|
NIFEdipine 10 mg capsule 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 23155019401
|
|
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
|
|
|
NIFEdipine 10 mg capsule 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 23155019401
|
|
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
|
|
|
NIFEdipine XL 30 mg tablet extended release 24hr 1 Each BLIST PACK
|
Facility
|
IP
|
$5.96
|
|
|
Service Code
|
NDC 68084059711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.47 |
| 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 |
$5.96
|
| Rate for Payer: Cash Price |
$5.96
|
| 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 |
$4.47
|
| Rate for Payer: Provider Network of America Commercial |
$4.77
|
|
|
NIFEdipine XL 30 mg tablet extended release 24hr 1 Each BLIST PACK
|
Facility
|
OP
|
$5.96
|
|
|
Service Code
|
NDC 68084059711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$5.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.20
|
| Rate for Payer: Aetna Workers' Compensation |
$4.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.70
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: Cigna Medicare Advantage |
$3.40
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.75
|
| Rate for Payer: Home State Health Plan Exchange |
$3.40
|
| Rate for Payer: Humana Medicare |
$4.47
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.47
|
| Rate for Payer: Provider Network of America Commercial |
$4.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.93
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.96
|
|
|
NIFEdipine XL 30 mg tablet extended release 24hr 50 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904720806
|
|
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
|
|
|
NIFEdipine XL 30 mg tablet extended release 24hr 50 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904720806
|
|
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
|
|
|
nitrofurantoin 100 mg capsule 1 Each BLIST PACK
|
Facility
|
OP
|
$11.49
|
|
|
Service Code
|
NDC 50268062411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$8.10
|
| Rate for Payer: Aetna Workers' Compensation |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$7.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$7.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$9.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$8.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$9.05
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cigna Commercial |
$7.03
|
| Rate for Payer: Cigna Medicare Advantage |
$6.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$7.24
|
| Rate for Payer: Home State Health Plan Exchange |
$6.55
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$8.62
|
| Rate for Payer: Provider Network of America Commercial |
$9.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.49
|
|
|
nitrofurantoin 100 mg capsule 1 Each BLIST PACK
|
Facility
|
IP
|
$11.49
|
|
|
Service Code
|
NDC 50268062411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| 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 |
$11.49
|
| Rate for Payer: Cash Price |
$11.49
|
| 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 |
$8.62
|
| Rate for Payer: Provider Network of America Commercial |
$9.19
|
|
|
nitroglycerin 0.2 mg/hr patch 24 hour 1 Each Packet
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00378910416
|
|
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
|
|
|
nitroglycerin 0.2 mg/hr patch 24 hour 1 Each Packet
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00378910416
|
|
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
|
|
|
nitroglycerin 0.4 mg tablet, sublingual 25 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 59762330403
|
|
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
|
|
|
nitroglycerin 0.4 mg tablet, sublingual 25 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 59762330403
|
|
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
|
|
|
nitroglycerin 2 % ointment 1 g Packet
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00281032608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$31.73
|
| Rate for Payer: Aetna Workers' Compensation |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$31.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$35.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$35.46
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$27.54
|
| Rate for Payer: Cigna Medicare Advantage |
$25.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$28.35
|
| Rate for Payer: Home State Health Plan Exchange |
$25.65
|
| Rate for Payer: Humana Medicare |
$33.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Provider Network of America Commercial |
$36.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.70
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$45.00
|
|
|
nitroglycerin 2 % ointment 1 g Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00281032608
|
|
Hospital Revenue Code
|
637
|
| 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
|
|
|
nitroglycerin 50 mg/250 mL (200 mcg/mL) solution 250 mL Bottle
|
Facility
|
OP
|
$90.15
|
|
|
Service Code
|
NDC 00338104902
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$51.39 |
| Max. Negotiated Rate |
$90.15 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$63.56
|
| Rate for Payer: Aetna Workers' Compensation |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$71.04
|
| Rate for Payer: Cash Price |
$90.15
|
| Rate for Payer: Cigna Commercial |
$55.17
|
| Rate for Payer: Cigna Medicare Advantage |
$51.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$56.79
|
| Rate for Payer: Home State Health Plan Exchange |
$51.39
|
| Rate for Payer: Humana Medicare |
$67.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$67.61
|
| Rate for Payer: Provider Network of America Commercial |
$72.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$90.15
|
|
|
nitroglycerin 50 mg/250 mL (200 mcg/mL) solution 250 mL Bottle
|
Facility
|
IP
|
$90.15
|
|
|
Service Code
|
HCPCS J2305
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$67.61 |
| 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 |
$90.15
|
| Rate for Payer: Cash Price |
$90.15
|
| 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 |
$67.61
|
| Rate for Payer: Provider Network of America Commercial |
$72.12
|
|
|
nitroglycerin 50 mg/250 mL (200 mcg/mL) solution 250 mL Bottle
|
Facility
|
IP
|
$90.15
|
|
|
Service Code
|
NDC 00338104902
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$67.61 |
| 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 |
$90.15
|
| Rate for Payer: Cash Price |
$90.15
|
| 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 |
$67.61
|
| Rate for Payer: Provider Network of America Commercial |
$72.12
|
|
|
nitroglycerin 50 mg/250 mL (200 mcg/mL) solution 250 mL Bottle
|
Facility
|
OP
|
$90.15
|
|
|
Service Code
|
HCPCS J2305
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$51.39 |
| Max. Negotiated Rate |
$90.15 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$63.56
|
| Rate for Payer: Aetna Workers' Compensation |
$63.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$62.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$69.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$71.04
|
| Rate for Payer: Cash Price |
$90.15
|
| Rate for Payer: Cigna Commercial |
$55.17
|
| Rate for Payer: Cigna Medicare Advantage |
$51.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$56.79
|
| Rate for Payer: Home State Health Plan Exchange |
$51.39
|
| Rate for Payer: Humana Medicare |
$67.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$67.61
|
| Rate for Payer: Provider Network of America Commercial |
$72.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$59.50
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$90.15
|
|
|
nitroprusside 25 mg/mL solution 2 mL Vial
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
NDC 72485010501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$60.00 |
| 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 |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| 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 |
$60.00
|
| Rate for Payer: Provider Network of America Commercial |
$64.00
|
|
|
nitroprusside 25 mg/mL solution 2 mL Vial
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
NDC 72485010501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$56.40
|
| Rate for Payer: Aetna Workers' Compensation |
$56.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$63.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$61.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$63.04
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$48.96
|
| Rate for Payer: Cigna Medicare Advantage |
$45.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$50.40
|
| Rate for Payer: Home State Health Plan Exchange |
$45.60
|
| Rate for Payer: Humana Medicare |
$60.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Provider Network of America Commercial |
$64.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.80
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$80.00
|
|
|
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic 1 Level
|
Facility
|
OP
|
$1,919.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
Px07616447901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.36 |
| Max. Negotiated Rate |
$1,919.91 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,353.54
|
| Rate for Payer: Aetna Workers' Compensation |
$1,353.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,330.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,330.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,512.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,512.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,512.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,478.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,512.89
|
| Rate for Payer: Cash Price |
$1,919.91
|
| Rate for Payer: Cash Price |
$1,919.91
|
| Rate for Payer: Cigna Commercial |
$1,174.98
|
| Rate for Payer: Cigna Medicare Advantage |
$1,094.35
|
| Rate for Payer: Family Health Partners Medicaid |
$1,116.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,209.54
|
| Rate for Payer: Healthy Blue Medicaid |
$1,205.53
|
| Rate for Payer: Home State Health Plan Exchange |
$1,094.35
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,116.23
|
| Rate for Payer: Humana Medicare |
$1,439.93
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,116.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,439.93
|
| Rate for Payer: Provider Network of America Commercial |
$1,535.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,267.14
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,919.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$840.36
|
|
|
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic 1 Level
|
Facility
|
IP
|
$1,919.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
Px07616447901
|
|
Hospital Revenue Code
|
761
|
| 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 |
$1,919.91
|
| Rate for Payer: Cash Price |
$1,919.91
|
| 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 |
$1,439.93
|
| Rate for Payer: Provider Network of America Commercial |
$1,535.93
|
|
|
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl
|
Facility
|
OP
|
$700.35
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
Px07616448001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$700.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$493.75
|
| Rate for Payer: Aetna Workers' Compensation |
$493.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$485.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$485.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$539.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$551.88
|
| Rate for Payer: Cash Price |
$700.35
|
| Rate for Payer: Cigna Commercial |
$428.61
|
| Rate for Payer: Cigna Medicare Advantage |
$399.20
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$441.22
|
| Rate for Payer: Home State Health Plan Exchange |
$399.20
|
| Rate for Payer: Humana Medicare |
$525.26
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$525.26
|
| Rate for Payer: Provider Network of America Commercial |
$560.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$462.23
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$700.35
|
|
|
Njx Aa&/Strd Tfrml Epi Cervical/Thoracic Ea Addl
|
Facility
|
IP
|
$700.35
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
Px07616448001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.26 |
| 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 |
$700.35
|
| Rate for Payer: Cash Price |
$700.35
|
| 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 |
$525.26
|
| Rate for Payer: Provider Network of America Commercial |
$560.28
|
|
|
Njx Anes Stellate Ganglion Crv Sympathetic
|
Facility
|
IP
|
$1,919.91
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
Px07616451001
|
|
Hospital Revenue Code
|
761
|
| 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 |
$1,919.91
|
| Rate for Payer: Cash Price |
$1,919.91
|
| 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 |
$1,439.93
|
| Rate for Payer: Provider Network of America Commercial |
$1,535.93
|
|
