|
MRI Abdomen W/O Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
Px09727418101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Abdomen W/O Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
Px09727418101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI Abdomen W/O & W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
Px09727418301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Abdomen W/O & W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
Px09727418301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
MRI Any Jt Lower Extrem W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
Px09727372201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Lower Extrem W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
Px09727372201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$1,068.47 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$989.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$1,068.47
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$989.32
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$989.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$744.82
|
|
|
MRI Any Jt Lower Extrem W/O Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
Px09727372101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Lower Extrem W/O Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
Px09727372101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI Any Jt Lower Extrem W/O & W/Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
Px09727372301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
MRI Any Jt Lower Extrem W/O & W/Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
Px09727372301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Lower Extrem W/O & W/Contrast Matrl
|
Professional
|
Both
|
$3,526.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
Px00000073723
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$423.80 |
| Rate for Payer: Cash Price |
$3,526.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$423.80
|
|
|
MRI Any Jt Upper Extremity W/Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
Px09727322201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$1,068.47 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$989.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$1,068.47
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$989.32
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$989.32
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$744.82
|
|
|
MRI Any Jt Upper Extremity W/Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
Px09727322201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Upper Extremity W/O Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
Px09727322101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI Any Jt Upper Extremity W/O Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
Px09727322101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Upper Extremity W/O & W/Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
Px09727322301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Any Jt Upper Extremity W/O & W/Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
Px09727322301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
MRI Brain Brain Stem W/O Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
Px09727055101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Brain Brain Stem W/O Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
Px09727055101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI Brain Brain Stem W/O W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
Px09727055301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
MRI Brain Brain Stem W/O W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
Px09727055301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Chest W/O Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
Px09727155001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
|
MRI Chest W/O Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
Px09727155001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI Chest W/O & W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
Px09727155201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$475.51 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$188.62
|
| Rate for Payer: Aetna Workers' Compensation |
$188.62
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$185.41
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$206.01
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$210.82
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cigna Commercial |
$163.73
|
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| Rate for Payer: Family Health Partners Medicaid |
$440.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$168.55
|
| Rate for Payer: Healthy Blue Medicaid |
$475.51
|
| Rate for Payer: Home State Health Plan Exchange |
$152.50
|
| Rate for Payer: Home State Health Plan Medicaid |
$440.29
|
| Rate for Payer: Humana Medicare |
$200.66
|
| Rate for Payer: Mercy CarePlus Medicaid |
$440.29
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
| Rate for Payer: UnitedHealthcare Commercial |
$176.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$267.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$331.47
|
|
|
MRI Chest W/O & W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
Px09727155201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$200.66 |
| 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 |
$267.54
|
| Rate for Payer: Cash Price |
$267.54
|
| 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 |
$200.66
|
| Rate for Payer: Provider Network of America Commercial |
$214.03
|
|
