|
HC Bordetella Antibody - Bordetella Pertussis Antibody Igg
|
Facility
|
OP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661502
|
|
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 Igg
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
Px03028661502
|
|
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 Boujie Coude 15 Fr
|
Facility
|
OP
|
$13.18
|
|
|
Service Code
|
LOCAL 2700002652
|
| Hospital Charge Code |
Px02700002652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: UnitedHealthcare Commercial |
$8.70
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9.29
|
| Rate for Payer: Aetna Workers' Compensation |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10.39
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cigna Commercial |
$8.07
|
| Rate for Payer: Cigna Medicare Advantage |
$7.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8.30
|
| Rate for Payer: Home State Health Plan Exchange |
$7.51
|
| Rate for Payer: Humana Medicare |
$9.88
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9.88
|
| Rate for Payer: Provider Network of America Commercial |
$10.54
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13.18
|
|
|
HC Boujie Coude 15 Fr
|
Facility
|
IP
|
$13.18
|
|
|
Service Code
|
LOCAL 2700002652
|
| Hospital Charge Code |
Px02700002652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.88 |
| 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 |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| 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 |
$9.88
|
| Rate for Payer: Provider Network of America Commercial |
$10.54
|
|
|
HC Bowel Imaging - NM Meckels Diverticulum
|
Facility
|
OP
|
$879.18
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
Px03417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.84 |
| Max. Negotiated Rate |
$879.18 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$619.82
|
| Rate for Payer: Aetna Workers' Compensation |
$619.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$609.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$609.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$692.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$692.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$692.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$676.97
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$692.79
|
| Rate for Payer: Cash Price |
$879.18
|
| Rate for Payer: Cash Price |
$879.18
|
| Rate for Payer: Cigna Commercial |
$538.06
|
| Rate for Payer: Cigna Medicare Advantage |
$501.13
|
| Rate for Payer: Family Health Partners Medicaid |
$504.53
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$553.88
|
| Rate for Payer: Healthy Blue Medicaid |
$544.89
|
| Rate for Payer: Home State Health Plan Exchange |
$501.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$504.53
|
| Rate for Payer: Humana Medicare |
$659.38
|
| Rate for Payer: Mercy CarePlus Medicaid |
$504.53
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$659.38
|
| Rate for Payer: Provider Network of America Commercial |
$703.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$580.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$879.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$379.84
|
|
|
HC Bowel Imaging - NM Meckels Diverticulum
|
Facility
|
IP
|
$879.18
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
Px03417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$659.38 |
| 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 |
$879.18
|
| Rate for Payer: Cash Price |
$879.18
|
| 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 |
$659.38
|
| Rate for Payer: Provider Network of America Commercial |
$703.34
|
|
|
HC Brace Cash Orthosis 300 30 Belt
|
Facility
|
OP
|
$340.23
|
|
| Hospital Charge Code |
Px02720000635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.93 |
| Max. Negotiated Rate |
$340.23 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$239.86
|
| Rate for Payer: Aetna Workers' Compensation |
$239.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$235.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$235.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$268.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$268.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$268.10
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$261.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$268.10
|
| Rate for Payer: Cash Price |
$340.23
|
| Rate for Payer: Cigna Commercial |
$208.22
|
| Rate for Payer: Cigna Medicare Advantage |
$193.93
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$214.34
|
| Rate for Payer: Home State Health Plan Exchange |
$193.93
|
| Rate for Payer: Humana Medicare |
$255.17
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$255.17
|
| Rate for Payer: Provider Network of America Commercial |
$272.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$224.55
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$340.23
|
|
|
HC Brace Cash Orthosis 300 30 Belt
|
Facility
|
IP
|
$340.23
|
|
| Hospital Charge Code |
Px02720000635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.17 |
| 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 |
$340.23
|
| Rate for Payer: Cash Price |
$340.23
|
| 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 |
$255.17
|
| Rate for Payer: Provider Network of America Commercial |
$272.18
|
|
|
HC Brace Cash Orthosis 300 36 Belt
|
Facility
|
OP
|
$345.78
|
|
| Hospital Charge Code |
Px02720000634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.09 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$243.77
|
| Rate for Payer: Aetna Workers' Compensation |
$243.77
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$239.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$239.63
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$272.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$272.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$272.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$266.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$272.47
|
| Rate for Payer: Cash Price |
$345.78
|
| Rate for Payer: Cigna Commercial |
$211.62
|
| Rate for Payer: Cigna Medicare Advantage |
$197.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$217.84
|
| Rate for Payer: Home State Health Plan Exchange |
$197.09
|
| Rate for Payer: Humana Medicare |
$259.33
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$259.33
|
| Rate for Payer: Provider Network of America Commercial |
$276.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$228.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$345.78
|
|
|
HC Brace Cash Orthosis 300 36 Belt
|
Facility
|
IP
|
$345.78
|
|
| Hospital Charge Code |
Px02720000634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.33 |
| 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 |
$345.78
|
| Rate for Payer: Cash Price |
$345.78
|
| 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 |
$259.33
|
| Rate for Payer: Provider Network of America Commercial |
$276.62
|
|
|
HC Brace Cash Orthosis 300 42 Belt
|
Facility
|
OP
|
$318.69
|
|
| Hospital Charge Code |
Px02720000636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.65 |
| Max. Negotiated Rate |
$318.69 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$224.68
|
| Rate for Payer: Aetna Workers' Compensation |
$224.68
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$220.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$220.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$245.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$251.13
|
| Rate for Payer: Cash Price |
$318.69
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Cigna Medicare Advantage |
$181.65
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$200.77
|
| Rate for Payer: Home State Health Plan Exchange |
$181.65
|
| Rate for Payer: Humana Medicare |
$239.02
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$239.02
|
| Rate for Payer: Provider Network of America Commercial |
$254.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$210.34
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$318.69
|
|
|
HC Brace Cash Orthosis 300 42 Belt
|
Facility
|
IP
|
$318.69
|
|
| Hospital Charge Code |
Px02720000636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.02 |
| 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 |
$318.69
|
| Rate for Payer: Cash Price |
$318.69
|
| 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 |
$239.02
|
| Rate for Payer: Provider Network of America Commercial |
$254.95
|
|
|
HC Brace Clav Infant
|
Facility
|
OP
|
$35.17
|
|
| Hospital Charge Code |
Px02700002716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$24.79
|
| Rate for Payer: Aetna Workers' Compensation |
$24.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$24.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$24.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$27.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$27.71
|
| Rate for Payer: Cash Price |
$35.17
|
| Rate for Payer: Cigna Commercial |
$21.52
|
| Rate for Payer: Cigna Medicare Advantage |
$20.05
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$22.16
|
| Rate for Payer: Home State Health Plan Exchange |
$20.05
|
| Rate for Payer: Humana Medicare |
$26.38
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$26.38
|
| Rate for Payer: Provider Network of America Commercial |
$28.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$23.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$35.17
|
|
|
HC Brace Clav Infant
|
Facility
|
IP
|
$35.17
|
|
| Hospital Charge Code |
Px02700002716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.38 |
| 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 |
$35.17
|
| Rate for Payer: Cash Price |
$35.17
|
| 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 |
$26.38
|
| Rate for Payer: Provider Network of America Commercial |
$28.14
|
|
|
HC Brain Image W/Flow 4 + Views - NM Brain With Flow 4 or More Views
|
Facility
|
OP
|
$1,141.30
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
Px03417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.89 |
| Max. Negotiated Rate |
$1,141.30 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$804.62
|
| Rate for Payer: Aetna Workers' Compensation |
$804.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$790.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$790.92
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$899.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$899.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$899.34
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$878.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$899.34
|
| Rate for Payer: Cash Price |
$1,141.30
|
| Rate for Payer: Cash Price |
$1,141.30
|
| Rate for Payer: Cigna Commercial |
$698.48
|
| Rate for Payer: Cigna Medicare Advantage |
$650.54
|
| Rate for Payer: Family Health Partners Medicaid |
$685.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$719.02
|
| Rate for Payer: Healthy Blue Medicaid |
$740.06
|
| Rate for Payer: Home State Health Plan Exchange |
$650.54
|
| Rate for Payer: Home State Health Plan Medicaid |
$685.24
|
| Rate for Payer: Humana Medicare |
$855.98
|
| Rate for Payer: Mercy CarePlus Medicaid |
$685.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$855.98
|
| Rate for Payer: Provider Network of America Commercial |
$913.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$753.26
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,141.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$515.89
|
|
|
HC Brain Image W/Flow 4 + Views - NM Brain With Flow 4 or More Views
|
Facility
|
IP
|
$1,141.30
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
Px03417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$855.98 |
| 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 |
$1,141.30
|
| Rate for Payer: Cash Price |
$1,141.30
|
| 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 |
$855.98
|
| Rate for Payer: Provider Network of America Commercial |
$913.04
|
|
|
HC Brain Imaging (Pet) - Pet Brain
|
Facility
|
IP
|
$5,937.75
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
Px04047860801
|
|
Hospital Revenue Code
|
404
|
| 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 |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| 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 |
$4,453.31
|
| Rate for Payer: Provider Network of America Commercial |
$4,750.20
|
|
|
HC Brain Imaging (Pet) - Pet Brain
|
Facility
|
OP
|
$5,937.75
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
Px04047860801
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,358.64 |
| Max. Negotiated Rate |
$5,937.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,186.11
|
| Rate for Payer: Aetna Workers' Compensation |
$4,186.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,114.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,114.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,572.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,678.95
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cigna Commercial |
$2,472.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3,384.52
|
| Rate for Payer: Family Health Partners Medicaid |
$1,804.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,740.78
|
| Rate for Payer: Healthy Blue Medicaid |
$1,949.01
|
| Rate for Payer: Home State Health Plan Exchange |
$3,384.52
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,804.64
|
| Rate for Payer: Humana Medicare |
$4,453.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,804.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,453.31
|
| Rate for Payer: Provider Network of America Commercial |
$4,750.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,918.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,937.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,358.64
|
|
|
HC Brain Imaging (Pet) - Pt Brain Metabolic
|
Facility
|
IP
|
$5,937.75
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
Px04047860802
|
|
Hospital Revenue Code
|
404
|
| 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 |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| 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 |
$4,453.31
|
| Rate for Payer: Provider Network of America Commercial |
$4,750.20
|
|
|
HC Brain Imaging (Pet) - Pt Brain Metabolic
|
Facility
|
OP
|
$5,937.75
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
Px04047860802
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,358.64 |
| Max. Negotiated Rate |
$5,937.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,186.11
|
| Rate for Payer: Aetna Workers' Compensation |
$4,186.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,114.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,114.86
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4,678.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,572.07
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4,678.95
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cash Price |
$5,937.75
|
| Rate for Payer: Cigna Commercial |
$2,472.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3,384.52
|
| Rate for Payer: Family Health Partners Medicaid |
$1,804.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3,740.78
|
| Rate for Payer: Healthy Blue Medicaid |
$1,949.01
|
| Rate for Payer: Home State Health Plan Exchange |
$3,384.52
|
| Rate for Payer: Home State Health Plan Medicaid |
$1,804.64
|
| Rate for Payer: Humana Medicare |
$4,453.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$1,804.64
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,453.31
|
| Rate for Payer: Provider Network of America Commercial |
$4,750.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,918.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5,937.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,358.64
|
|
|
HC Breast Tomosynthesis Bi - Mammo Breast Diagnostic Tomosynthesis Bil
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77062 50
|
| Hospital Charge Code |
Px04017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$43.31 |
| 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 |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| 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 |
$43.31
|
| Rate for Payer: Provider Network of America Commercial |
$46.20
|
|
|
HC Breast Tomosynthesis Bi - Mammo Breast Diagnostic Tomosynthesis Bil
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77062 50
|
| Hospital Charge Code |
Px04017706201
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.71
|
| Rate for Payer: Aetna Workers' Compensation |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.51
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$35.34
|
| Rate for Payer: Cigna Medicare Advantage |
$32.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.38
|
| Rate for Payer: Home State Health Plan Exchange |
$32.92
|
| Rate for Payer: Humana Medicare |
$43.31
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.31
|
| Rate for Payer: Provider Network of America Commercial |
$46.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.75
|
|
|
HC Breast Tomosynthesis Bi - Mammo Breast Screening Tomosynthesis Bilat
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
Px04037706301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$67.57 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$40.71
|
| Rate for Payer: Aetna Workers' Compensation |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$45.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$44.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$45.51
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna Commercial |
$35.34
|
| Rate for Payer: Cigna Medicare Advantage |
$32.92
|
| Rate for Payer: Family Health Partners Medicaid |
$62.57
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$36.38
|
| Rate for Payer: Healthy Blue Medicaid |
$67.57
|
| Rate for Payer: Home State Health Plan Exchange |
$32.92
|
| Rate for Payer: Home State Health Plan Medicaid |
$62.57
|
| Rate for Payer: Humana Medicare |
$43.31
|
| Rate for Payer: Mercy CarePlus Medicaid |
$62.57
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$43.31
|
| Rate for Payer: Provider Network of America Commercial |
$46.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.12
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$57.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.10
|
|
|
HC Breast Tomosynthesis Bi - Mammo Breast Screening Tomosynthesis Bilat
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
Px04037706301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$43.31 |
| 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 |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| 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 |
$43.31
|
| Rate for Payer: Provider Network of America Commercial |
$46.20
|
|
|
HC Breast Tomosynthesis Bi - Mammo Breast Screening Tomosynthesis Left
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77063 LT
|
| Hospital Charge Code |
Px04037706302
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$43.31 |
| 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 |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| 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 |
$43.31
|
| Rate for Payer: Provider Network of America Commercial |
$46.20
|
|
