|
HC Assay of Urine Sodium - Sodium 24 Hour Urine
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
Px03018430003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.19 |
| 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 |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| 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 |
$51.19
|
| Rate for Payer: Provider Network of America Commercial |
$54.60
|
|
|
HC Assay of Urine Sodium - Sodium Random Urine
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
Px03018430001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.19 |
| 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 |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| 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 |
$51.19
|
| Rate for Payer: Provider Network of America Commercial |
$54.60
|
|
|
HC Assay of Urine Sodium - Sodium Random Urine
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
Px03018430001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$48.12
|
| Rate for Payer: Aetna Workers' Compensation |
$48.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.78
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$35.76
|
| Rate for Payer: Cigna Medicare Advantage |
$38.90
|
| Rate for Payer: Family Health Partners Medicaid |
$6.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$43.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6.88
|
| Rate for Payer: Home State Health Plan Exchange |
$38.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$6.37
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.19
|
| Rate for Payer: Provider Network of America Commercial |
$54.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.80
|
|
|
HC Assay of Urine Sodium - Sodium Timed Urine
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
Px03018430002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$48.12
|
| Rate for Payer: Aetna Workers' Compensation |
$48.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$52.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$53.78
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cigna Commercial |
$35.76
|
| Rate for Payer: Cigna Medicare Advantage |
$38.90
|
| Rate for Payer: Family Health Partners Medicaid |
$6.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$43.00
|
| Rate for Payer: Healthy Blue Medicaid |
$6.88
|
| Rate for Payer: Home State Health Plan Exchange |
$38.90
|
| Rate for Payer: Home State Health Plan Medicaid |
$6.37
|
| Rate for Payer: Humana Medicare |
$51.19
|
| Rate for Payer: Mercy CarePlus Medicaid |
$6.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$51.19
|
| Rate for Payer: Provider Network of America Commercial |
$54.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.05
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.80
|
|
|
HC Assay of Urine Sodium - Sodium Timed Urine
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
Px03018430002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.19 |
| 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 |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| 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 |
$51.19
|
| Rate for Payer: Provider Network of America Commercial |
$54.60
|
|
|
HC Assay of Urine Vma - Vma 24 Hour Urine
|
Facility
|
OP
|
$166.95
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
Px03018458501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$133.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$117.70
|
| Rate for Payer: Aetna Workers' Compensation |
$117.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$115.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$115.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$128.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$131.56
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna Commercial |
$87.48
|
| Rate for Payer: Cigna Medicare Advantage |
$95.16
|
| Rate for Payer: Family Health Partners Medicaid |
$19.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$105.18
|
| Rate for Payer: Healthy Blue Medicaid |
$21.09
|
| Rate for Payer: Home State Health Plan Exchange |
$95.16
|
| Rate for Payer: Home State Health Plan Medicaid |
$19.53
|
| Rate for Payer: Humana Medicare |
$125.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$125.21
|
| Rate for Payer: Provider Network of America Commercial |
$133.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.70
|
|
|
HC Assay of Urine Vma - Vma 24 Hour Urine
|
Facility
|
IP
|
$166.95
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
Px03018458501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.21 |
| 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 |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| 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 |
$125.21
|
| Rate for Payer: Provider Network of America Commercial |
$133.56
|
|
|
HC Assay of Urine Vma - Vma, Urine
|
Facility
|
IP
|
$166.95
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
Px03018458502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.21 |
| 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 |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| 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 |
$125.21
|
| Rate for Payer: Provider Network of America Commercial |
$133.56
|
|
|
HC Assay of Urine Vma - Vma, Urine
|
Facility
|
OP
|
$166.95
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
Px03018458502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$133.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$117.70
|
| Rate for Payer: Aetna Workers' Compensation |
$117.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$115.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$115.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$131.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$128.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$131.56
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna Commercial |
$87.48
|
| Rate for Payer: Cigna Medicare Advantage |
$95.16
|
| Rate for Payer: Family Health Partners Medicaid |
$19.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$105.18
|
| Rate for Payer: Healthy Blue Medicaid |
$21.09
|
| Rate for Payer: Home State Health Plan Exchange |
$95.16
|
| Rate for Payer: Home State Health Plan Medicaid |
$19.53
|
| Rate for Payer: Humana Medicare |
$125.21
|
| Rate for Payer: Mercy CarePlus Medicaid |
$19.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$125.21
|
| Rate for Payer: Provider Network of America Commercial |
$133.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$110.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.70
|
|
|
HC Assay of Vancomycin
|
Facility
|
IP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.03 |
| 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 |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| 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 |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
|
|
HC Assay of Vancomycin
|
Facility
|
OP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$146.16 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$128.80
|
| Rate for Payer: Aetna Workers' Compensation |
$128.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$143.97
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$95.73
|
| Rate for Payer: Cigna Medicare Advantage |
$104.14
|
| Rate for Payer: Family Health Partners Medicaid |
$17.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.10
|
| Rate for Payer: Healthy Blue Medicaid |
$18.43
|
| Rate for Payer: Home State Health Plan Exchange |
$104.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.07
|
| Rate for Payer: Humana Medicare |
$137.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.85
|
|
|
HC Assay of Vancomycin - Vancomycin Peak
|
Facility
|
OP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$146.16 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$128.80
|
| Rate for Payer: Aetna Workers' Compensation |
$128.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$143.97
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$95.73
|
| Rate for Payer: Cigna Medicare Advantage |
$104.14
|
| Rate for Payer: Family Health Partners Medicaid |
$17.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.10
|
| Rate for Payer: Healthy Blue Medicaid |
$18.43
|
| Rate for Payer: Home State Health Plan Exchange |
$104.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.07
|
| Rate for Payer: Humana Medicare |
$137.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.85
|
|
|
HC Assay of Vancomycin - Vancomycin Peak
|
Facility
|
IP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.03 |
| 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 |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| 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 |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
|
|
HC Assay of Vancomycin - Vancomycin Random
|
Facility
|
IP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.03 |
| 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 |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| 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 |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
|
|
HC Assay of Vancomycin - Vancomycin Random
|
Facility
|
OP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$146.16 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$128.80
|
| Rate for Payer: Aetna Workers' Compensation |
$128.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$143.97
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$95.73
|
| Rate for Payer: Cigna Medicare Advantage |
$104.14
|
| Rate for Payer: Family Health Partners Medicaid |
$17.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.10
|
| Rate for Payer: Healthy Blue Medicaid |
$18.43
|
| Rate for Payer: Home State Health Plan Exchange |
$104.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.07
|
| Rate for Payer: Humana Medicare |
$137.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.85
|
|
|
HC Assay of Vancomycin - Vancomycin Trough
|
Facility
|
OP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$146.16 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$128.80
|
| Rate for Payer: Aetna Workers' Compensation |
$128.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$126.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$140.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$143.97
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$95.73
|
| Rate for Payer: Cigna Medicare Advantage |
$104.14
|
| Rate for Payer: Family Health Partners Medicaid |
$17.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$115.10
|
| Rate for Payer: Healthy Blue Medicaid |
$18.43
|
| Rate for Payer: Home State Health Plan Exchange |
$104.14
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.07
|
| Rate for Payer: Humana Medicare |
$137.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$120.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.85
|
|
|
HC Assay of Vancomycin - Vancomycin Trough
|
Facility
|
IP
|
$182.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
Px03018020201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.03 |
| 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 |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| 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 |
$137.03
|
| Rate for Payer: Provider Network of America Commercial |
$146.16
|
|
|
HC Assay of Vitamin a - Vitamin A
|
Facility
|
OP
|
$123.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
Px03018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$99.12 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$87.35
|
| Rate for Payer: Aetna Workers' Compensation |
$87.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$97.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$97.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$97.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$97.63
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$64.92
|
| Rate for Payer: Cigna Medicare Advantage |
$70.62
|
| Rate for Payer: Family Health Partners Medicaid |
$14.63
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$78.06
|
| Rate for Payer: Healthy Blue Medicaid |
$15.80
|
| Rate for Payer: Home State Health Plan Exchange |
$70.62
|
| Rate for Payer: Home State Health Plan Medicaid |
$14.63
|
| Rate for Payer: Humana Medicare |
$92.92
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14.63
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$92.92
|
| Rate for Payer: Provider Network of America Commercial |
$99.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$81.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.01
|
|
|
HC Assay of Vitamin a - Vitamin A
|
Facility
|
IP
|
$123.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
Px03018459001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.92 |
| 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 |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| 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 |
$92.92
|
| Rate for Payer: Provider Network of America Commercial |
$99.12
|
|
|
HC Assay of Vitamin B-1 - Vitamin B1
|
Facility
|
IP
|
$186.90
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
Px03018442501
|
|
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
|
|
|
HC Assay of Vitamin B-1 - Vitamin B1
|
Facility
|
OP
|
$186.90
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
Px03018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.14 |
| 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 |
$26.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$117.75
|
| Rate for Payer: Healthy Blue Medicaid |
$28.89
|
| Rate for Payer: Home State Health Plan Exchange |
$106.53
|
| Rate for Payer: Home State Health Plan Medicaid |
$26.75
|
| Rate for Payer: Humana Medicare |
$140.18
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26.75
|
| 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 |
$21.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.14
|
|
|
HC Assay of Vitamin B-1 - Vitamin B1, Whole Blood
|
Facility
|
OP
|
$186.90
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
Px03018442502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.14 |
| 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 |
$26.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$117.75
|
| Rate for Payer: Healthy Blue Medicaid |
$28.89
|
| Rate for Payer: Home State Health Plan Exchange |
$106.53
|
| Rate for Payer: Home State Health Plan Medicaid |
$26.75
|
| Rate for Payer: Humana Medicare |
$140.18
|
| Rate for Payer: Mercy CarePlus Medicaid |
$26.75
|
| 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 |
$21.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.14
|
|
|
HC Assay of Vitamin B-1 - Vitamin B1, Whole Blood
|
Facility
|
IP
|
$186.90
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
Px03018442502
|
|
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
|
|
|
HC Assay of Vitamin B-2 - Vitamin B2
|
Facility
|
IP
|
$231.53
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
Px03018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.65 |
| 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 |
$231.53
|
| Rate for Payer: Cash Price |
$231.53
|
| 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 |
$173.65
|
| Rate for Payer: Provider Network of America Commercial |
$185.22
|
|
|
HC Assay of Vitamin B-2 - Vitamin B2
|
Facility
|
OP
|
$231.53
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
Px03018425201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$185.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$163.23
|
| Rate for Payer: Aetna Workers' Compensation |
$163.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$160.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$160.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$182.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$182.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$182.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$178.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$182.45
|
| Rate for Payer: Cash Price |
$231.53
|
| Rate for Payer: Cash Price |
$231.53
|
| Rate for Payer: Cigna Commercial |
$121.32
|
| Rate for Payer: Cigna Medicare Advantage |
$131.97
|
| Rate for Payer: Family Health Partners Medicaid |
$25.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$145.86
|
| Rate for Payer: Healthy Blue Medicaid |
$27.55
|
| Rate for Payer: Home State Health Plan Exchange |
$131.97
|
| Rate for Payer: Home State Health Plan Medicaid |
$25.51
|
| Rate for Payer: Humana Medicare |
$173.65
|
| Rate for Payer: Mercy CarePlus Medicaid |
$25.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$173.65
|
| Rate for Payer: Provider Network of America Commercial |
$185.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$152.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$20.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
|
