|
Pet Imaging CT Attenuation Skull Base Mid-Thigh
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
Px09727881501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$1,949.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$240.58
|
| Rate for Payer: Aetna Workers' Compensation |
$240.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$262.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$268.90
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cigna Medicare Advantage |
$194.51
|
| Rate for Payer: Family Health Partners Medicaid |
$1,804.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$214.99
|
| Rate for Payer: Healthy Blue Medicaid |
$1,949.01
|
| Rate for Payer: Home State Health Plan Exchange |
$194.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,804.64
|
| Rate for Payer: Humana Medicare |
$255.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,804.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$255.94
|
| Rate for Payer: Provider Network of America Commercial |
$273.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,358.64
|
|
|
Pet Imaging for CT Attenuation Whole Body
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
Px09727881601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$255.94 |
| 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 |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| 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 |
$255.94
|
| Rate for Payer: Provider Network of America Commercial |
$273.00
|
|
|
Pet Imaging for CT Attenuation Whole Body
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
Px09727881601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$1,949.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$240.58
|
| Rate for Payer: Aetna Workers' Compensation |
$240.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$262.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$268.90
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cigna Medicare Advantage |
$194.51
|
| Rate for Payer: Family Health Partners Medicaid |
$1,804.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$214.99
|
| Rate for Payer: Healthy Blue Medicaid |
$1,949.01
|
| Rate for Payer: Home State Health Plan Exchange |
$194.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,804.64
|
| Rate for Payer: Humana Medicare |
$255.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,804.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$255.94
|
| Rate for Payer: Provider Network of America Commercial |
$273.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,358.64
|
|
|
phenazopyridine 100 mg tablet 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 65162068110
|
|
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
|
|
|
phenazopyridine 100 mg tablet 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 65162068110
|
|
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
|
|
|
phenol 89 % swab 30 Each Packet
|
Facility
|
IP
|
$18.19
|
|
|
Service Code
|
NDC 00884629730
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.64 |
| 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 |
$18.19
|
| Rate for Payer: Cash Price |
$18.19
|
| 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 |
$13.64
|
| Rate for Payer: Provider Network of America Commercial |
$14.55
|
|
|
phenol 89 % swab 30 Each Packet
|
Facility
|
OP
|
$18.19
|
|
|
Service Code
|
NDC 00884629730
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$12.82
|
| Rate for Payer: Aetna Workers' Compensation |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$12.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$12.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$14.33
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cigna Commercial |
$11.13
|
| Rate for Payer: Cigna Medicare Advantage |
$10.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$11.46
|
| Rate for Payer: Home State Health Plan Exchange |
$10.37
|
| Rate for Payer: Humana Medicare |
$13.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$13.64
|
| Rate for Payer: Provider Network of America Commercial |
$14.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$18.19
|
|
|
Phentolaine mesylate inj
|
Facility
|
IP
|
$910.70
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
Px0636J276001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$683.02 |
| 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 |
$910.70
|
| Rate for Payer: Cash Price |
$910.70
|
| 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 |
$683.02
|
| Rate for Payer: Provider Network of America Commercial |
$728.56
|
|
|
Phentolaine mesylate inj
|
Facility
|
OP
|
$910.70
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
Px0636J276001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$519.10 |
| Max. Negotiated Rate |
$910.70 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$642.04
|
| Rate for Payer: Aetna Workers' Compensation |
$642.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$717.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$717.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$717.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$701.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$717.63
|
| Rate for Payer: Cash Price |
$910.70
|
| Rate for Payer: Cigna Commercial |
$557.35
|
| Rate for Payer: Cigna Medicare Advantage |
$519.10
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$573.74
|
| Rate for Payer: Home State Health Plan Exchange |
$519.10
|
| Rate for Payer: Humana Medicare |
$683.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$683.02
|
| Rate for Payer: Provider Network of America Commercial |
$728.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$601.06
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$910.70
|
|
|
phentolamine 5 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$1,679.20
|
|
|
Service Code
|
NDC 68094010120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$957.14 |
| Max. Negotiated Rate |
$1,679.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,183.84
|
| Rate for Payer: Aetna Workers' Compensation |
$1,183.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,163.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,163.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,323.21
|
| Rate for Payer: Cash Price |
$1,679.20
|
| Rate for Payer: Cigna Commercial |
$1,027.67
|
| Rate for Payer: Cigna Medicare Advantage |
$957.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,057.90
|
| Rate for Payer: Home State Health Plan Exchange |
$957.14
|
| Rate for Payer: Humana Medicare |
$1,259.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,259.40
|
| Rate for Payer: Provider Network of America Commercial |
$1,343.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,108.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,679.20
|
|
|
phentolamine 5 mg recon soln 1 Each Vial
|
Facility
|
OP
|
$1,679.20
|
|
|
Service Code
|
HCPCS J2760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$957.14 |
| Max. Negotiated Rate |
$1,679.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,183.84
|
| Rate for Payer: Aetna Workers' Compensation |
$1,183.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,163.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,163.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,323.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,323.21
|
| Rate for Payer: Cash Price |
$1,679.20
|
| Rate for Payer: Cigna Commercial |
$1,027.67
|
| Rate for Payer: Cigna Medicare Advantage |
$957.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,057.90
|
| Rate for Payer: Home State Health Plan Exchange |
$957.14
|
| Rate for Payer: Humana Medicare |
$1,259.40
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,259.40
|
| Rate for Payer: Provider Network of America Commercial |
$1,343.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,108.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,679.20
|
|
|
phentolamine 5 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$1,679.20
|
|
|
Service Code
|
NDC 68094010120
|
|
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 |
$1,679.20
|
| Rate for Payer: Cash Price |
$1,679.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,259.40
|
| Rate for Payer: Provider Network of America Commercial |
$1,343.36
|
|
|
phentolamine 5 mg recon soln 1 Each Vial
|
Facility
|
IP
|
$1,679.20
|
|
|
Service Code
|
HCPCS J2760
|
|
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 |
$1,679.20
|
| Rate for Payer: Cash Price |
$1,679.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,259.40
|
| Rate for Payer: Provider Network of America Commercial |
$1,343.36
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 63323075100
|
|
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
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 55150030001
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 63323075100
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS J2371
|
|
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
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 55150030001
|
|
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
|
|
|
phenylephrine 10 mg/mL solution 1 mL Vial
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
phenylephrine 1 % spray,non-aerosol 15 mL SQUEEZ BTL
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 00225081047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.67 |
| 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 |
$15.56
|
| Rate for Payer: Cash Price |
$15.56
|
| 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 |
$11.67
|
| Rate for Payer: Provider Network of America Commercial |
$12.45
|
|
|
phenylephrine 1 % spray,non-aerosol 15 mL SQUEEZ BTL
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 00225081047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$10.97
|
| Rate for Payer: Aetna Workers' Compensation |
$10.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12.26
|
| Rate for Payer: Cash Price |
$15.56
|
| Rate for Payer: Cigna Commercial |
$9.52
|
| Rate for Payer: Cigna Medicare Advantage |
$8.87
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$9.80
|
| Rate for Payer: Home State Health Plan Exchange |
$8.87
|
| Rate for Payer: Humana Medicare |
$11.67
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$11.67
|
| Rate for Payer: Provider Network of America Commercial |
$12.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.27
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$15.56
|
|
|
phenylephrine 1 % spray,non-aerosol 29.6 mL SQUEEZ BTL
|
Facility
|
IP
|
$21.36
|
|
|
Service Code
|
NDC 00067208601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.02 |
| 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 |
$21.36
|
| Rate for Payer: Cash Price |
$21.36
|
| 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 |
$16.02
|
| Rate for Payer: Provider Network of America Commercial |
$17.09
|
|
|
phenylephrine 1 % spray,non-aerosol 29.6 mL SQUEEZ BTL
|
Facility
|
OP
|
$21.36
|
|
|
Service Code
|
NDC 00067208601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: UnitedHealthcare Commercial |
$14.10
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.06
|
| Rate for Payer: Aetna Workers' Compensation |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$14.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$16.83
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cigna Commercial |
$13.07
|
| Rate for Payer: Cigna Medicare Advantage |
$12.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.46
|
| Rate for Payer: Home State Health Plan Exchange |
$12.18
|
| Rate for Payer: Humana Medicare |
$16.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.02
|
| Rate for Payer: Provider Network of America Commercial |
$17.09
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.36
|
|
|
phenylephrine in NS 1 mg/10 mL syringe 10 mL Syringe
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
phenylephrine in NS 1 mg/10 mL syringe 10 mL Syringe
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 71449000115
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
