|
HC Cardiopulmonary Resuscitation
|
Facility
|
OP
|
$2,971.50
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
Px07619295001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$2,971.50 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,094.91
|
| Rate for Payer: Aetna Workers' Compensation |
$2,094.91
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,059.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,059.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,341.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,341.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,341.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,288.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,341.54
|
| Rate for Payer: Cash Price |
$2,971.50
|
| Rate for Payer: Cash Price |
$2,971.50
|
| Rate for Payer: Cigna Commercial |
$1,818.56
|
| Rate for Payer: Cigna Medicare Advantage |
$1,693.76
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,872.05
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$1,693.76
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$2,228.62
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,228.62
|
| Rate for Payer: Provider Network of America Commercial |
$2,377.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,961.19
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,971.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiopulmonary Resuscitation
|
Facility
|
IP
|
$2,971.50
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
Px07619295001
|
|
Hospital Revenue Code
|
761
|
| 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 |
$2,971.50
|
| Rate for Payer: Cash Price |
$2,971.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,228.62
|
| Rate for Payer: Provider Network of America Commercial |
$2,377.20
|
|
|
HC Cardiovascular Stress Test - Adenosine W Myocardial Perfusion Mult
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Adenosine W Myocardial Perfusion Mult
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301724
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Adenosine W Myocardial Perfusion Sing
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Adenosine W Myocardial Perfusion Sing
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301723
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool First Pass
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301727
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool First Pass
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301727
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool Muga
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301725
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool Muga
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301725
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool Muga W Rvef
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301726
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Adenosine W NM Blood Pool Muga W Rvef
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301726
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Myocardial Perf Mult
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Myocardial Perf Mult
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301712
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Myocardial Perf Sing
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Myocardial Perf Sing
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301711
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W NM Bld Pool Muga W Rvef
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301714
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W NM Bld Pool Muga W Rvef
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301714
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W NM Blood Pool 1st Pass
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301715
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W NM Blood Pool 1st Pass
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301715
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Nuc Med Blood Pool Muga
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301713
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dipyridamole W Nuc Med Blood Pool Muga
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301713
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dobutamine W Myocard Perfusion Mult
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301706
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$205.16 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$888.30
|
| Rate for Payer: Aetna Workers' Compensation |
$888.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$873.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$992.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$992.88
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$771.12
|
| Rate for Payer: Cigna Medicare Advantage |
$718.20
|
| Rate for Payer: Family Health Partners Medicaid |
$272.51
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$793.80
|
| Rate for Payer: Healthy Blue Medicaid |
$294.31
|
| Rate for Payer: Home State Health Plan Exchange |
$718.20
|
| Rate for Payer: Home State Health Plan Medicaid |
$272.51
|
| Rate for Payer: Humana Medicare |
$945.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$272.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$831.60
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$1,260.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$205.16
|
|
|
HC Cardiovascular Stress Test - Dobutamine W Myocard Perfusion Mult
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301706
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
|
HC Cardiovascular Stress Test - Dobutamine W Myocard Perfusion Sing
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
Px04829301705
|
|
Hospital Revenue Code
|
482
|
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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 |
$945.00
|
| Rate for Payer: Provider Network of America Commercial |
$1,008.00
|
|
