|
HC Bandage Comp Lopress4.7 X5.4yd
|
Facility
|
OP
|
$22.10
|
|
| Hospital Charge Code |
Px02720000629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.58
|
| Rate for Payer: Aetna Workers' Compensation |
$15.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.41
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Cigna Commercial |
$13.53
|
| Rate for Payer: Cigna Medicare Advantage |
$12.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.92
|
| Rate for Payer: Home State Health Plan Exchange |
$12.60
|
| Rate for Payer: Humana Medicare |
$16.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.57
|
| Rate for Payer: Provider Network of America Commercial |
$17.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$22.10
|
|
|
HC Bandage Comp Lopress4.7 X5.4yd
|
Facility
|
IP
|
$22.10
|
|
| Hospital Charge Code |
Px02720000629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.57 |
| 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 |
$22.10
|
| Rate for Payer: Cash Price |
$22.10
|
| 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 |
$16.57
|
| Rate for Payer: Provider Network of America Commercial |
$17.68
|
|
|
HC Bandage Elastic 2"
|
Facility
|
IP
|
$3.41
|
|
| Hospital Charge Code |
Px02700000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
|
|
HC Bandage Elastic 2"
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02700000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Bandage Elastic 3"
|
Facility
|
IP
|
$3.41
|
|
| Hospital Charge Code |
Px02700000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
|
|
HC Bandage Elastic 3"
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02700000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Bandage Elastic 4"
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
LOCAL 2700000670
|
| Hospital Charge Code |
Px02700000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Bandage Elastic 4"
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
LOCAL 2700000670
|
| Hospital Charge Code |
Px02700000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
|
|
HC Bandage Elastic 6"
|
Facility
|
OP
|
$3.51
|
|
| Hospital Charge Code |
Px02700000671
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.47
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.35
|
| Rate for Payer: Aetna Workers' Compensation |
$2.35
|
| Rate for Payer: Aetna Workers' Compensation |
$2.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.77
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna Commercial |
$2.04
|
| Rate for Payer: Cigna Commercial |
$2.15
|
| Rate for Payer: Cigna Medicare Advantage |
$2.00
|
| Rate for Payer: Cigna Medicare Advantage |
$1.90
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.10
|
| Rate for Payer: Home State Health Plan Exchange |
$1.90
|
| Rate for Payer: Home State Health Plan Exchange |
$2.00
|
| Rate for Payer: Humana Medicare |
$2.63
|
| Rate for Payer: Humana Medicare |
$2.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.63
|
| Rate for Payer: Provider Network of America Commercial |
$2.81
|
| Rate for Payer: Provider Network of America Commercial |
$2.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.51
|
|
|
HC Bandage Elastic 6"
|
Facility
|
IP
|
$3.51
|
|
| Hospital Charge Code |
Px02700000671
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.63
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.50
|
| Rate for Payer: Provider Network of America Commercial |
$2.81
|
| Rate for Payer: Provider Network of America Commercial |
$2.67
|
|
|
HC Bandage Lymphedema Kit Arm
|
Facility
|
IP
|
$154.34
|
|
| Hospital Charge Code |
Px02720000584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.75 |
| 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 |
$154.34
|
| Rate for Payer: Cash Price |
$154.34
|
| 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 |
$115.75
|
| Rate for Payer: Provider Network of America Commercial |
$123.47
|
|
|
HC Bandage Lymphedema Kit Arm
|
Facility
|
OP
|
$154.34
|
|
| Hospital Charge Code |
Px02720000584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$154.34 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$108.81
|
| Rate for Payer: Aetna Workers' Compensation |
$108.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$106.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$106.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$121.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$121.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$121.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$118.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$121.62
|
| Rate for Payer: Cash Price |
$154.34
|
| Rate for Payer: Cigna Commercial |
$94.46
|
| Rate for Payer: Cigna Medicare Advantage |
$87.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$97.23
|
| Rate for Payer: Home State Health Plan Exchange |
$87.97
|
| Rate for Payer: Humana Medicare |
$115.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$115.75
|
| Rate for Payer: Provider Network of America Commercial |
$123.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$101.86
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$154.34
|
|
|
HC Bandage Lymphedema Kit Leg
|
Facility
|
OP
|
$375.38
|
|
| Hospital Charge Code |
Px02720000628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.97 |
| Max. Negotiated Rate |
$375.38 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$264.64
|
| Rate for Payer: Aetna Workers' Compensation |
$264.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$260.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$260.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$295.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$289.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$295.80
|
| Rate for Payer: Cash Price |
$375.38
|
| Rate for Payer: Cigna Commercial |
$229.73
|
| Rate for Payer: Cigna Medicare Advantage |
$213.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$236.49
|
| Rate for Payer: Home State Health Plan Exchange |
$213.97
|
| Rate for Payer: Humana Medicare |
$281.54
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$281.54
|
| Rate for Payer: Provider Network of America Commercial |
$300.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$247.75
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$375.38
|
|
|
HC Bandage Lymphedema Kit Leg
|
Facility
|
IP
|
$375.38
|
|
| Hospital Charge Code |
Px02720000628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.54 |
| 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 |
$375.38
|
| Rate for Payer: Cash Price |
$375.38
|
| 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 |
$281.54
|
| Rate for Payer: Provider Network of America Commercial |
$300.30
|
|
|
HC Bandage Self-Adherent 2 Lf
|
Facility
|
OP
|
$6.01
|
|
| Hospital Charge Code |
Px02700002750
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.24
|
| Rate for Payer: Aetna Workers' Compensation |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.74
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Cigna Medicare Advantage |
$3.43
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.79
|
| Rate for Payer: Home State Health Plan Exchange |
$3.43
|
| Rate for Payer: Humana Medicare |
$4.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.51
|
| Rate for Payer: Provider Network of America Commercial |
$4.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.01
|
|
|
HC Bandage Self-Adherent 2 Lf
|
Facility
|
IP
|
$6.01
|
|
| Hospital Charge Code |
Px02700002750
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| 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 |
$4.51
|
| Rate for Payer: Provider Network of America Commercial |
$4.81
|
|
|
HC Bandage Self-Adherent 3 Lf
|
Facility
|
OP
|
$6.01
|
|
| Hospital Charge Code |
Px02700002696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.24
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.03
|
| Rate for Payer: Aetna Workers' Compensation |
$4.03
|
| Rate for Payer: Aetna Workers' Compensation |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.74
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Cigna Medicare Advantage |
$3.43
|
| Rate for Payer: Cigna Medicare Advantage |
$3.26
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.60
|
| Rate for Payer: Home State Health Plan Exchange |
$3.26
|
| Rate for Payer: Home State Health Plan Exchange |
$3.43
|
| Rate for Payer: Humana Medicare |
$4.51
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.51
|
| Rate for Payer: Provider Network of America Commercial |
$4.81
|
| Rate for Payer: Provider Network of America Commercial |
$4.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.97
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.72
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.01
|
|
|
HC Bandage Self-Adherent 3 Lf
|
Facility
|
IP
|
$6.01
|
|
| Hospital Charge Code |
Px02700002696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$6.01
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$5.72
|
| 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 |
$4.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.29
|
| Rate for Payer: Provider Network of America Commercial |
$4.81
|
| Rate for Payer: Provider Network of America Commercial |
$4.58
|
|
|
HC Bandage Self-Adherent Sterile 6 Lf
|
Facility
|
IP
|
$14.20
|
|
| Hospital Charge Code |
Px02720000554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.65 |
| 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 |
$14.20
|
| Rate for Payer: Cash Price |
$14.20
|
| 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 |
$10.65
|
| Rate for Payer: Provider Network of America Commercial |
$11.36
|
|
|
HC Bandage Self-Adherent Sterile 6 Lf
|
Facility
|
OP
|
$14.20
|
|
| Hospital Charge Code |
Px02720000554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$14.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$10.01
|
| Rate for Payer: Aetna Workers' Compensation |
$10.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$11.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$11.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$11.19
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$11.19
|
| Rate for Payer: Cash Price |
$14.20
|
| Rate for Payer: Cigna Commercial |
$8.69
|
| Rate for Payer: Cigna Medicare Advantage |
$8.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8.95
|
| Rate for Payer: Home State Health Plan Exchange |
$8.09
|
| Rate for Payer: Humana Medicare |
$10.65
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10.65
|
| Rate for Payer: Provider Network of America Commercial |
$11.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14.20
|
|
|
HC Bandage Telfa Strips 3x8
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002675
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.29
|
| Rate for Payer: Aetna Workers' Compensation |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Commercial |
$1.99
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Cigna Medicare Advantage |
$1.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.05
|
| Rate for Payer: Home State Health Plan Exchange |
$1.85
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Bandage Telfa Strips 3x8
|
Facility
|
IP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002675
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.44
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: Provider Network of America Commercial |
$2.60
|
|
|
HC Bandage Tublar Medigrip Size F
|
Facility
|
OP
|
$104.49
|
|
| Hospital Charge Code |
Px02720000644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$104.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.67
|
| Rate for Payer: Aetna Workers' Compensation |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$72.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$72.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$80.46
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$82.34
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cigna Commercial |
$63.95
|
| Rate for Payer: Cigna Medicare Advantage |
$59.56
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.83
|
| Rate for Payer: Home State Health Plan Exchange |
$59.56
|
| Rate for Payer: Humana Medicare |
$78.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$78.37
|
| Rate for Payer: Provider Network of America Commercial |
$83.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.96
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$104.49
|
|
|
HC Bandage Tublar Medigrip Size F
|
Facility
|
IP
|
$104.49
|
|
| Hospital Charge Code |
Px02720000644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cash Price |
$104.49
|
| 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 |
$78.37
|
| Rate for Payer: Provider Network of America Commercial |
$83.59
|
|
|
HC Bandage Tublar Medigrip Size G
|
Facility
|
OP
|
$105.21
|
|
| Hospital Charge Code |
Px02720000645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$74.17
|
| Rate for Payer: Aetna Workers' Compensation |
$74.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$72.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$72.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$82.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$82.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$82.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$81.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$82.91
|
| Rate for Payer: Cash Price |
$105.21
|
| Rate for Payer: Cigna Commercial |
$64.39
|
| Rate for Payer: Cigna Medicare Advantage |
$59.97
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$66.28
|
| Rate for Payer: Home State Health Plan Exchange |
$59.97
|
| Rate for Payer: Humana Medicare |
$78.91
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$78.91
|
| Rate for Payer: Provider Network of America Commercial |
$84.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.44
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$105.21
|
|
