|
HC Application Long Leg Splint
|
Facility
|
OP
|
$329.50
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
Px07612950501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$329.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$232.30
|
| Rate for Payer: Aetna Workers' Compensation |
$232.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$228.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$259.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$259.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$259.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$259.65
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cash Price |
$329.50
|
| Rate for Payer: Cigna Commercial |
$201.65
|
| Rate for Payer: Cigna Medicare Advantage |
$187.81
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$207.59
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Home State Health Plan Exchange |
$187.81
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Humana Medicare |
$247.12
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$247.12
|
| Rate for Payer: Provider Network of America Commercial |
$263.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$217.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$329.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
|
|
HC Application Short Leg Cast
|
Facility
|
OP
|
$562.63
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
Px07612940501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.75 |
| Max. Negotiated Rate |
$562.63 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$396.65
|
| Rate for Payer: Aetna Workers' Compensation |
$396.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$433.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$443.35
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Cigna Medicare Advantage |
$320.70
|
| Rate for Payer: Family Health Partners Medicaid |
$352.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$354.46
|
| Rate for Payer: Healthy Blue Medicaid |
$381.22
|
| Rate for Payer: Home State Health Plan Exchange |
$320.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$352.98
|
| Rate for Payer: Humana Medicare |
$421.97
|
| Rate for Payer: Mercy CarePlus Medicaid |
$352.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$371.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$562.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.75
|
|
|
HC Application Short Leg Cast
|
Facility
|
IP
|
$562.63
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
Px07612940501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.97 |
| 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 |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| 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 |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
|
|
HC Application Short Leg Cast Walking/Ambulatory
|
Facility
|
IP
|
$562.63
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
Px07612942501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.97 |
| 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 |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| 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 |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
|
|
HC Application Short Leg Cast Walking/Ambulatory
|
Facility
|
OP
|
$562.63
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
Px07612942501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.75 |
| Max. Negotiated Rate |
$562.63 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$396.65
|
| Rate for Payer: Aetna Workers' Compensation |
$396.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$433.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$443.35
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Cigna Medicare Advantage |
$320.70
|
| Rate for Payer: Family Health Partners Medicaid |
$352.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$354.46
|
| Rate for Payer: Healthy Blue Medicaid |
$381.22
|
| Rate for Payer: Home State Health Plan Exchange |
$320.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$352.98
|
| Rate for Payer: Humana Medicare |
$421.97
|
| Rate for Payer: Mercy CarePlus Medicaid |
$352.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$371.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$562.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.75
|
|
|
HC Applic Bone Fixation
|
Facility
|
OP
|
$14,608.65
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
Px03612069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,894.33 |
| Max. Negotiated Rate |
$14,608.65 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$10,123.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$10,123.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$11,511.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$11,511.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$11,511.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$11,248.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$11,511.62
|
| Rate for Payer: Cash Price |
$14,608.65
|
| Rate for Payer: Cash Price |
$14,608.65
|
| Rate for Payer: Cigna Commercial |
$9,685.53
|
| Rate for Payer: Cigna Medicare Advantage |
$8,326.93
|
| Rate for Payer: Family Health Partners Medicaid |
$9,157.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$9,203.45
|
| Rate for Payer: Healthy Blue Medicaid |
$9,890.16
|
| Rate for Payer: Home State Health Plan Exchange |
$8,326.93
|
| Rate for Payer: Home State Health Plan Medicaid |
$9,157.55
|
| Rate for Payer: Humana Medicare |
$10,956.49
|
| Rate for Payer: Mercy CarePlus Medicaid |
$9,157.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10,956.49
|
| Rate for Payer: Provider Network of America Commercial |
$11,686.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,641.71
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14,608.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6,894.33
|
|
|
HC Applic Bone Fixation
|
Facility
|
IP
|
$14,608.65
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
Px03612069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,686.92 |
| 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 |
$14,608.65
|
| Rate for Payer: Cash Price |
$14,608.65
|
| 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 |
$10,956.49
|
| Rate for Payer: Provider Network of America Commercial |
$11,686.92
|
|
|
HC Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 29581 GO
|
| Hospital Charge Code |
Px04302958101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$231.58 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$340.51
|
| Rate for Payer: Aetna Workers' Compensation |
$340.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$371.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$380.60
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$295.60
|
| Rate for Payer: Cigna Medicare Advantage |
$275.31
|
| Rate for Payer: Family Health Partners Medicaid |
$307.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$304.29
|
| Rate for Payer: Healthy Blue Medicaid |
$332.22
|
| Rate for Payer: Home State Health Plan Exchange |
$275.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$307.61
|
| Rate for Payer: Humana Medicare |
$362.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$307.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$318.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$483.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.58
|
|
|
HC Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 29581 GO
|
| Hospital Charge Code |
Px04302958101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$362.25 |
| 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 |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| 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 |
$362.25
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
|
|
HC Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
Px04202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$231.58 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$340.51
|
| Rate for Payer: Aetna Workers' Compensation |
$340.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$334.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$380.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$371.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$380.60
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$295.60
|
| Rate for Payer: Cigna Medicare Advantage |
$275.31
|
| Rate for Payer: Family Health Partners Medicaid |
$307.61
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$304.29
|
| Rate for Payer: Healthy Blue Medicaid |
$332.22
|
| Rate for Payer: Home State Health Plan Exchange |
$275.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$307.61
|
| Rate for Payer: Humana Medicare |
$362.25
|
| Rate for Payer: Mercy CarePlus Medicaid |
$307.61
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$318.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$483.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.58
|
|
|
HC Appl Mlt-Layer Venous Wound Compress Below Knee
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
Px04202958101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$362.25 |
| 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 |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| 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 |
$362.25
|
| Rate for Payer: Provider Network of America Commercial |
$386.40
|
|
|
HC Apply Finger Splint,Static
|
Facility
|
OP
|
$262.98
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
Px07612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$262.98 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$185.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$179.07
|
| Rate for Payer: Aetna Workers' Compensation |
$185.40
|
| Rate for Payer: Aetna Workers' Compensation |
$179.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$182.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$176.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$182.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$176.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$200.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$200.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$200.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$195.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$202.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$200.15
|
| Rate for Payer: Cash Price |
$262.98
|
| Rate for Payer: Cash Price |
$262.98
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$160.94
|
| Rate for Payer: Cigna Commercial |
$155.45
|
| Rate for Payer: Cigna Medicare Advantage |
$144.78
|
| Rate for Payer: Cigna Medicare Advantage |
$149.90
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$165.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$160.02
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$149.90
|
| Rate for Payer: Home State Health Plan Exchange |
$144.78
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$190.50
|
| Rate for Payer: Humana Medicare |
$197.24
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$190.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$197.24
|
| Rate for Payer: Provider Network of America Commercial |
$203.20
|
| Rate for Payer: Provider Network of America Commercial |
$210.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$167.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$173.57
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$254.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$262.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
HC Apply Finger Splint,Static
|
Facility
|
IP
|
$262.98
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
Px07612913001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.24 |
| 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 |
$254.00
|
| Rate for Payer: Cash Price |
$262.98
|
| Rate for Payer: Cash Price |
$262.98
|
| Rate for Payer: Cash Price |
$254.00
|
| 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 |
$197.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$190.50
|
| Rate for Payer: Provider Network of America Commercial |
$210.38
|
| Rate for Payer: Provider Network of America Commercial |
$203.20
|
|
|
HC Apply Forearm Splint,Static
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
Px07612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| 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 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 |
$470.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$470.00
|
| 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 |
$378.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$352.50
|
| Rate for Payer: Provider Network of America Commercial |
$403.20
|
| Rate for Payer: Provider Network of America Commercial |
$376.00
|
|
|
HC Apply Forearm Splint,Static
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
Px07612912501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$355.32
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$331.35
|
| Rate for Payer: Aetna Workers' Compensation |
$355.32
|
| Rate for Payer: Aetna Workers' Compensation |
$331.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$349.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$325.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$349.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$325.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$397.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$370.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$397.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$370.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$370.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$397.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$361.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$388.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$397.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$370.36
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$308.45
|
| Rate for Payer: Cigna Commercial |
$287.64
|
| Rate for Payer: Cigna Medicare Advantage |
$267.90
|
| Rate for Payer: Cigna Medicare Advantage |
$287.28
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$317.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$296.10
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$287.28
|
| Rate for Payer: Home State Health Plan Exchange |
$267.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$352.50
|
| Rate for Payer: Humana Medicare |
$378.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$352.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$378.00
|
| Rate for Payer: Provider Network of America Commercial |
$376.00
|
| Rate for Payer: Provider Network of America Commercial |
$403.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$310.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$332.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$470.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$504.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
HC Apply Long Arm Cast
|
Facility
|
OP
|
$562.63
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
Px07612906501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.75 |
| Max. Negotiated Rate |
$562.63 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$396.65
|
| Rate for Payer: Aetna Workers' Compensation |
$396.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$389.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$443.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$433.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$443.35
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| Rate for Payer: Cigna Commercial |
$344.33
|
| Rate for Payer: Cigna Medicare Advantage |
$320.70
|
| Rate for Payer: Family Health Partners Medicaid |
$352.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$354.46
|
| Rate for Payer: Healthy Blue Medicaid |
$381.22
|
| Rate for Payer: Home State Health Plan Exchange |
$320.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$352.98
|
| Rate for Payer: Humana Medicare |
$421.97
|
| Rate for Payer: Mercy CarePlus Medicaid |
$352.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$371.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$562.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$265.75
|
|
|
HC Apply Long Arm Cast
|
Facility
|
IP
|
$562.63
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
Px07612906501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.97 |
| 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 |
$562.63
|
| Rate for Payer: Cash Price |
$562.63
|
| 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 |
$421.97
|
| Rate for Payer: Provider Network of America Commercial |
$450.10
|
|
|
HC Apply Long Arm Splint
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
Px07612910501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$240.58
|
| Rate for Payer: Aetna Workers' Compensation |
$240.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$236.49
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$268.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$262.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$268.90
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cigna Medicare Advantage |
$194.51
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$214.99
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Home State Health Plan Exchange |
$194.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Humana Medicare |
$255.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$255.94
|
| Rate for Payer: Provider Network of America Commercial |
$273.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$225.22
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$341.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
|
|
HC Apply Long Arm Splint
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
Px07612910501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.94 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cash Price |
$341.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$255.94
|
| Rate for Payer: Provider Network of America Commercial |
$273.00
|
|
|
HC Apply Lower Leg Splint
|
Facility
|
IP
|
$451.50
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
Px07612951501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.62 |
| 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 |
$451.50
|
| Rate for Payer: Cash Price |
$451.50
|
| 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 |
$338.62
|
| Rate for Payer: Provider Network of America Commercial |
$361.20
|
|
|
HC Apply Lower Leg Splint
|
Facility
|
OP
|
$451.50
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
Px07612951501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$318.31
|
| Rate for Payer: Aetna Workers' Compensation |
$318.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$312.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$312.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$355.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$355.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$355.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$347.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$355.78
|
| Rate for Payer: Cash Price |
$451.50
|
| Rate for Payer: Cash Price |
$451.50
|
| Rate for Payer: Cigna Commercial |
$276.32
|
| Rate for Payer: Cigna Medicare Advantage |
$257.36
|
| Rate for Payer: Family Health Partners Medicaid |
$205.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$284.44
|
| Rate for Payer: Healthy Blue Medicaid |
$221.48
|
| Rate for Payer: Home State Health Plan Exchange |
$257.36
|
| Rate for Payer: Home State Health Plan Medicaid |
$205.07
|
| Rate for Payer: Humana Medicare |
$338.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$205.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$338.62
|
| Rate for Payer: Provider Network of America Commercial |
$361.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$297.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$451.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$154.39
|
|
|
HC Aquaporin-4 Receptor Ab
|
Facility
|
IP
|
$802.20
|
|
|
Service Code
|
CPT 86051
|
| Hospital Charge Code |
Px03008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$601.65 |
| 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 |
$802.20
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$601.65
|
| Rate for Payer: Provider Network of America Commercial |
$641.76
|
|
|
HC Aquaporin-4 Receptor Ab
|
Facility
|
OP
|
$802.20
|
|
|
Service Code
|
CPT 86051
|
| Hospital Charge Code |
Px03008625601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$641.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$565.55
|
| Rate for Payer: Aetna Workers' Compensation |
$565.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$555.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$555.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$632.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$632.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$632.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$617.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$632.13
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$420.35
|
| Rate for Payer: Cigna Medicare Advantage |
$457.25
|
| Rate for Payer: Family Health Partners Medicaid |
$14.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$505.39
|
| Rate for Payer: Healthy Blue Medicaid |
$15.69
|
| Rate for Payer: Home State Health Plan Exchange |
$457.25
|
| Rate for Payer: Home State Health Plan Medicaid |
$14.53
|
| Rate for Payer: Humana Medicare |
$601.65
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$601.65
|
| Rate for Payer: Provider Network of America Commercial |
$641.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$529.45
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.94
|
|
|
HC Aripiprazole - Arup
|
Facility
|
OP
|
$186.90
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
Px03018378908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$149.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$131.76
|
| Rate for Payer: Aetna Workers' Compensation |
$131.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$147.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$147.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$147.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$143.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$147.28
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: Cigna Medicare Advantage |
$106.53
|
| Rate for Payer: Family Health Partners Medicaid |
$30.38
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$117.75
|
| Rate for Payer: Healthy Blue Medicaid |
$32.81
|
| Rate for Payer: Home State Health Plan Exchange |
$106.53
|
| Rate for Payer: Home State Health Plan Medicaid |
$30.38
|
| Rate for Payer: Humana Medicare |
$140.18
|
| Rate for Payer: Mercy CarePlus Medicaid |
$30.38
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$140.18
|
| Rate for Payer: Provider Network of America Commercial |
$149.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$123.35
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$24.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.87
|
|
|
HC Aripiprazole - Arup
|
Facility
|
IP
|
$186.90
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
Px03018378908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.18 |
| 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 |
$186.90
|
| Rate for Payer: Cash Price |
$186.90
|
| 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 |
$140.18
|
| Rate for Payer: Provider Network of America Commercial |
$149.52
|
|
