|
HC Breast Tomosynthesis Bi - Mammo Breast Screening Tomosynthesis Left
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77063 LT
|
| Hospital Charge Code |
Px04037706302
|
|
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 Right
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77063 RT
|
| Hospital Charge Code |
Px04037706303
|
|
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 Right
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77063 RT
|
| Hospital Charge Code |
Px04037706303
|
|
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 Uni - Mammo Breast Diagnostic Tomosynthesis Lt
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
Px04017706101
|
|
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 Uni - Mammo Breast Diagnostic Tomosynthesis Lt
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
Px04017706101
|
|
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 Uni - Mammo Breast Diagnostic Tomosynthesis Rt
|
Facility
|
IP
|
$57.75
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
Px04017706102
|
|
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 Uni - Mammo Breast Diagnostic Tomosynthesis Rt
|
Facility
|
OP
|
$57.75
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
Px04017706102
|
|
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 Breathing Capacity Test - Bp Pre & Post
|
Facility
|
OP
|
$617.24
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
Px04609401004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$351.83 |
| Max. Negotiated Rate |
$617.24 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$435.15
|
| Rate for Payer: Aetna Workers' Compensation |
$435.15
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$427.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$427.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$486.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$486.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$486.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$475.27
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$486.39
|
| Rate for Payer: Cash Price |
$617.24
|
| Rate for Payer: Cash Price |
$617.24
|
| Rate for Payer: Cigna Commercial |
$377.75
|
| Rate for Payer: Cigna Medicare Advantage |
$351.83
|
| Rate for Payer: Family Health Partners Medicaid |
$470.93
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$388.86
|
| Rate for Payer: Healthy Blue Medicaid |
$508.61
|
| Rate for Payer: Home State Health Plan Exchange |
$351.83
|
| Rate for Payer: Home State Health Plan Medicaid |
$470.93
|
| Rate for Payer: Humana Medicare |
$462.93
|
| Rate for Payer: Mercy CarePlus Medicaid |
$470.93
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$462.93
|
| Rate for Payer: Provider Network of America Commercial |
$493.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$407.38
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$617.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.54
|
|
|
HC Breathing Capacity Test - Bp Pre & Post
|
Facility
|
IP
|
$617.24
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
Px04609401004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$462.93 |
| 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 |
$617.24
|
| Rate for Payer: Cash Price |
$617.24
|
| 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 |
$462.93
|
| Rate for Payer: Provider Network of America Commercial |
$493.79
|
|
|
HC Breathing Capacity Test - Breathing Capacity Test
|
Facility
|
IP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$244.22 |
| 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 |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| 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 |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
|
|
HC Breathing Capacity Test - Breathing Capacity Test
|
Facility
|
OP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$325.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$229.56
|
| Rate for Payer: Aetna Workers' Compensation |
$229.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$250.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$256.59
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cigna Commercial |
$199.28
|
| Rate for Payer: Cigna Medicare Advantage |
$185.60
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$205.14
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$185.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$244.22
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$214.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$325.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Breathing Capacity Test - Office Spirometry
|
Facility
|
OP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$325.62 |
| Rate for Payer: Aetna Workers' Compensation |
$229.56
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$229.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$250.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$256.59
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cigna Commercial |
$199.28
|
| Rate for Payer: Cigna Medicare Advantage |
$185.60
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$205.14
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$185.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$244.22
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$214.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$325.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Breathing Capacity Test - Office Spirometry
|
Facility
|
IP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$244.22 |
| 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 |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| 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 |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
|
|
HC Breathing Capacity Test - Spirometry Without Bronchodilator
|
Facility
|
OP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$325.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$229.56
|
| Rate for Payer: Aetna Workers' Compensation |
$229.56
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$225.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$250.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$256.59
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| Rate for Payer: Cigna Commercial |
$199.28
|
| Rate for Payer: Cigna Medicare Advantage |
$185.60
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$205.14
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$185.60
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$244.22
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$214.91
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$325.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Breathing Capacity Test - Spirometry Without Bronchodilator
|
Facility
|
IP
|
$325.62
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
Px04609401002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$244.22 |
| 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 |
$325.62
|
| Rate for Payer: Cash Price |
$325.62
|
| 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 |
$244.22
|
| Rate for Payer: Provider Network of America Commercial |
$260.50
|
|
|
HC Brnchsc Incl Fluor Gdnce Dx W/Cell Washg Spx
|
Facility
|
OP
|
$3,489.37
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
Px03603162201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,691.12 |
| Max. Negotiated Rate |
$3,489.37 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,686.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,749.62
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cigna Commercial |
$2,313.45
|
| Rate for Payer: Cigna Medicare Advantage |
$1,988.94
|
| Rate for Payer: Family Health Partners Medicaid |
$2,246.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,198.30
|
| Rate for Payer: Healthy Blue Medicaid |
$2,425.97
|
| Rate for Payer: Home State Health Plan Exchange |
$1,988.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,246.27
|
| Rate for Payer: Humana Medicare |
$2,617.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,246.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,302.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,489.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,691.12
|
|
|
HC Brnchsc Incl Fluor Gdnce Dx W/Cell Washg Spx
|
Facility
|
IP
|
$3,489.37
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
Px03603162201
|
|
Hospital Revenue Code
|
360
|
| 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 |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| 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 |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
|
|
HC Bronchoscopy, Rigid or Flex W/Biopsy
|
Facility
|
OP
|
$3,489.37
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
Px03603162501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,691.12 |
| Max. Negotiated Rate |
$3,489.37 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,686.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,749.62
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cigna Commercial |
$2,313.45
|
| Rate for Payer: Cigna Medicare Advantage |
$1,988.94
|
| Rate for Payer: Family Health Partners Medicaid |
$2,246.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,198.30
|
| Rate for Payer: Healthy Blue Medicaid |
$2,425.97
|
| Rate for Payer: Home State Health Plan Exchange |
$1,988.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,246.27
|
| Rate for Payer: Humana Medicare |
$2,617.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,246.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,302.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,489.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,691.12
|
|
|
HC Bronchoscopy, Rigid or Flex W/Biopsy
|
Facility
|
IP
|
$3,489.37
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
Px03603162501
|
|
Hospital Revenue Code
|
360
|
| 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 |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| 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 |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
|
|
HC Bronchoscopy, Rigid or Flex W/Fluro Guid
|
Facility
|
OP
|
$3,489.37
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
Px03603162202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,691.12 |
| Max. Negotiated Rate |
$3,489.37 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,686.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,749.62
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cigna Commercial |
$2,313.45
|
| Rate for Payer: Cigna Medicare Advantage |
$1,988.94
|
| Rate for Payer: Family Health Partners Medicaid |
$2,246.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,198.30
|
| Rate for Payer: Healthy Blue Medicaid |
$2,425.97
|
| Rate for Payer: Home State Health Plan Exchange |
$1,988.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,246.27
|
| Rate for Payer: Humana Medicare |
$2,617.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,246.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,302.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,489.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,691.12
|
|
|
HC Bronchoscopy, Rigid or Flex W/Fluro Guid
|
Facility
|
IP
|
$3,489.37
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
Px03603162202
|
|
Hospital Revenue Code
|
360
|
| 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 |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| 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 |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
|
|
HC Bronchoscopy, W/Fluro Guid W/Cytology Br
|
Facility
|
OP
|
$3,489.37
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
Px03603162301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,691.12 |
| Max. Negotiated Rate |
$3,489.37 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,418.13
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,749.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,686.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,749.62
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| Rate for Payer: Cigna Commercial |
$2,313.45
|
| Rate for Payer: Cigna Medicare Advantage |
$1,988.94
|
| Rate for Payer: Family Health Partners Medicaid |
$2,246.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,198.30
|
| Rate for Payer: Healthy Blue Medicaid |
$2,425.97
|
| Rate for Payer: Home State Health Plan Exchange |
$1,988.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,246.27
|
| Rate for Payer: Humana Medicare |
$2,617.03
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,246.27
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,302.98
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,489.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,691.12
|
|
|
HC Bronchoscopy, W/Fluro Guid W/Cytology Br
|
Facility
|
IP
|
$3,489.37
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
Px03603162301
|
|
Hospital Revenue Code
|
360
|
| 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 |
$3,489.37
|
| Rate for Payer: Cash Price |
$3,489.37
|
| 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 |
$2,617.03
|
| Rate for Payer: Provider Network of America Commercial |
$2,791.50
|
|
|
HC Bubblejet
|
Facility
|
IP
|
$6.99
|
|
| Hospital Charge Code |
Px02700002658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$875.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cash Price |
$6.99
|
| 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 |
$5.24
|
| Rate for Payer: Provider Network of America Commercial |
$5.59
|
|
|
HC Bubblejet
|
Facility
|
OP
|
$6.99
|
|
| Hospital Charge Code |
Px02700002658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.93
|
| Rate for Payer: Aetna Workers' Compensation |
$4.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5.51
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cigna Commercial |
$4.28
|
| Rate for Payer: Cigna Medicare Advantage |
$3.98
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4.40
|
| Rate for Payer: Home State Health Plan Exchange |
$3.98
|
| Rate for Payer: Humana Medicare |
$5.24
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5.24
|
| Rate for Payer: Provider Network of America Commercial |
$5.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6.99
|
|
