Negotiated Rate	$27.97
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	$37.29
Rate for Payer: Cash Price	$37.29
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	$27.97
Rate for Payer: Provider Network of America Commercial	$29.83

modafinil 100 mg tablet 30 Each BLIST PACK

Facility

$37.29

Service Code	NDC 00904679104
Hospital Revenue Code	637
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$37.29
Rate for Payer: Aetna Commercial/Medicare Advantage	$26.29
Rate for Payer: Aetna Workers' Compensation	$26.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$25.84
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$25.84
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$29.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$29.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$29.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$28.71
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$29.38
Rate for Payer: Cash Price	$37.29
Rate for Payer: Cigna Commercial	$22.82
Rate for Payer: Cigna Medicare Advantage	$21.26
Rate for Payer: Harmony Health CHIP/Medicaid	$23.49
Rate for Payer: Home State Health Plan Exchange	$21.26
Rate for Payer: Humana Medicare	$27.97
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$27.97
Rate for Payer: Provider Network of America Commercial	$29.83
Rate for Payer: UnitedHealthcare Commercial	$24.61
Rate for Payer: UnitedHealthcare Individual Exchange	$37.29

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$11,820.90

Service Code	APR-DRG 7931
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,820.90
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	$11,820.90
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,820.90
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,820.90
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,820.90

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$15,583.69

Service Code	APR-DRG 7932
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,583.69
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	$15,583.69
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,583.69
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,583.69
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,583.69

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$22,553.64

Service Code	APR-DRG 7933
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$22,553.64
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	$22,553.64
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$22,553.64
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$22,553.64
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$22,553.64

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$39,341.98

Service Code	APR-DRG 7934
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$39,341.98
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	$39,341.98
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$39,341.98
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$39,341.98
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$39,341.98

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$43,861.03

Service Code	APR-DRG 9514
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$43,861.03
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	$43,861.03
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$43,861.03
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$43,861.03
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$43,861.03

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$17,390.20

Service Code	APR-DRG 9512
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,390.20
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: Family Health Partners Medicaid	$17,390.20
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$17,390.20
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$17,390.20
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$17,390.20

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$11,865.28

Service Code	APR-DRG 9511
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,865.28
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	$11,865.28
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,865.28
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,865.28
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,865.28

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$25,925.36

Service Code	APR-DRG 9513
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,925.36
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	$25,925.36
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,925.36
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,925.36
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,925.36

montelukast 10 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904680861
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

montelukast 10 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904680861
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

morphine 100 mg/5 mL (20 mg/mL) solution 30 mL Bottle

Facility

$68.72

Service Code	NDC 00054051744
Hospital Revenue Code	637
Min. Negotiated Rate	$51.54
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	$68.72
Rate for Payer: Cash Price	$68.72
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	$51.54
Rate for Payer: Provider Network of America Commercial	$54.98

morphine 100 mg/5 mL (20 mg/mL) solution 30 mL Bottle

Facility

$68.72

Service Code	NDC 00054051744
Hospital Revenue Code	637
Min. Negotiated Rate	$39.17
Max. Negotiated Rate	$68.72
Rate for Payer: Aetna Commercial/Medicare Advantage	$48.45
Rate for Payer: Aetna Workers' Compensation	$48.45
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$47.62
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$47.62
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$54.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$54.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$54.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$52.91
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$54.15
Rate for Payer: Cash Price	$68.72
Rate for Payer: Cigna Commercial	$42.06
Rate for Payer: Cigna Medicare Advantage	$39.17
Rate for Payer: Harmony Health CHIP/Medicaid	$43.29
Rate for Payer: Home State Health Plan Exchange	$39.17
Rate for Payer: Humana Medicare	$51.54
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$51.54
Rate for Payer: Provider Network of America Commercial	$54.98
Rate for Payer: UnitedHealthcare Commercial	$45.36
Rate for Payer: UnitedHealthcare Individual Exchange	$68.72

morphine 15 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00406511862
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

morphine 15 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00406511862
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

morphine 15 mg tablet 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00406511823
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

morphine 15 mg tablet 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00406511823
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

morphine 4 mg/mL solution 1 mL Vial

Facility

$35.00

Service Code	NDC 00641612501
Hospital Revenue Code	250
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$6,053.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$875.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$900.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cigna Medicare Advantage	$6,053.00
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00

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