|
HC Aerochamber for Mdi
|
Facility
|
OP
|
$16.12
|
|
| Hospital Charge Code |
Px02720000580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.36
|
| Rate for Payer: Aetna Workers' Compensation |
$11.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$12.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$12.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$12.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$12.70
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cigna Commercial |
$9.87
|
| Rate for Payer: Cigna Medicare Advantage |
$9.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.16
|
| Rate for Payer: Home State Health Plan Exchange |
$9.19
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.09
|
| Rate for Payer: Provider Network of America Commercial |
$12.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.12
|
|
|
HC Aerochamber for Mdi
|
Facility
|
IP
|
$16.12
|
|
| Hospital Charge Code |
Px02720000580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.09 |
| 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 |
$16.12
|
| Rate for Payer: Cash Price |
$16.12
|
| 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 |
$12.09
|
| Rate for Payer: Provider Network of America Commercial |
$12.90
|
|
|
HC Aerochamber Plus Z Stat
|
Facility
|
IP
|
$36.79
|
|
| Hospital Charge Code |
Px02720000598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.59 |
| 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 |
$36.79
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.59
|
| Rate for Payer: Provider Network of America Commercial |
$29.43
|
|
|
HC Aerochamber Plus Z Stat
|
Facility
|
OP
|
$36.79
|
|
| Hospital Charge Code |
Px02720000598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$36.79 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$25.94
|
| Rate for Payer: Aetna Workers' Compensation |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$28.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$28.99
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cigna Commercial |
$22.52
|
| Rate for Payer: Cigna Medicare Advantage |
$20.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$23.18
|
| Rate for Payer: Home State Health Plan Exchange |
$20.97
|
| Rate for Payer: Humana Medicare |
$27.59
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$27.59
|
| Rate for Payer: Provider Network of America Commercial |
$29.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$36.79
|
|
|
HC Aerosol Daily-Clear
|
Facility
|
IP
|
$3.25
|
|
| Hospital Charge Code |
Px02700002698
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.44 |
| 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 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.25
|
| 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 |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
HC Aerosol Daily-Clear
|
Facility
|
OP
|
$3.25
|
|
| Hospital Charge Code |
Px02700002698
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Afb Culture Arup
|
Facility
|
IP
|
$220.50
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
Px03068711602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$165.38 |
| 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 |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| 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 |
$165.38
|
| Rate for Payer: Provider Network of America Commercial |
$176.40
|
|
|
HC Afb Culture Arup
|
Facility
|
OP
|
$220.50
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
Px03068711602
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$155.45
|
| Rate for Payer: Aetna Workers' Compensation |
$155.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$173.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$169.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$173.75
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$115.54
|
| Rate for Payer: Cigna Medicare Advantage |
$125.69
|
| Rate for Payer: Family Health Partners Medicaid |
$13.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$138.91
|
| Rate for Payer: Healthy Blue Medicaid |
$14.70
|
| Rate for Payer: Home State Health Plan Exchange |
$125.69
|
| Rate for Payer: Home State Health Plan Medicaid |
$13.61
|
| Rate for Payer: Humana Medicare |
$165.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$13.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$165.38
|
| Rate for Payer: Provider Network of America Commercial |
$176.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.24
|
|
|
HC Agent Nos Assay W/Optic - Candida Antigen
|
Facility
|
OP
|
$198.45
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
Px03068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$139.91
|
| Rate for Payer: Aetna Workers' Compensation |
$139.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$137.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$137.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$156.38
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna Commercial |
$103.99
|
| Rate for Payer: Cigna Medicare Advantage |
$113.12
|
| Rate for Payer: Family Health Partners Medicaid |
$20.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$125.02
|
| Rate for Payer: Healthy Blue Medicaid |
$21.86
|
| Rate for Payer: Home State Health Plan Exchange |
$113.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.24
|
| Rate for Payer: Humana Medicare |
$148.84
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$148.84
|
| Rate for Payer: Provider Network of America Commercial |
$158.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.24
|
|
|
HC Agent Nos Assay W/Optic - Candida Antigen
|
Facility
|
IP
|
$198.45
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
Px03068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.84 |
| 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 |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| 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 |
$148.84
|
| Rate for Payer: Provider Network of America Commercial |
$158.76
|
|
|
HC Agent Nos Assay W/Optic - Strep Typing Other
|
Facility
|
OP
|
$198.45
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
Px03068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$158.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$139.91
|
| Rate for Payer: Aetna Workers' Compensation |
$139.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$137.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$137.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$156.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$152.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$156.38
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna Commercial |
$103.99
|
| Rate for Payer: Cigna Medicare Advantage |
$113.12
|
| Rate for Payer: Family Health Partners Medicaid |
$20.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$125.02
|
| Rate for Payer: Healthy Blue Medicaid |
$21.86
|
| Rate for Payer: Home State Health Plan Exchange |
$113.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.24
|
| Rate for Payer: Humana Medicare |
$148.84
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$148.84
|
| Rate for Payer: Provider Network of America Commercial |
$158.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$130.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.24
|
|
|
HC Agent Nos Assay W/Optic - Strep Typing Other
|
Facility
|
IP
|
$198.45
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
Px03068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.84 |
| 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 |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| 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 |
$148.84
|
| Rate for Payer: Provider Network of America Commercial |
$158.76
|
|
|
HC Airvo Medium Universal Optiflow Plus Adult Nasal Cannula for High Flow
|
Facility
|
OP
|
$76.27
|
|
| Hospital Charge Code |
Px02720000323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$53.77
|
| Rate for Payer: Aetna Workers' Compensation |
$53.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$52.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$52.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$60.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$60.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$60.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$58.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$60.10
|
| Rate for Payer: Cash Price |
$76.27
|
| Rate for Payer: Cigna Commercial |
$46.68
|
| Rate for Payer: Cigna Medicare Advantage |
$43.47
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$48.05
|
| Rate for Payer: Home State Health Plan Exchange |
$43.47
|
| Rate for Payer: Humana Medicare |
$57.20
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$57.20
|
| Rate for Payer: Provider Network of America Commercial |
$61.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$50.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$76.27
|
|
|
HC Airvo Medium Universal Optiflow Plus Adult Nasal Cannula for High Flow
|
Facility
|
IP
|
$76.27
|
|
| Hospital Charge Code |
Px02720000323
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.20 |
| 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 |
$76.27
|
| Rate for Payer: Cash Price |
$76.27
|
| 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 |
$57.20
|
| Rate for Payer: Provider Network of America Commercial |
$61.02
|
|
|
HC Alcohol Biomarkers; 1 or 2
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
Px03018032101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.25 |
| 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 |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| 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 |
$110.25
|
| Rate for Payer: Provider Network of America Commercial |
$117.60
|
|
|
HC Alcohol Biomarkers; 1 or 2
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
Px03018032101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$103.64
|
| Rate for Payer: Aetna Workers' Compensation |
$103.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$115.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$113.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$115.84
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$77.03
|
| Rate for Payer: Cigna Medicare Advantage |
$83.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$92.61
|
| Rate for Payer: Home State Health Plan Exchange |
$83.79
|
| Rate for Payer: Humana Medicare |
$110.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Provider Network of America Commercial |
$117.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$97.02
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$147.00
|
|
|
HC Alkaloids Not Otherwise Specified
|
Facility
|
IP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.17 |
| 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 |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| 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 |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
|
|
HC Alkaloids Not Otherwise Specified
|
Facility
|
OP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.62
|
| Rate for Payer: Aetna Workers' Compensation |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.17
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$41.34
|
| Rate for Payer: Cigna Medicare Advantage |
$44.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.71
|
| Rate for Payer: Home State Health Plan Exchange |
$44.97
|
| Rate for Payer: Humana Medicare |
$59.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.07
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.90
|
|
|
HC Alkaloids Not Otherwise Specified - Cotinine, Serum
|
Facility
|
IP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.17 |
| 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 |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| 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 |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
|
|
HC Alkaloids Not Otherwise Specified - Cotinine, Serum
|
Facility
|
OP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.62
|
| Rate for Payer: Aetna Workers' Compensation |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.17
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$41.34
|
| Rate for Payer: Cigna Medicare Advantage |
$44.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.71
|
| Rate for Payer: Home State Health Plan Exchange |
$44.97
|
| Rate for Payer: Humana Medicare |
$59.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.07
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.90
|
|
|
HC Alkaloids Not Otherwise Specified - Cotinine, Urine
|
Facility
|
OP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.62
|
| Rate for Payer: Aetna Workers' Compensation |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.17
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$41.34
|
| Rate for Payer: Cigna Medicare Advantage |
$44.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.71
|
| Rate for Payer: Home State Health Plan Exchange |
$44.97
|
| Rate for Payer: Humana Medicare |
$59.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.07
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.90
|
|
|
HC Alkaloids Not Otherwise Specified - Cotinine, Urine
|
Facility
|
IP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.17 |
| 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 |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| 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 |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
|
|
HC Alkaloids Not Otherwise Specified - Nicotine Screen Urine
|
Facility
|
IP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.17 |
| 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 |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| 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 |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
|
|
HC Alkaloids Not Otherwise Specified - Nicotine Screen Urine
|
Facility
|
OP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$78.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$55.62
|
| Rate for Payer: Aetna Workers' Compensation |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$54.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$62.17
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$41.34
|
| Rate for Payer: Cigna Medicare Advantage |
$44.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$49.71
|
| Rate for Payer: Home State Health Plan Exchange |
$44.97
|
| Rate for Payer: Humana Medicare |
$59.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.07
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$78.90
|
|
|
HC Alkaloids Not Otherwise Specified - Nicotine Serum
|
Facility
|
IP
|
$78.90
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
Px03018032306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.17 |
| 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 |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| 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 |
$59.17
|
| Rate for Payer: Provider Network of America Commercial |
$63.12
|
|
