|
HC Assay of Sodium, Other Source - Sodium Stool
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
Px03018430202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.55 |
| 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 |
$54.06
|
| Rate for Payer: Cash Price |
$54.06
|
| 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 |
$40.55
|
| Rate for Payer: Provider Network of America Commercial |
$43.25
|
|
|
HC Assay of Sodium, Other Source - Sodium Stool
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
Px03018430202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$43.25 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$38.11
|
| Rate for Payer: Aetna Workers' Compensation |
$38.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$37.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$37.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$41.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$42.60
|
| Rate for Payer: Cash Price |
$54.06
|
| Rate for Payer: Cash Price |
$54.06
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: Cigna Medicare Advantage |
$30.81
|
| Rate for Payer: Family Health Partners Medicaid |
$6.12
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$34.06
|
| Rate for Payer: Healthy Blue Medicaid |
$6.61
|
| Rate for Payer: Home State Health Plan Exchange |
$30.81
|
| Rate for Payer: Home State Health Plan Medicaid |
$6.12
|
| Rate for Payer: Humana Medicare |
$40.55
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$40.55
|
| Rate for Payer: Provider Network of America Commercial |
$43.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.61
|
|
|
HC Assay of Somatomedin - Insulin-Like Growth Factor
|
Facility
|
OP
|
$232.05
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
Px03018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$185.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$163.60
|
| Rate for Payer: Aetna Workers' Compensation |
$163.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$160.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$160.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$182.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$182.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$182.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$178.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$182.86
|
| Rate for Payer: Cash Price |
$232.05
|
| Rate for Payer: Cash Price |
$232.05
|
| Rate for Payer: Cigna Commercial |
$121.59
|
| Rate for Payer: Cigna Medicare Advantage |
$132.27
|
| Rate for Payer: Family Health Partners Medicaid |
$26.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$146.19
|
| Rate for Payer: Healthy Blue Medicaid |
$28.92
|
| Rate for Payer: Home State Health Plan Exchange |
$132.27
|
| Rate for Payer: Home State Health Plan Medicaid |
$26.78
|
| Rate for Payer: Humana Medicare |
$174.04
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$174.04
|
| Rate for Payer: Provider Network of America Commercial |
$185.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$153.15
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.16
|
|
|
HC Assay of Somatomedin - Insulin-Like Growth Factor
|
Facility
|
IP
|
$232.05
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
Px03018430501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$174.04 |
| 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 |
$232.05
|
| Rate for Payer: Cash Price |
$232.05
|
| 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 |
$174.04
|
| Rate for Payer: Provider Network of America Commercial |
$185.64
|
|
|
HC Assay of Tacrolimus - Tacrolimus
|
Facility
|
OP
|
$276.15
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
Px03018019701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$220.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$194.69
|
| Rate for Payer: Aetna Workers' Compensation |
$194.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$191.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$191.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$217.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$217.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$217.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$212.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$217.61
|
| Rate for Payer: Cash Price |
$276.15
|
| Rate for Payer: Cash Price |
$276.15
|
| Rate for Payer: Cigna Commercial |
$144.70
|
| Rate for Payer: Cigna Medicare Advantage |
$157.41
|
| Rate for Payer: Family Health Partners Medicaid |
$17.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$173.97
|
| Rate for Payer: Healthy Blue Medicaid |
$18.69
|
| Rate for Payer: Home State Health Plan Exchange |
$157.41
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.30
|
| Rate for Payer: Humana Medicare |
$207.11
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$207.11
|
| Rate for Payer: Provider Network of America Commercial |
$220.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$182.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.03
|
|
|
HC Assay of Tacrolimus - Tacrolimus
|
Facility
|
IP
|
$276.15
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
Px03018019701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$207.11 |
| 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 |
$276.15
|
| Rate for Payer: Cash Price |
$276.15
|
| 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 |
$207.11
|
| Rate for Payer: Provider Network of America Commercial |
$220.92
|
|
|
HC Assay of Testosterone - Testosterone Total Free
|
Facility
|
IP
|
$171.15
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
Px03018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.36 |
| 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 |
$171.15
|
| Rate for Payer: Cash Price |
$171.15
|
| 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 |
$128.36
|
| Rate for Payer: Provider Network of America Commercial |
$136.92
|
|
|
HC Assay of Testosterone - Testosterone Total Free
|
Facility
|
OP
|
$171.15
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
Px03018440201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$136.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$120.66
|
| Rate for Payer: Aetna Workers' Compensation |
$120.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$118.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$118.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$134.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$134.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$134.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$131.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$134.87
|
| Rate for Payer: Cash Price |
$171.15
|
| Rate for Payer: Cash Price |
$171.15
|
| Rate for Payer: Cigna Commercial |
$89.68
|
| Rate for Payer: Cigna Medicare Advantage |
$97.56
|
| Rate for Payer: Family Health Partners Medicaid |
$32.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$107.82
|
| Rate for Payer: Healthy Blue Medicaid |
$34.66
|
| Rate for Payer: Home State Health Plan Exchange |
$97.56
|
| Rate for Payer: Home State Health Plan Medicaid |
$32.09
|
| Rate for Payer: Humana Medicare |
$128.36
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32.09
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$128.36
|
| Rate for Payer: Provider Network of America Commercial |
$136.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.16
|
|
|
HC Assay of Testosterone Total
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
Px03008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$140.65
|
| Rate for Payer: Aetna Workers' Compensation |
$140.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$138.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$138.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$153.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$157.21
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Cigna Medicare Advantage |
$113.72
|
| Rate for Payer: Family Health Partners Medicaid |
$32.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$125.69
|
| Rate for Payer: Healthy Blue Medicaid |
$35.12
|
| Rate for Payer: Home State Health Plan Exchange |
$113.72
|
| Rate for Payer: Home State Health Plan Medicaid |
$32.52
|
| Rate for Payer: Humana Medicare |
$149.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32.52
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$149.62
|
| Rate for Payer: Provider Network of America Commercial |
$159.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$131.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.48
|
|
|
HC Assay of Testosterone Total
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
Px03008440301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.62 |
| 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 |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| 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 |
$149.62
|
| Rate for Payer: Provider Network of America Commercial |
$159.60
|
|
|
HC Assay of Theophylline - Theophylline
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
Px03018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.83
|
| Rate for Payer: Aetna Workers' Compensation |
$88.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.29
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Cigna Medicare Advantage |
$71.82
|
| Rate for Payer: Family Health Partners Medicaid |
$17.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.38
|
| Rate for Payer: Healthy Blue Medicaid |
$19.25
|
| Rate for Payer: Home State Health Plan Exchange |
$71.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.82
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.82
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
|
|
HC Assay of Theophylline - Theophylline
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
Px03018019801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| 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 |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
|
|
HC Assay of Thyroglobulin - Thyroglobulin
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
Px03018443201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$114.19 |
| 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 |
$152.25
|
| Rate for Payer: Cash Price |
$152.25
|
| 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 |
$114.19
|
| Rate for Payer: Provider Network of America Commercial |
$121.80
|
|
|
HC Assay of Thyroglobulin - Thyroglobulin
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
Px03018443201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$121.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$107.34
|
| Rate for Payer: Aetna Workers' Compensation |
$107.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$105.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$105.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$117.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$119.97
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cigna Commercial |
$79.78
|
| Rate for Payer: Cigna Medicare Advantage |
$86.78
|
| Rate for Payer: Family Health Partners Medicaid |
$20.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$95.92
|
| Rate for Payer: Healthy Blue Medicaid |
$21.85
|
| Rate for Payer: Home State Health Plan Exchange |
$86.78
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.23
|
| Rate for Payer: Humana Medicare |
$114.19
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.23
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$114.19
|
| Rate for Payer: Provider Network of America Commercial |
$121.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.48
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.23
|
|
|
HC Assay of Thyroid Stim Immunoglobulins (Tsi) - Thyroid Stimulating Im
|
Facility
|
IP
|
$188.62
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
Px03018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.47 |
| 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 |
$188.62
|
| Rate for Payer: Cash Price |
$188.62
|
| 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 |
$141.47
|
| Rate for Payer: Provider Network of America Commercial |
$150.90
|
|
|
HC Assay of Thyroid Stim Immunoglobulins (Tsi) - Thyroid Stimulating Im
|
Facility
|
OP
|
$188.62
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
Px03018444501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$150.90 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$132.98
|
| Rate for Payer: Aetna Workers' Compensation |
$132.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$130.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$130.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$148.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$148.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$148.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$145.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$148.63
|
| Rate for Payer: Cash Price |
$188.62
|
| Rate for Payer: Cash Price |
$188.62
|
| Rate for Payer: Cigna Commercial |
$98.84
|
| Rate for Payer: Cigna Medicare Advantage |
$107.51
|
| Rate for Payer: Family Health Partners Medicaid |
$64.08
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$118.83
|
| Rate for Payer: Healthy Blue Medicaid |
$69.20
|
| Rate for Payer: Home State Health Plan Exchange |
$107.51
|
| Rate for Payer: Home State Health Plan Medicaid |
$64.08
|
| Rate for Payer: Humana Medicare |
$141.47
|
| Rate for Payer: Mercy CarePlus Medicaid |
$64.08
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$141.47
|
| Rate for Payer: Provider Network of America Commercial |
$150.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.49
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$50.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.24
|
|
|
HC Assay of Thyroxine Bndng Globulin - Thyroxine Binding Globulin
|
Facility
|
IP
|
$180.60
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
Px03018444201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.45 |
| 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 |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| 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 |
$135.45
|
| Rate for Payer: Provider Network of America Commercial |
$144.48
|
|
|
HC Assay of Thyroxine Bndng Globulin - Thyroxine Binding Globulin
|
Facility
|
OP
|
$180.60
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
Px03018444201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$127.32
|
| Rate for Payer: Aetna Workers' Compensation |
$127.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$125.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$125.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$142.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$139.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$142.31
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$94.63
|
| Rate for Payer: Cigna Medicare Advantage |
$102.94
|
| Rate for Payer: Family Health Partners Medicaid |
$18.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$113.78
|
| Rate for Payer: Healthy Blue Medicaid |
$20.11
|
| Rate for Payer: Home State Health Plan Exchange |
$102.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$18.62
|
| Rate for Payer: Humana Medicare |
$135.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$18.62
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$135.45
|
| Rate for Payer: Provider Network of America Commercial |
$144.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$119.20
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.02
|
|
|
HC Assay of Tobramycin - Tobramycin Peak
|
Facility
|
OP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$169.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.53
|
| Rate for Payer: Aetna Workers' Compensation |
$149.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$163.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$167.13
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$111.14
|
| Rate for Payer: Cigna Medicare Advantage |
$120.90
|
| Rate for Payer: Family Health Partners Medicaid |
$20.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.62
|
| Rate for Payer: Healthy Blue Medicaid |
$21.95
|
| Rate for Payer: Home State Health Plan Exchange |
$120.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.33
|
| Rate for Payer: Humana Medicare |
$159.07
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.30
|
|
|
HC Assay of Tobramycin - Tobramycin Peak
|
Facility
|
IP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.07 |
| 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 |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| 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 |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
|
|
HC Assay of Tobramycin - Tobramycin Random
|
Facility
|
OP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$169.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.53
|
| Rate for Payer: Aetna Workers' Compensation |
$149.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$163.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$167.13
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$111.14
|
| Rate for Payer: Cigna Medicare Advantage |
$120.90
|
| Rate for Payer: Family Health Partners Medicaid |
$20.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.62
|
| Rate for Payer: Healthy Blue Medicaid |
$21.95
|
| Rate for Payer: Home State Health Plan Exchange |
$120.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.33
|
| Rate for Payer: Humana Medicare |
$159.07
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.30
|
|
|
HC Assay of Tobramycin - Tobramycin Random
|
Facility
|
IP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.07 |
| 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 |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| 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 |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
|
|
HC Assay of Tobramycin - Tobramycin Trough
|
Facility
|
IP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.07 |
| 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 |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| 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 |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
|
|
HC Assay of Tobramycin - Tobramycin Trough
|
Facility
|
OP
|
$212.10
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
Px03018020003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$169.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$149.53
|
| Rate for Payer: Aetna Workers' Compensation |
$149.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$146.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$167.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$163.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$167.13
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$111.14
|
| Rate for Payer: Cigna Medicare Advantage |
$120.90
|
| Rate for Payer: Family Health Partners Medicaid |
$20.33
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$133.62
|
| Rate for Payer: Healthy Blue Medicaid |
$21.95
|
| Rate for Payer: Home State Health Plan Exchange |
$120.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$20.33
|
| Rate for Payer: Humana Medicare |
$159.07
|
| Rate for Payer: Mercy CarePlus Medicaid |
$20.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$159.07
|
| Rate for Payer: Provider Network of America Commercial |
$169.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$139.99
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.30
|
|
|
HC Assay of Total Testosterone - Testosterone
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
Px03018440301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$140.65
|
| Rate for Payer: Aetna Workers' Compensation |
$140.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$138.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$138.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$157.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$153.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$157.21
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Cigna Medicare Advantage |
$113.72
|
| Rate for Payer: Family Health Partners Medicaid |
$32.52
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$125.69
|
| Rate for Payer: Healthy Blue Medicaid |
$35.12
|
| Rate for Payer: Home State Health Plan Exchange |
$113.72
|
| Rate for Payer: Home State Health Plan Medicaid |
$32.52
|
| Rate for Payer: Humana Medicare |
$149.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32.52
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$149.62
|
| Rate for Payer: Provider Network of America Commercial |
$159.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$131.67
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.48
|
|
