|
HC Bandage Tublar Medigrip Size G
|
Facility
|
IP
|
$105.21
|
|
| Hospital Charge Code |
Px02720000645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.91 |
| 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 |
$105.21
|
| Rate for Payer: Cash Price |
$105.21
|
| 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 |
$78.91
|
| Rate for Payer: Provider Network of America Commercial |
$84.17
|
|
|
HC Bar Horizontal
|
Facility
|
OP
|
$26.28
|
|
| Hospital Charge Code |
Px02720000572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$26.28 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$18.53
|
| Rate for Payer: Aetna Workers' Compensation |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$18.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$20.71
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cigna Commercial |
$16.08
|
| Rate for Payer: Cigna Medicare Advantage |
$14.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$16.56
|
| Rate for Payer: Home State Health Plan Exchange |
$14.98
|
| Rate for Payer: Humana Medicare |
$19.71
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$19.71
|
| Rate for Payer: Provider Network of America Commercial |
$21.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$26.28
|
|
|
HC Bar Horizontal
|
Facility
|
IP
|
$26.28
|
|
| Hospital Charge Code |
Px02720000572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.71 |
| 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 |
$26.28
|
| Rate for Payer: Cash Price |
$26.28
|
| 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 |
$19.71
|
| Rate for Payer: Provider Network of America Commercial |
$21.02
|
|
|
HC Barrier Flat Skin 2-3/4
|
Facility
|
OP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002682
|
|
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 Workers' Compensation |
$2.40
|
| 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) |
$2.36
|
| 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 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 Blue Risk (PPO) |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2.69
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna Commercial |
$2.09
|
| Rate for Payer: Cigna Medicare Advantage |
$1.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2.15
|
| Rate for Payer: Home State Health Plan Exchange |
$1.94
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.41
|
|
|
HC Barrier Flat Skin 2-3/4
|
Facility
|
IP
|
$3.41
|
|
| Hospital Charge Code |
Px02700002682
|
|
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 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 |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| 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 |
$2.56
|
| Rate for Payer: Provider Network of America Commercial |
$2.73
|
|
|
HC Bar Vertical
|
Facility
|
IP
|
$28.32
|
|
| Hospital Charge Code |
Px02720000573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$28.32
|
| Rate for Payer: Cash Price |
$28.32
|
| 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 |
$21.24
|
| Rate for Payer: Provider Network of America Commercial |
$22.66
|
|
|
HC Bar Vertical
|
Facility
|
OP
|
$28.32
|
|
| Hospital Charge Code |
Px02720000573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$28.32 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$19.97
|
| Rate for Payer: Aetna Workers' Compensation |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$21.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$22.32
|
| Rate for Payer: Cash Price |
$28.32
|
| Rate for Payer: Cigna Commercial |
$17.33
|
| Rate for Payer: Cigna Medicare Advantage |
$16.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$17.84
|
| Rate for Payer: Home State Health Plan Exchange |
$16.14
|
| Rate for Payer: Humana Medicare |
$21.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$21.24
|
| Rate for Payer: Provider Network of America Commercial |
$22.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$18.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$28.32
|
|
|
HC Basic Metabolic Panel Calcium Ionized - Bundled Charge
|
Facility
|
IP
|
$278.25
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
Px03018004701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$208.69 |
| 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 |
$278.25
|
| Rate for Payer: Cash Price |
$278.25
|
| 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 |
$208.69
|
| Rate for Payer: Provider Network of America Commercial |
$222.60
|
|
|
HC Basic Metabolic Panel Calcium Ionized - Bundled Charge
|
Facility
|
OP
|
$278.25
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
Px03018004701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$222.60 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$196.17
|
| Rate for Payer: Aetna Workers' Compensation |
$196.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$192.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$192.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$219.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$219.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$219.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$214.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$219.26
|
| Rate for Payer: Cash Price |
$278.25
|
| Rate for Payer: Cash Price |
$278.25
|
| Rate for Payer: Cigna Commercial |
$145.80
|
| Rate for Payer: Cigna Medicare Advantage |
$158.60
|
| Rate for Payer: Family Health Partners Medicaid |
$17.30
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$175.30
|
| Rate for Payer: Healthy Blue Medicaid |
$18.69
|
| Rate for Payer: Home State Health Plan Exchange |
$158.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$17.30
|
| Rate for Payer: Humana Medicare |
$208.69
|
| Rate for Payer: Mercy CarePlus Medicaid |
$17.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$208.69
|
| Rate for Payer: Provider Network of America Commercial |
$222.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$183.65
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.03
|
|
|
HC Basic Metabolic Panel Calcium Total
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
Px03018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.50 |
| 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 |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| 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 |
$157.50
|
| Rate for Payer: Provider Network of America Commercial |
$168.00
|
|
|
HC Basic Metabolic Panel Calcium Total
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
Px03018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$148.05
|
| Rate for Payer: Aetna Workers' Compensation |
$148.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$145.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$145.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$165.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$165.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$165.48
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$161.70
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$165.48
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$110.04
|
| Rate for Payer: Cigna Medicare Advantage |
$119.70
|
| Rate for Payer: Family Health Partners Medicaid |
$10.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$132.30
|
| Rate for Payer: Healthy Blue Medicaid |
$11.51
|
| Rate for Payer: Home State Health Plan Exchange |
$119.70
|
| Rate for Payer: Home State Health Plan Medicaid |
$10.65
|
| Rate for Payer: Humana Medicare |
$157.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10.65
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Provider Network of America Commercial |
$168.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$138.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.02
|
|
|
HC Bcr Abl1 Gene Qn Pcr - Ref Lab
|
Facility
|
IP
|
$1,088.85
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
Px03098120601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$816.64 |
| 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 |
$1,088.85
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$816.64
|
| Rate for Payer: Provider Network of America Commercial |
$871.08
|
|
|
HC Bcr Abl1 Gene Qn Pcr - Ref Lab
|
Facility
|
OP
|
$1,088.85
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
Px03098120601
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$871.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$767.64
|
| Rate for Payer: Aetna Workers' Compensation |
$767.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$754.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$754.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$838.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$858.01
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cigna Commercial |
$570.56
|
| Rate for Payer: Cigna Medicare Advantage |
$620.64
|
| Rate for Payer: Family Health Partners Medicaid |
$206.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$685.98
|
| Rate for Payer: Healthy Blue Medicaid |
$223.11
|
| Rate for Payer: Home State Health Plan Exchange |
$620.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$206.58
|
| Rate for Payer: Humana Medicare |
$816.64
|
| Rate for Payer: Mercy CarePlus Medicaid |
$206.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$816.64
|
| Rate for Payer: Provider Network of America Commercial |
$871.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$718.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$163.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.53
|
|
|
HC Bcr Abl1 P120 - Ref Lab
|
Facility
|
IP
|
$1,088.85
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
Px03098120602
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$816.64 |
| 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 |
$1,088.85
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$816.64
|
| Rate for Payer: Provider Network of America Commercial |
$871.08
|
|
|
HC Bcr Abl1 P120 - Ref Lab
|
Facility
|
OP
|
$1,088.85
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
Px03098120602
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$871.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$767.64
|
| Rate for Payer: Aetna Workers' Compensation |
$767.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$754.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$754.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$858.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$838.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$858.01
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cash Price |
$1,088.85
|
| Rate for Payer: Cigna Commercial |
$570.56
|
| Rate for Payer: Cigna Medicare Advantage |
$620.64
|
| Rate for Payer: Family Health Partners Medicaid |
$206.58
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$685.98
|
| Rate for Payer: Healthy Blue Medicaid |
$223.11
|
| Rate for Payer: Home State Health Plan Exchange |
$620.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$206.58
|
| Rate for Payer: Humana Medicare |
$816.64
|
| Rate for Payer: Mercy CarePlus Medicaid |
$206.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$816.64
|
| Rate for Payer: Provider Network of America Commercial |
$871.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$718.64
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$163.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.53
|
|
|
HC Be Double W Air
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
Px09727428001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
HC Be Double W Air
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
Px09727428001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$239.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$221.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$239.08
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$221.37
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$221.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.66
|
|
|
HC Be Gastrographin
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
Px09727427001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$239.08 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$221.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$239.08
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$221.37
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$221.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.66
|
|
|
HC Be Gastrographin
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
Px09727427001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
HC Bence Jones
|
Facility
|
IP
|
$768.60
|
|
|
Service Code
|
CPT 86325
|
| Hospital Charge Code |
Px03028632501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$576.45 |
| 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 |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| 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 |
$576.45
|
| Rate for Payer: Provider Network of America Commercial |
$614.88
|
|
|
HC Bence Jones
|
Facility
|
OP
|
$768.60
|
|
|
Service Code
|
CPT 86325
|
| Hospital Charge Code |
Px03028632501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$614.88 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$541.86
|
| Rate for Payer: Aetna Workers' Compensation |
$541.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$532.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$532.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$605.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$605.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$605.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$591.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$605.66
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$402.75
|
| Rate for Payer: Cigna Medicare Advantage |
$438.10
|
| Rate for Payer: Family Health Partners Medicaid |
$29.15
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$484.22
|
| Rate for Payer: Healthy Blue Medicaid |
$31.48
|
| Rate for Payer: Home State Health Plan Exchange |
$438.10
|
| Rate for Payer: Home State Health Plan Medicaid |
$29.15
|
| Rate for Payer: Humana Medicare |
$576.45
|
| Rate for Payer: Mercy CarePlus Medicaid |
$29.15
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$576.45
|
| Rate for Payer: Provider Network of America Commercial |
$614.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$507.28
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$23.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.94
|
|
|
HC Beta 2 Glycoprotein I Antibody,Ea - Beta-2 Glycoprotein Abs
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
Px03028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.33 |
| 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 |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| 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 |
$80.33
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
|
|
HC Beta 2 Glycoprotein I Antibody,Ea - Beta-2 Glycoprotein Abs
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
Px03028614601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.51
|
| Rate for Payer: Aetna Workers' Compensation |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.39
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Cigna Medicare Advantage |
$61.05
|
| Rate for Payer: Family Health Partners Medicaid |
$32.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.47
|
| Rate for Payer: Healthy Blue Medicaid |
$34.64
|
| Rate for Payer: Home State Health Plan Exchange |
$61.05
|
| Rate for Payer: Home State Health Plan Medicaid |
$32.07
|
| Rate for Payer: Humana Medicare |
$80.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.33
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.15
|
|
|
HC Beta 2 Glycoprotein I Antibody - Glycoprotein Iga
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
Px03028614603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.33 |
| 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 |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| 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 |
$80.33
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
|
|
HC Beta 2 Glycoprotein I Antibody - Glycoprotein Iga
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
Px03028614603
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$75.51
|
| Rate for Payer: Aetna Workers' Compensation |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$74.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$84.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$82.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$84.39
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Cigna Medicare Advantage |
$61.05
|
| Rate for Payer: Family Health Partners Medicaid |
$32.07
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$67.47
|
| Rate for Payer: Healthy Blue Medicaid |
$34.64
|
| Rate for Payer: Home State Health Plan Exchange |
$61.05
|
| Rate for Payer: Home State Health Plan Medicaid |
$32.07
|
| Rate for Payer: Humana Medicare |
$80.33
|
| Rate for Payer: Mercy CarePlus Medicaid |
$32.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$80.33
|
| Rate for Payer: Provider Network of America Commercial |
$85.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.69
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.15
|
|
