|
HC Blood Transfusion Service Each Additional Unit
|
Facility
|
OP
|
$1,205.40
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
Px03913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$419.18 |
| Max. Negotiated Rate |
$1,205.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$849.81
|
| Rate for Payer: Aetna Workers' Compensation |
$849.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$835.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$835.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$949.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$949.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$949.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$928.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$949.86
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cigna Commercial |
$737.70
|
| Rate for Payer: Cigna Medicare Advantage |
$687.08
|
| Rate for Payer: Family Health Partners Medicaid |
$556.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$759.40
|
| Rate for Payer: Healthy Blue Medicaid |
$601.32
|
| Rate for Payer: Home State Health Plan Exchange |
$687.08
|
| Rate for Payer: Home State Health Plan Medicaid |
$556.78
|
| Rate for Payer: Humana Medicare |
$904.05
|
| Rate for Payer: Mercy CarePlus Medicaid |
$556.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$904.05
|
| Rate for Payer: Provider Network of America Commercial |
$964.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$795.56
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,205.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$419.18
|
|
|
HC Blood Transfusion Service Each Additional Unit
|
Facility
|
IP
|
$1,205.40
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
Px03913643002
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| 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 |
$904.05
|
| Rate for Payer: Provider Network of America Commercial |
$964.32
|
|
|
HC Blood Type Antigen Donor Reagent Serum Each - Blood Typing, Antigen
|
Facility
|
IP
|
$127.05
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
Px03008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.29 |
| 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 |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$95.29
|
| Rate for Payer: Provider Network of America Commercial |
$101.64
|
|
|
HC Blood Type Antigen Donor Reagent Serum Each - Blood Typing, Antigen
|
Facility
|
OP
|
$127.05
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
Px03008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$488.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$89.57
|
| Rate for Payer: Aetna Workers' Compensation |
$89.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$88.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$88.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$100.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$100.12
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cash Price |
$127.05
|
| Rate for Payer: Cigna Commercial |
$66.57
|
| Rate for Payer: Cigna Medicare Advantage |
$72.42
|
| Rate for Payer: Family Health Partners Medicaid |
$452.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$80.04
|
| Rate for Payer: Healthy Blue Medicaid |
$488.56
|
| Rate for Payer: Home State Health Plan Exchange |
$72.42
|
| Rate for Payer: Home State Health Plan Medicaid |
$452.37
|
| Rate for Payer: Humana Medicare |
$95.29
|
| Rate for Payer: Mercy CarePlus Medicaid |
$452.37
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$95.29
|
| Rate for Payer: Provider Network of America Commercial |
$101.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.57
|
|
|
HC Blood Typing Antigen Screen Patient Serum/Unit - Blood Typing, Pat
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
Px03008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.54 |
| 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 |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.54
|
| Rate for Payer: Provider Network of America Commercial |
$17.64
|
|
|
HC Blood Typing Antigen Screen Patient Serum/Unit - Blood Typing, Pat
|
Facility
|
OP
|
$22.05
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
Px03008690401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.55
|
| Rate for Payer: Aetna Workers' Compensation |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.38
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna Commercial |
$11.55
|
| Rate for Payer: Cigna Medicare Advantage |
$12.57
|
| Rate for Payer: Family Health Partners Medicaid |
$74.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.89
|
| Rate for Payer: Healthy Blue Medicaid |
$80.41
|
| Rate for Payer: Home State Health Plan Exchange |
$12.57
|
| Rate for Payer: Home State Health Plan Medicaid |
$74.45
|
| Rate for Payer: Humana Medicare |
$16.54
|
| Rate for Payer: Mercy CarePlus Medicaid |
$74.45
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.54
|
| Rate for Payer: Provider Network of America Commercial |
$17.64
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.55
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.05
|
|
|
HC Blood Typing Serologic Abo
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
Px03008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$62.18
|
| Rate for Payer: Aetna Workers' Compensation |
$62.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$69.50
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$46.22
|
| Rate for Payer: Cigna Medicare Advantage |
$50.27
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$55.57
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$50.27
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$66.15
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
HC Blood Typing Serologic Abo
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
Px03008690001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.15 |
| 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 |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| 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 |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
|
|
HC Blood Typing Serologic Abo - Abo/Rh Type
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
Px03008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$62.18
|
| Rate for Payer: Aetna Workers' Compensation |
$62.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$69.50
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$46.22
|
| Rate for Payer: Cigna Medicare Advantage |
$50.27
|
| Rate for Payer: Family Health Partners Medicaid |
$167.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$55.57
|
| Rate for Payer: Healthy Blue Medicaid |
$181.35
|
| Rate for Payer: Home State Health Plan Exchange |
$50.27
|
| Rate for Payer: Home State Health Plan Medicaid |
$167.92
|
| Rate for Payer: Humana Medicare |
$66.15
|
| Rate for Payer: Mercy CarePlus Medicaid |
$167.92
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.42
|
|
|
HC Blood Typing Serologic Abo - Abo/Rh Type
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
Px03008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.15 |
| 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 |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| 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 |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
|
|
HC Blood Typing Serologic Rh (D)
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
Px03008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.15 |
| 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 |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| 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 |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
|
|
HC Blood Typing Serologic Rh (D)
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
Px03008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$70.56 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$62.18
|
| Rate for Payer: Aetna Workers' Compensation |
$62.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$61.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$69.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$67.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$69.50
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna Commercial |
$46.22
|
| Rate for Payer: Cigna Medicare Advantage |
$50.27
|
| Rate for Payer: Family Health Partners Medicaid |
$47.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$55.57
|
| Rate for Payer: Healthy Blue Medicaid |
$50.91
|
| Rate for Payer: Home State Health Plan Exchange |
$50.27
|
| Rate for Payer: Home State Health Plan Medicaid |
$47.14
|
| Rate for Payer: Humana Medicare |
$66.15
|
| Rate for Payer: Mercy CarePlus Medicaid |
$47.14
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$66.15
|
| Rate for Payer: Provider Network of America Commercial |
$70.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.49
|
|
|
HC Blood Viscosity Examination - Viscosity, Serum
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
Px03058581001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$86.62
|
| Rate for Payer: Provider Network of America Commercial |
$92.40
|
|
|
HC Blood Viscosity Examination - Viscosity, Serum
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
Px03058581001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$81.43
|
| Rate for Payer: Aetna Workers' Compensation |
$81.43
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$80.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$91.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$91.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$91.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$88.94
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$91.01
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$60.52
|
| Rate for Payer: Cigna Medicare Advantage |
$65.83
|
| Rate for Payer: Family Health Partners Medicaid |
$14.70
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$72.77
|
| Rate for Payer: Healthy Blue Medicaid |
$15.88
|
| Rate for Payer: Home State Health Plan Exchange |
$65.83
|
| Rate for Payer: Home State Health Plan Medicaid |
$14.70
|
| Rate for Payer: Humana Medicare |
$86.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14.70
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$86.62
|
| Rate for Payer: Provider Network of America Commercial |
$92.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$76.23
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$11.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.07
|
|
|
HC Blood (Whole), for Transfusion, per Unit
|
Facility
|
IP
|
$56.70
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
Px0390P901001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$42.52 |
| 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 |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| 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 |
$42.52
|
| Rate for Payer: Provider Network of America Commercial |
$45.36
|
|
|
HC Blood (Whole), for Transfusion, per Unit
|
Facility
|
OP
|
$56.70
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
Px0390P901001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$253.26 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$39.97
|
| Rate for Payer: Aetna Workers' Compensation |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$39.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$44.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$44.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$44.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$44.68
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$34.70
|
| Rate for Payer: Cigna Medicare Advantage |
$32.32
|
| Rate for Payer: Family Health Partners Medicaid |
$234.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$35.72
|
| Rate for Payer: Healthy Blue Medicaid |
$253.26
|
| Rate for Payer: Home State Health Plan Exchange |
$32.32
|
| Rate for Payer: Home State Health Plan Medicaid |
$234.50
|
| Rate for Payer: Humana Medicare |
$42.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$234.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$42.52
|
| Rate for Payer: Provider Network of America Commercial |
$45.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$37.42
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.54
|
|
|
HC B Miyamotoi Pcr, Misc
|
Facility
|
IP
|
$110.25
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
Px03068779823
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.69 |
| 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 |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| 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 |
$82.69
|
| Rate for Payer: Provider Network of America Commercial |
$88.20
|
|
|
HC B Miyamotoi Pcr, Misc
|
Facility
|
OP
|
$110.25
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
Px03068779823
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$77.73
|
| Rate for Payer: Aetna Workers' Compensation |
$77.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$76.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$76.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$84.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$86.88
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna Commercial |
$57.77
|
| Rate for Payer: Cigna Medicare Advantage |
$62.84
|
| Rate for Payer: Family Health Partners Medicaid |
$44.21
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$69.46
|
| Rate for Payer: Healthy Blue Medicaid |
$47.75
|
| Rate for Payer: Home State Health Plan Exchange |
$62.84
|
| Rate for Payer: Home State Health Plan Medicaid |
$44.21
|
| Rate for Payer: Humana Medicare |
$82.69
|
| Rate for Payer: Mercy CarePlus Medicaid |
$44.21
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$82.69
|
| Rate for Payer: Provider Network of America Commercial |
$88.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$72.77
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.29
|
|
|
HC Body Fluid Specific Gravity - Specific Gravity Body Fluid
|
Facility
|
OP
|
$60.90
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
Px03018431501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$42.93
|
| Rate for Payer: Aetna Workers' Compensation |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$42.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$42.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$47.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$46.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$47.99
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna Commercial |
$31.91
|
| Rate for Payer: Cigna Medicare Advantage |
$34.71
|
| Rate for Payer: Family Health Partners Medicaid |
$4.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$38.37
|
| Rate for Payer: Healthy Blue Medicaid |
$4.46
|
| Rate for Payer: Home State Health Plan Exchange |
$34.71
|
| Rate for Payer: Home State Health Plan Medicaid |
$4.13
|
| Rate for Payer: Humana Medicare |
$45.67
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$45.67
|
| Rate for Payer: Provider Network of America Commercial |
$48.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.11
|
|
|
HC Body Fluid Specific Gravity - Specific Gravity Body Fluid
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
Px03018431501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.67 |
| 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 |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| 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 |
$45.67
|
| Rate for Payer: Provider Network of America Commercial |
$48.72
|
|
|
HC Bone Age Studies Tc
|
Facility
|
IP
|
$253.91
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
Px03207707203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.43 |
| 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 |
$253.91
|
| Rate for Payer: Cash Price |
$253.91
|
| 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 |
$190.43
|
| Rate for Payer: Provider Network of America Commercial |
$203.13
|
|
|
HC Bone Age Studies Tc
|
Facility
|
OP
|
$253.91
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
Px03207707203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$253.91 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$179.01
|
| Rate for Payer: Aetna Workers' Compensation |
$179.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$200.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$200.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$200.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$200.08
|
| Rate for Payer: Cash Price |
$253.91
|
| Rate for Payer: Cash Price |
$253.91
|
| Rate for Payer: Cigna Commercial |
$155.39
|
| Rate for Payer: Cigna Medicare Advantage |
$144.73
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$159.96
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$144.73
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$190.43
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Provider Network of America Commercial |
$203.13
|
| Rate for Payer: UnitedHealthcare Commercial |
$167.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$253.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
HC Bone Imaging, 3 Phase - NM Bone Whole Body 3 Phase
|
Facility
|
OP
|
$2,136.75
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
Px03417831501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.84 |
| Max. Negotiated Rate |
$2,136.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,506.41
|
| Rate for Payer: Aetna Workers' Compensation |
$1,506.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,480.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,480.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,683.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,683.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,683.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,645.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,683.76
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| Rate for Payer: Cigna Commercial |
$1,307.69
|
| Rate for Payer: Cigna Medicare Advantage |
$1,217.95
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,346.15
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$1,217.95
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$1,602.56
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,602.56
|
| Rate for Payer: Provider Network of America Commercial |
$1,709.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,410.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,136.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
HC Bone Imaging, 3 Phase - NM Bone Whole Body 3 Phase
|
Facility
|
IP
|
$2,136.75
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
Px03417831501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue 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 |
$2,136.75
|
| Rate for Payer: Cash Price |
$2,136.75
|
| 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 |
$1,602.56
|
| Rate for Payer: Provider Network of America Commercial |
$1,709.40
|
|
|
HC Bone Imaging, Limited Area - NM Bone Limited
|
Facility
|
IP
|
$962.85
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
Px03417830001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$722.14 |
| 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 |
$962.85
|
| Rate for Payer: Cash Price |
$962.85
|
| 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 |
$722.14
|
| Rate for Payer: Provider Network of America Commercial |
$770.28
|
|
