|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Amitriptyline Lvl
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Desipramine Lvl
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| 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 |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Desipramine Lvl
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Imipramine Level
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Imipramine Level
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| 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 |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Nortriptyline Lvl
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Nortriptyline Lvl
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| 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 |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Tricyclic Antidep
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| 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 |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
|
|
HC Antidepressants Tricyclic Other Cyclicals 1 or 2 - Tricyclic Antidep
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidep Tricyclic/Cyclicals 1-2 Amitriptyline Lvl - Bundled Charge
|
Facility
|
OP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.75
|
| Rate for Payer: Aetna Workers' Compensation |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.55
|
| Rate for Payer: Cash Price |
$57.80
|
| Rate for Payer: Cigna Commercial |
$30.29
|
| Rate for Payer: Cigna Medicare Advantage |
$32.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.41
|
| Rate for Payer: Home State Health Plan Exchange |
$32.95
|
| Rate for Payer: Humana Medicare |
$43.35
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.80
|
|
|
HC Antidep Tricyclic/Cyclicals 1-2 Amitriptyline Lvl - Bundled Charge
|
Facility
|
IP
|
$57.80
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
Px03018033508
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| 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 |
$57.80
|
| Rate for Payer: Cash Price |
$57.80
|
| 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 |
$43.35
|
| Rate for Payer: Provider Network of America Commercial |
$46.24
|
|
|
HC Anti-Dsdna Rfx Titer Ref Lab
|
Facility
|
IP
|
$359.10
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
Px03028625514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$269.32 |
| 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 |
$359.10
|
| Rate for Payer: Cash Price |
$359.10
|
| 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 |
$269.32
|
| Rate for Payer: Provider Network of America Commercial |
$287.28
|
|
|
HC Anti-Dsdna Rfx Titer Ref Lab
|
Facility
|
OP
|
$359.10
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
Px03028625514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$253.17
|
| Rate for Payer: Aetna Workers' Compensation |
$253.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$248.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$248.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$282.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$282.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$282.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$276.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$282.97
|
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: Cash Price |
$359.10
|
| Rate for Payer: Cigna Commercial |
$188.17
|
| Rate for Payer: Cigna Medicare Advantage |
$204.69
|
| Rate for Payer: Family Health Partners Medicaid |
$15.19
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$226.23
|
| Rate for Payer: Healthy Blue Medicaid |
$16.41
|
| Rate for Payer: Home State Health Plan Exchange |
$204.69
|
| Rate for Payer: Home State Health Plan Medicaid |
$15.19
|
| Rate for Payer: Humana Medicare |
$269.32
|
| Rate for Payer: Mercy CarePlus Medicaid |
$15.19
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$269.32
|
| Rate for Payer: Provider Network of America Commercial |
$287.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$237.01
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
|
|
HC Antifungal Ointment
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
LOCAL 2700002591
|
| Hospital Charge Code |
Px02700002591
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| 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 |
$8.02
|
| Rate for Payer: Cash Price |
$8.02
|
| 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 |
$6.01
|
| Rate for Payer: Provider Network of America Commercial |
$6.42
|
|
|
HC Antifungal Ointment
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
LOCAL 2700002591
|
| Hospital Charge Code |
Px02700002591
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5.65
|
| Rate for Payer: Aetna Workers' Compensation |
$5.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6.32
|
| Rate for Payer: Cash Price |
$8.02
|
| Rate for Payer: Cigna Commercial |
$4.91
|
| Rate for Payer: Cigna Medicare Advantage |
$4.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5.05
|
| Rate for Payer: Home State Health Plan Exchange |
$4.57
|
| Rate for Payer: Humana Medicare |
$6.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6.01
|
| Rate for Payer: Provider Network of America Commercial |
$6.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.29
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.02
|
|
|
HC Antifungal Powder
|
Facility
|
OP
|
$9.66
|
|
| Hospital Charge Code |
Px02700002594
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$6.81
|
| Rate for Payer: Aetna Workers' Compensation |
$6.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$6.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$6.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$7.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$7.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$7.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$7.61
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Cigna Commercial |
$5.91
|
| Rate for Payer: Cigna Medicare Advantage |
$5.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$6.09
|
| Rate for Payer: Home State Health Plan Exchange |
$5.51
|
| Rate for Payer: Humana Medicare |
$7.25
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$7.25
|
| Rate for Payer: Provider Network of America Commercial |
$7.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$9.66
|
|
|
HC Antifungal Powder
|
Facility
|
IP
|
$9.66
|
|
| Hospital Charge Code |
Px02700002594
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.25 |
| 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 |
$9.66
|
| Rate for Payer: Cash Price |
$9.66
|
| 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 |
$7.25
|
| Rate for Payer: Provider Network of America Commercial |
$7.73
|
|
|
HC Antihistamine Ab - Arup
|
Facility
|
OP
|
$679.35
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
Px03118818406
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$340.57 |
| Max. Negotiated Rate |
$543.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$478.94
|
| Rate for Payer: Aetna Workers' Compensation |
$478.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$470.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$470.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$535.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$535.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$535.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$523.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$535.33
|
| Rate for Payer: Cash Price |
$679.35
|
| Rate for Payer: Cash Price |
$679.35
|
| Rate for Payer: Cigna Commercial |
$355.98
|
| Rate for Payer: Cigna Medicare Advantage |
$387.23
|
| Rate for Payer: Family Health Partners Medicaid |
$452.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$427.99
|
| Rate for Payer: Healthy Blue Medicaid |
$488.56
|
| Rate for Payer: Home State Health Plan Exchange |
$387.23
|
| Rate for Payer: Home State Health Plan Medicaid |
$452.37
|
| Rate for Payer: Humana Medicare |
$509.51
|
| Rate for Payer: Mercy CarePlus Medicaid |
$452.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$509.51
|
| Rate for Payer: Provider Network of America Commercial |
$543.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$448.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$359.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.57
|
|
|
HC Antihistamine Ab - Arup
|
Facility
|
IP
|
$679.35
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
Px03118818406
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$509.51 |
| 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 |
$679.35
|
| Rate for Payer: Cash Price |
$679.35
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$509.51
|
| Rate for Payer: Provider Network of America Commercial |
$543.48
|
|
|
HC Antihuman Globulin Dir Ea Antiserum - Cord Blood Evaluation
|
Facility
|
IP
|
$129.83
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
Px03008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.37 |
| 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 |
$129.83
|
| Rate for Payer: Cash Price |
$129.83
|
| 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 |
$97.37
|
| Rate for Payer: Provider Network of America Commercial |
$103.86
|
|
|
HC Antihuman Globulin Dir Ea Antiserum - Cord Blood Evaluation
|
Facility
|
OP
|
$129.83
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
Px03008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$103.86 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$91.53
|
| Rate for Payer: Aetna Workers' Compensation |
$91.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$89.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$89.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$102.31
|
| Rate for Payer: Cash Price |
$129.83
|
| Rate for Payer: Cash Price |
$129.83
|
| Rate for Payer: Cigna Commercial |
$68.03
|
| Rate for Payer: Cigna Medicare Advantage |
$74.00
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$81.79
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Home State Health Plan Exchange |
$74.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Humana Medicare |
$97.37
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$97.37
|
| Rate for Payer: Provider Network of America Commercial |
$103.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
|
|
HC Antihuman Globulin Dir Ea Antiserum - Direct Antiglobulin Test
|
Facility
|
IP
|
$129.83
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
Px03008688002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.37 |
| 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 |
$129.83
|
| Rate for Payer: Cash Price |
$129.83
|
| 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 |
$97.37
|
| Rate for Payer: Provider Network of America Commercial |
$103.86
|
|
|
HC Antihuman Globulin Dir Ea Antiserum - Direct Antiglobulin Test
|
Facility
|
OP
|
$129.83
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
Px03008688002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$103.86 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$91.53
|
| Rate for Payer: Aetna Workers' Compensation |
$91.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$89.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$89.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$102.31
|
| Rate for Payer: Cash Price |
$129.83
|
| Rate for Payer: Cash Price |
$129.83
|
| Rate for Payer: Cigna Commercial |
$68.03
|
| Rate for Payer: Cigna Medicare Advantage |
$74.00
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$81.79
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Home State Health Plan Exchange |
$74.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Humana Medicare |
$97.37
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$97.37
|
| Rate for Payer: Provider Network of America Commercial |
$103.86
|
| Rate for Payer: UnitedHealthcare Commercial |
$85.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
|
|
HC Antihuman Globulin Indir Qual Ea Reagent Cell - Coombs Test, Ind
|
Facility
|
IP
|
$122.85
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
Px03008688501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.14 |
| 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 |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| 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 |
$92.14
|
| Rate for Payer: Provider Network of America Commercial |
$98.28
|
|
|
HC Antihuman Globulin Indir Qual Ea Reagent Cell - Coombs Test, Ind
|
Facility
|
OP
|
$122.85
|
|
|
Service Code
|
CPT 86885
|
| Hospital Charge Code |
Px03008688501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$232.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$86.61
|
| Rate for Payer: Aetna Workers' Compensation |
$86.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$96.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$96.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$96.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$94.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$96.81
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna Commercial |
$64.37
|
| Rate for Payer: Cigna Medicare Advantage |
$70.02
|
| Rate for Payer: Family Health Partners Medicaid |
$215.01
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$77.40
|
| Rate for Payer: Healthy Blue Medicaid |
$232.21
|
| Rate for Payer: Home State Health Plan Exchange |
$70.02
|
| Rate for Payer: Home State Health Plan Medicaid |
$215.01
|
| Rate for Payer: Humana Medicare |
$92.14
|
| Rate for Payer: Mercy CarePlus Medicaid |
$215.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$92.14
|
| Rate for Payer: Provider Network of America Commercial |
$98.28
|
| Rate for Payer: UnitedHealthcare Commercial |
$81.08
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.87
|
|
