|
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
|
|
|
HC Bone Imaging (Spect) - CT 3d Reconstruction
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
Px03407832001
|
|
Hospital Revenue Code
|
340
|
| 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 |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| 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 |
$976.50
|
| Rate for Payer: Provider Network of America Commercial |
$1,041.60
|
|
|
HC Bone Imaging (Spect) - CT 3d Reconstruction
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
Px03407832001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$742.14 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$917.91
|
| Rate for Payer: Aetna Workers' Compensation |
$917.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$902.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$902.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,025.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,025.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,025.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,002.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,025.98
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$796.82
|
| Rate for Payer: Cigna Medicare Advantage |
$742.14
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$820.26
|
| Rate for Payer: Home State Health Plan Exchange |
$742.14
|
| Rate for Payer: Humana Medicare |
$976.50
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$976.50
|
| Rate for Payer: Provider Network of America Commercial |
$1,041.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$859.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,302.00
|
|
|
HC Bone Imaging, Whole Body - NM Bone Whole Body
|
Facility
|
IP
|
$2,048.55
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
Px03417830601
|
|
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 |
$2,048.55
|
| Rate for Payer: Cash Price |
$2,048.55
|
| 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 |
$1,536.41
|
| Rate for Payer: Provider Network of America Commercial |
$1,638.84
|
|
|
HC Bone Imaging, Whole Body - NM Bone Whole Body
|
Facility
|
OP
|
$2,048.55
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
Px03417830601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.84 |
| Max. Negotiated Rate |
$2,048.55 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,444.23
|
| Rate for Payer: Aetna Workers' Compensation |
$1,444.23
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,419.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,419.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,614.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,614.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,614.26
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,577.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,614.26
|
| Rate for Payer: Cash Price |
$2,048.55
|
| Rate for Payer: Cash Price |
$2,048.55
|
| Rate for Payer: Cigna Commercial |
$1,253.71
|
| Rate for Payer: Cigna Medicare Advantage |
$1,167.67
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,290.59
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$1,167.67
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$1,536.41
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,536.41
|
| Rate for Payer: Provider Network of America Commercial |
$1,638.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,352.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,048.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
HC Bone Marrow Bx, Needle/Trocar
|
Facility
|
OP
|
$3,281.25
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
Px03613822101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,569.23 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,273.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,273.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,585.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,585.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,585.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,526.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,585.62
|
| Rate for Payer: Cash Price |
$3,281.25
|
| Rate for Payer: Cash Price |
$3,281.25
|
| Rate for Payer: Cigna Commercial |
$2,175.47
|
| Rate for Payer: Cigna Medicare Advantage |
$1,870.31
|
| Rate for Payer: Family Health Partners Medicaid |
$2,084.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,067.19
|
| Rate for Payer: Healthy Blue Medicaid |
$2,251.11
|
| Rate for Payer: Home State Health Plan Exchange |
$1,870.31
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,084.36
|
| Rate for Payer: Humana Medicare |
$2,460.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,084.36
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,460.94
|
| Rate for Payer: Provider Network of America Commercial |
$2,625.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,165.62
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,281.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,569.23
|
|
|
HC Bone Marrow Bx, Needle/Trocar
|
Facility
|
IP
|
$3,281.25
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
Px03613822101
|
|
Hospital Revenue Code
|
361
|
| 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 |
$3,281.25
|
| Rate for Payer: Cash Price |
$3,281.25
|
| 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 |
$2,460.94
|
| Rate for Payer: Provider Network of America Commercial |
$2,625.00
|
|
|
HC Bone Survey Infant
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
Px09727707601
|
|
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 Bone Survey Infant
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
Px09727707601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$142.49 |
| 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 |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| 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 |
$99.33
|
|
|
HC Boot Cast Sm
|
Facility
|
IP
|
$21.77
|
|
| Hospital Charge Code |
Px02700002705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.33 |
| 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 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 |
$21.77
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$20.74
|
| 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 |
$16.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$15.55
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
| Rate for Payer: Provider Network of America Commercial |
$16.59
|
|
|
HC Boot Cast Sm
|
Facility
|
OP
|
$21.77
|
|
| Hospital Charge Code |
Px02700002705
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$15.35
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$14.62
|
| Rate for Payer: Aetna Workers' Compensation |
$14.62
|
| Rate for Payer: Aetna Workers' Compensation |
$15.35
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$16.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$16.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$17.15
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cigna Commercial |
$12.69
|
| Rate for Payer: Cigna Commercial |
$13.32
|
| Rate for Payer: Cigna Medicare Advantage |
$12.41
|
| Rate for Payer: Cigna Medicare Advantage |
$11.82
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$13.07
|
| Rate for Payer: Home State Health Plan Exchange |
$11.82
|
| Rate for Payer: Home State Health Plan Exchange |
$12.41
|
| Rate for Payer: Humana Medicare |
$16.33
|
| Rate for Payer: Humana Medicare |
$15.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$15.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$16.33
|
| Rate for Payer: Provider Network of America Commercial |
$17.42
|
| Rate for Payer: Provider Network of America Commercial |
$16.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.37
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$20.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$21.77
|
|
|
HC Boot Heel Care
|
Facility
|
OP
|
$81.49
|
|
| Hospital Charge Code |
Px02700002659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$81.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$57.45
|
| Rate for Payer: Aetna Workers' Compensation |
$57.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$56.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$56.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$64.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$64.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$64.21
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$62.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$64.21
|
| Rate for Payer: Cash Price |
$81.49
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: Cigna Medicare Advantage |
$46.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$51.34
|
| Rate for Payer: Home State Health Plan Exchange |
$46.45
|
| Rate for Payer: Humana Medicare |
$61.12
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$61.12
|
| Rate for Payer: Provider Network of America Commercial |
$65.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$53.78
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$81.49
|
|
|
HC Boot Heel Care
|
Facility
|
IP
|
$81.49
|
|
| Hospital Charge Code |
Px02700002659
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.12 |
| 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 |
$81.49
|
| Rate for Payer: Cash Price |
$81.49
|
| 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 |
$61.12
|
| Rate for Payer: Provider Network of America Commercial |
$65.19
|
|
|
HC Booties a-V Pump Lge
|
Facility
|
IP
|
$196.06
|
|
| Hospital Charge Code |
Px02700002662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.04 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$196.06
|
| Rate for Payer: Cash Price |
$196.06
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$147.04
|
| Rate for Payer: Provider Network of America Commercial |
$156.85
|
|
|
HC Booties a-V Pump Lge
|
Facility
|
OP
|
$196.06
|
|
| Hospital Charge Code |
Px02700002662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$138.22
|
| Rate for Payer: Aetna Workers' Compensation |
$138.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$135.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$135.87
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$154.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$154.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$154.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$150.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$154.50
|
| Rate for Payer: Cash Price |
$196.06
|
| Rate for Payer: Cigna Commercial |
$119.99
|
| Rate for Payer: Cigna Medicare Advantage |
$111.75
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$123.52
|
| Rate for Payer: Home State Health Plan Exchange |
$111.75
|
| Rate for Payer: Humana Medicare |
$147.04
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$147.04
|
| Rate for Payer: Provider Network of America Commercial |
$156.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$129.40
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$196.06
|
|
|
HC Booties a-V Pump Reg
|
Facility
|
IP
|
$220.68
|
|
| Hospital Charge Code |
Px02700002663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.51 |
| 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 |
$220.68
|
| Rate for Payer: Cash Price |
$220.68
|
| 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 |
$165.51
|
| Rate for Payer: Provider Network of America Commercial |
$176.54
|
|
|
HC Booties a-V Pump Reg
|
Facility
|
OP
|
$220.68
|
|
| Hospital Charge Code |
Px02700002663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.79 |
| Max. Negotiated Rate |
$220.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$155.58
|
| Rate for Payer: Aetna Workers' Compensation |
$155.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$152.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$173.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$173.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$173.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$169.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$173.90
|
| Rate for Payer: Cash Price |
$220.68
|
| Rate for Payer: Cigna Commercial |
$135.06
|
| Rate for Payer: Cigna Medicare Advantage |
$125.79
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$139.03
|
| Rate for Payer: Home State Health Plan Exchange |
$125.79
|
| Rate for Payer: Humana Medicare |
$165.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$165.51
|
| Rate for Payer: Provider Network of America Commercial |
$176.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$145.65
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$220.68
|
|
|
HC Boot, Leg Walker X-Lg
|
Facility
|
IP
|
$91.35
|
|
| Hospital Charge Code |
Px02700001645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.51 |
| 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 |
$91.35
|
| Rate for Payer: Cash Price |
$86.68
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$86.68
|
| 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 |
$68.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$65.01
|
| Rate for Payer: Provider Network of America Commercial |
$73.08
|
| Rate for Payer: Provider Network of America Commercial |
$69.34
|
|
|
HC Boot, Leg Walker X-Lg
|
Facility
|
OP
|
$91.35
|
|
| Hospital Charge Code |
Px02700001645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$64.40
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$61.11
|
| Rate for Payer: Aetna Workers' Compensation |
$61.11
|
| Rate for Payer: Aetna Workers' Compensation |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$60.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$63.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$60.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$63.31
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$71.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$71.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$71.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$66.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$68.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$71.98
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$86.68
|
| Rate for Payer: Cigna Commercial |
$53.05
|
| Rate for Payer: Cigna Commercial |
$55.91
|
| Rate for Payer: Cigna Medicare Advantage |
$52.07
|
| Rate for Payer: Cigna Medicare Advantage |
$49.41
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$57.55
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$54.61
|
| Rate for Payer: Home State Health Plan Exchange |
$49.41
|
| Rate for Payer: Home State Health Plan Exchange |
$52.07
|
| Rate for Payer: Humana Medicare |
$68.51
|
| Rate for Payer: Humana Medicare |
$65.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$65.01
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$68.51
|
| Rate for Payer: Provider Network of America Commercial |
$73.08
|
| Rate for Payer: Provider Network of America Commercial |
$69.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$57.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$60.29
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$86.68
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$91.35
|
|
|
HC Bordered Gauze Dressing 6x6
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
LOCAL 2700002597
|
| Hospital Charge Code |
Px02700002597
|
|
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 Bordered Gauze Dressing 6x6
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
LOCAL 2700002597
|
| Hospital Charge Code |
Px02700002597
|
|
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 Bordetella Antibody - Bordetella Pertussis Antibody
|
Facility
|
OP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.51 |
| 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 |
$16.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$38.37
|
| Rate for Payer: Healthy Blue Medicaid |
$17.95
|
| Rate for Payer: Home State Health Plan Exchange |
$34.71
|
| Rate for Payer: Home State Health Plan Medicaid |
$16.62
|
| Rate for Payer: Humana Medicare |
$45.67
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16.62
|
| 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 |
$13.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.51
|
|
|
HC Bordetella Antibody - Bordetella Pertussis Antibody
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661501
|
|
Hospital Revenue Code
|
302
|
| 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 Bordetella Antibody - Bordetella Pertussis Antibody Iga
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661503
|
|
Hospital Revenue Code
|
302
|
| 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 Bordetella Antibody - Bordetella Pertussis Antibody Iga
|
Facility
|
OP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.51 |
| 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 |
$16.62
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$38.37
|
| Rate for Payer: Healthy Blue Medicaid |
$17.95
|
| Rate for Payer: Home State Health Plan Exchange |
$34.71
|
| Rate for Payer: Home State Health Plan Medicaid |
$16.62
|
| Rate for Payer: Humana Medicare |
$45.67
|
| Rate for Payer: Mercy CarePlus Medicaid |
$16.62
|
| 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 |
$13.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.51
|
|
