|
Fluorouracil injection
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
Px0636J919001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| 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 |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| 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 |
$4.13
|
| Rate for Payer: Provider Network of America Commercial |
$4.41
|
|
|
FLUoxetine 10 mg capsule 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904578461
|
|
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
|
|
|
FLUoxetine 10 mg capsule 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904578461
|
|
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
|
|
|
FLUoxetine 10 mg capsule 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 65862019201
|
|
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
|
|
|
FLUoxetine 10 mg capsule 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 65862019201
|
|
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
|
|
|
FLUoxetine 10 mg capsule 100 Each Bottle
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 68001039900
|
|
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
|
|
|
FLUoxetine 10 mg capsule 100 Each Bottle
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 68001039900
|
|
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
|
|
|
FLUoxetine 20 mg capsule 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904734661
|
|
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
|
|
|
FLUoxetine 20 mg capsule 100 Each BLIST PACK
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904578561
|
|
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
|
|
|
FLUoxetine 20 mg capsule 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904578561
|
|
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
|
|
|
FLUoxetine 20 mg capsule 100 Each BLIST PACK
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904734661
|
|
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
|
|
|
fluticasone 50 mcg/actuation spray,suspension 16 g AER W/ADAP
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
NDC 60505082901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.00 |
| 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 |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| 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 |
$54.00
|
| Rate for Payer: Provider Network of America Commercial |
$57.60
|
|
|
fluticasone 50 mcg/actuation spray,suspension 16 g AER W/ADAP
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
NDC 60505082901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$50.76
|
| Rate for Payer: Aetna Workers' Compensation |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$49.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$49.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$56.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$56.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$56.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$56.74
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$44.06
|
| Rate for Payer: Cigna Medicare Advantage |
$41.04
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$45.36
|
| Rate for Payer: Home State Health Plan Exchange |
$41.04
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Provider Network of America Commercial |
$57.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$47.52
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$72.00
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$341.92
|
|
|
Service Code
|
CPT 90662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$256.44 |
| 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 |
$341.92
|
| Rate for Payer: Cash Price |
$341.92
|
| 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 |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$341.92
|
|
|
Service Code
|
NDC 49281012565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.89 |
| Max. Negotiated Rate |
$341.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$241.05
|
| Rate for Payer: Aetna Workers' Compensation |
$241.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$263.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$269.43
|
| Rate for Payer: Cash Price |
$341.92
|
| Rate for Payer: Cigna Commercial |
$209.26
|
| Rate for Payer: Cigna Medicare Advantage |
$194.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$215.41
|
| Rate for Payer: Home State Health Plan Exchange |
$194.89
|
| Rate for Payer: Humana Medicare |
$256.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.92
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$341.92
|
|
|
Service Code
|
NDC 49281012588
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.89 |
| Max. Negotiated Rate |
$341.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$241.05
|
| Rate for Payer: Aetna Workers' Compensation |
$241.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$263.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$269.43
|
| Rate for Payer: Cash Price |
$341.92
|
| Rate for Payer: Cigna Commercial |
$209.26
|
| Rate for Payer: Cigna Medicare Advantage |
$194.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$215.41
|
| Rate for Payer: Home State Health Plan Exchange |
$194.89
|
| Rate for Payer: Humana Medicare |
$256.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.92
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$341.92
|
|
|
Service Code
|
CPT 90662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.89 |
| Max. Negotiated Rate |
$341.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$241.05
|
| Rate for Payer: Aetna Workers' Compensation |
$241.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$269.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$263.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$269.43
|
| Rate for Payer: Cash Price |
$341.92
|
| Rate for Payer: Cigna Commercial |
$209.26
|
| Rate for Payer: Cigna Medicare Advantage |
$194.89
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$215.41
|
| Rate for Payer: Home State Health Plan Exchange |
$194.89
|
| Rate for Payer: Humana Medicare |
$256.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.92
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$341.92
|
|
|
Service Code
|
NDC 49281012565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$256.44 |
| 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 |
$341.92
|
| Rate for Payer: Cash Price |
$341.92
|
| 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 |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
|
|
flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$341.92
|
|
|
Service Code
|
NDC 49281012588
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$256.44 |
| 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 |
$341.92
|
| Rate for Payer: Cash Price |
$341.92
|
| 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 |
$256.44
|
| Rate for Payer: Provider Network of America Commercial |
$273.54
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
CPT 90656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.22 |
| 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 |
$78.96
|
| Rate for Payer: Cash Price |
$78.96
|
| 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 |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
CPT 90656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.67
|
| Rate for Payer: Aetna Workers' Compensation |
$55.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.22
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cigna Commercial |
$48.32
|
| Rate for Payer: Cigna Medicare Advantage |
$45.01
|
| Rate for Payer: Family Health Partners Medicaid |
$11.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.74
|
| Rate for Payer: Healthy Blue Medicaid |
$12.20
|
| Rate for Payer: Home State Health Plan Exchange |
$45.01
|
| Rate for Payer: Home State Health Plan Medicaid |
$11.30
|
| Rate for Payer: Humana Medicare |
$59.22
|
| Rate for Payer: Mercy CarePlus Medicaid |
$11.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.51
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 58160091241
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.67
|
| Rate for Payer: Aetna Workers' Compensation |
$55.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.22
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cigna Commercial |
$48.32
|
| Rate for Payer: Cigna Medicare Advantage |
$45.01
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.74
|
| Rate for Payer: Home State Health Plan Exchange |
$45.01
|
| Rate for Payer: Humana Medicare |
$59.22
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.96
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
NDC 58160091252
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.22 |
| 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 |
$78.96
|
| Rate for Payer: Cash Price |
$78.96
|
| 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 |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
NDC 58160091241
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.22 |
| 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 |
$78.96
|
| Rate for Payer: Cash Price |
$78.96
|
| 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 |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
|
|
flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 58160091252
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.67
|
| Rate for Payer: Aetna Workers' Compensation |
$55.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.22
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cigna Commercial |
$48.32
|
| Rate for Payer: Cigna Medicare Advantage |
$45.01
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.74
|
| Rate for Payer: Home State Health Plan Exchange |
$45.01
|
| Rate for Payer: Humana Medicare |
$59.22
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.22
|
| Rate for Payer: Provider Network of America Commercial |
$63.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.11
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.96
|
|
