|
potassium chloride CR 10 mEq tablet extended release 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687070811
|
|
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
|
|
|
potassium chloride CR 10 mEq tablet extended release 1 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687070811
|
|
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
|
|
|
potassium chloride CR 10 mEq tablet extended release 1 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00245083689
|
|
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
|
|
|
potassium phosphates 3 mmol/mL solution 15 mL Vial
|
Facility
|
OP
|
$59.16
|
|
|
Service Code
|
NDC 00409729501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$59.16 |
| Rate for Payer: UnitedHealthcare Commercial |
$39.05
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$41.71
|
| Rate for Payer: Aetna Workers' Compensation |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$41.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$41.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$46.62
|
| Rate for Payer: Cash Price |
$59.16
|
| Rate for Payer: Cigna Commercial |
$36.21
|
| Rate for Payer: Cigna Medicare Advantage |
$33.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$37.27
|
| Rate for Payer: Home State Health Plan Exchange |
$33.72
|
| Rate for Payer: Humana Medicare |
$44.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$44.37
|
| Rate for Payer: Provider Network of America Commercial |
$47.33
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$59.16
|
|
|
potassium phosphates 3 mmol/mL solution 15 mL Vial
|
Facility
|
IP
|
$59.16
|
|
|
Service Code
|
NDC 00409729501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$44.37 |
| 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 |
$59.16
|
| Rate for Payer: Cash Price |
$59.16
|
| 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 |
$44.37
|
| Rate for Payer: Provider Network of America Commercial |
$47.33
|
|
|
potassium, sodium phosphates 280-160-250 mg powder in packet 1 Each Packet
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 60258000615
|
|
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
|
|
|
potassium, sodium phosphates 280-160-250 mg powder in packet 1 Each Packet
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 60258000615
|
|
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
|
|
|
Powerloc Infusion 20x3/4
|
Facility
|
OP
|
$20.77
|
|
| Hospital Charge Code |
Px02720000077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$20.77 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$14.64
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.38
|
| Rate for Payer: Aetna Workers' Compensation |
$14.64
|
| Rate for Payer: Aetna Workers' Compensation |
$15.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$16.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$16.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$16.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$15.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$16.37
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$20.77
|
| Rate for Payer: Cigna Commercial |
$12.71
|
| Rate for Payer: Cigna Commercial |
$13.35
|
| Rate for Payer: Cigna Medicare Advantage |
$11.84
|
| Rate for Payer: Cigna Medicare Advantage |
$12.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.74
|
| Rate for Payer: Home State Health Plan Exchange |
$11.84
|
| Rate for Payer: Home State Health Plan Exchange |
$12.43
|
| Rate for Payer: Humana Medicare |
$15.58
|
| Rate for Payer: Humana Medicare |
$16.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$15.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.36
|
| Rate for Payer: Provider Network of America Commercial |
$16.62
|
| Rate for Payer: Provider Network of America Commercial |
$17.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.39
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$20.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.81
|
|
|
Powerloc Infusion 20x3/4
|
Facility
|
IP
|
$20.77
|
|
| Hospital Charge Code |
Px02720000077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.58 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$20.77
|
| Rate for Payer: Cash Price |
$20.77
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$15.58
|
| Rate for Payer: Provider Network of America Commercial |
$16.62
|
| Rate for Payer: Provider Network of America Commercial |
$17.45
|
|
|
Ppsv23 Vaccine 2 Yrs or Older for Subq/Im Use
|
Facility
|
IP
|
$342.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
Px06369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.22 |
| 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 |
$342.96
|
| Rate for Payer: Cash Price |
$342.96
|
| 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 |
$257.22
|
| Rate for Payer: Provider Network of America Commercial |
$274.37
|
|
|
Ppsv23 Vaccine 2 Yrs or Older for Subq/Im Use
|
Facility
|
OP
|
$342.96
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
Px06369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$342.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$241.79
|
| Rate for Payer: Aetna Workers' Compensation |
$241.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$237.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$237.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$270.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$270.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$270.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$264.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$270.25
|
| Rate for Payer: Cash Price |
$342.96
|
| Rate for Payer: Cash Price |
$342.96
|
| Rate for Payer: Cigna Commercial |
$209.89
|
| Rate for Payer: Cigna Medicare Advantage |
$195.49
|
| Rate for Payer: Family Health Partners Medicaid |
$11.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$216.06
|
| Rate for Payer: Healthy Blue Medicaid |
$12.20
|
| Rate for Payer: Home State Health Plan Exchange |
$195.49
|
| Rate for Payer: Home State Health Plan Medicaid |
$11.30
|
| Rate for Payer: Humana Medicare |
$257.22
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$257.22
|
| Rate for Payer: Provider Network of America Commercial |
$274.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$226.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$342.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.51
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$6,902.89
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,902.89 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,902.89
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$4,062.68
|
|
|
prednisoLONE 15 mg/5 mL (3 mg/mL) solution 237 mL Bottle
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 00121075908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.09
|
| Rate for Payer: Aetna Workers' Compensation |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: Cigna Medicare Advantage |
$2.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.76
|
| Rate for Payer: Home State Health Plan Exchange |
$2.50
|
| Rate for Payer: Humana Medicare |
$3.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.29
|
| Rate for Payer: Provider Network of America Commercial |
$3.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.38
|
|
|
prednisoLONE 15 mg/5 mL (3 mg/mL) solution 237 mL Bottle
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
HCPCS J7510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| 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 |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| 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 |
$3.29
|
| Rate for Payer: Provider Network of America Commercial |
$3.50
|
|
|
prednisoLONE 15 mg/5 mL (3 mg/mL) solution 237 mL Bottle
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 00121075908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| 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 |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| 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 |
$3.29
|
| Rate for Payer: Provider Network of America Commercial |
$3.50
|
|
|
prednisoLONE 15 mg/5 mL (3 mg/mL) solution 237 mL Bottle
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
HCPCS J7510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$3.09
|
| Rate for Payer: Aetna Workers' Compensation |
$3.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna Commercial |
$2.68
|
| Rate for Payer: Cigna Medicare Advantage |
$2.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.76
|
| Rate for Payer: Home State Health Plan Exchange |
$2.50
|
| Rate for Payer: Humana Medicare |
$3.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3.29
|
| Rate for Payer: Provider Network of America Commercial |
$3.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.38
|
|
|
prednisoLONE acetate 1 % drops,suspension 5 mL DROP BTL
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
NDC 61314063705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.89 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$124.78
|
| Rate for Payer: Aetna Workers' Compensation |
$124.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$122.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$122.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$139.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$139.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$139.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$136.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$139.48
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$108.32
|
| Rate for Payer: Cigna Medicare Advantage |
$100.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$111.51
|
| Rate for Payer: Home State Health Plan Exchange |
$100.89
|
| Rate for Payer: Humana Medicare |
$132.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Provider Network of America Commercial |
$141.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$116.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$177.00
|
|
|
prednisoLONE acetate 1 % drops,suspension 5 mL DROP BTL
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
NDC 61314063705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.75 |
| 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 |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| 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 |
$132.75
|
| Rate for Payer: Provider Network of America Commercial |
$141.60
|
|
|
predniSONE 10 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS J7512
|
|
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
|
|
|
predniSONE 10 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904692361
|
|
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
|
|
|
predniSONE 10 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904692361
|
|
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
|
|
|
predniSONE 10 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J7512
|
|
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
|
|
|
predniSONE 20 mg tablet 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904712761
|
|
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
|
|
|
predniSONE 20 mg tablet 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J7512
|
|
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
|
|
