|
MRI, Face, Neck - MRI Neck Soft Tissue Only WO Contrast
|
Facility
|
OP
|
$2,881.20
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px06157054001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$226.70 |
| Max. Negotiated Rate |
$2,881.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,031.25
|
| Rate for Payer: Aetna Workers' Compensation |
$2,031.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,996.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,996.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,218.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,270.39
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cigna Commercial |
$1,236.00
|
| Rate for Payer: Cigna Medicare Advantage |
$1,642.28
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,815.16
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$1,642.28
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$2,160.90
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,160.90
|
| Rate for Payer: Provider Network of America Commercial |
$2,304.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,901.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,881.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI, Face, Neck - MRI Neck Soft Tissue Only WO Contrast
|
Facility
|
IP
|
$2,881.20
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px06157054001
|
|
Hospital Revenue Code
|
615
|
| 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 |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| 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 |
$2,160.90
|
| Rate for Payer: Provider Network of America Commercial |
$2,304.96
|
|
|
MRI, Face, Neck - MR Orbit Face Neck WO IV Contrast
|
Facility
|
OP
|
$2,881.20
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px06157054002
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$226.70 |
| Max. Negotiated Rate |
$2,881.20 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,031.25
|
| Rate for Payer: Aetna Workers' Compensation |
$2,031.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,996.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,996.67
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,270.39
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,218.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,270.39
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| Rate for Payer: Cigna Commercial |
$1,236.00
|
| Rate for Payer: Cigna Medicare Advantage |
$1,642.28
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,815.16
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$1,642.28
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$2,160.90
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,160.90
|
| Rate for Payer: Provider Network of America Commercial |
$2,304.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,901.59
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,881.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
MRI, Face, Neck - MR Orbit Face Neck WO IV Contrast
|
Facility
|
IP
|
$2,881.20
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px06157054002
|
|
Hospital Revenue Code
|
615
|
| 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 |
$2,881.20
|
| Rate for Payer: Cash Price |
$2,881.20
|
| 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 |
$2,160.90
|
| Rate for Payer: Provider Network of America Commercial |
$2,304.96
|
|
|
MRI Lower Extrem Oth/Thn Jt W/O Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
Px09727371801
|
|
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 Lower Extrem Oth/Thn Jt W/O Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
Px09727371801
|
|
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 Lower Extrem Oth/Thn Jt W/O & W/Contr Matr
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
Px09727372001
|
|
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 Lower Extrem Oth/Thn Jt W/O & W/Contr Matr
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
Px09727372001
|
|
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 Orbit Face &/Neck W/O Contrast
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px09727054001
|
|
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 Orbit Face &/Neck W/O Contrast
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
Px09727054001
|
|
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 Orbit Face & Neck W/O & W/Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
Px09727054301
|
|
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 Orbit Face & Neck W/O & W/Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
Px09727054301
|
|
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 Pelvis W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
Px09727219601
|
|
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 Pelvis W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
Px09727219601
|
|
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 Pelvis W/O Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
Px09727219501
|
|
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 Pelvis W/O Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
Px09727219501
|
|
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 Pelvis W/O & W/Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
Px09727219701
|
|
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 Pelvis W/O & W/Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
Px09727219701
|
|
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 Spinal Canal Cervical W/Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
Px09727214201
|
|
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 Spinal Canal Cervical W/Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
Px09727214201
|
|
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 Spinal Canal Cervical W/O Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
Px09727214101
|
|
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 Spinal Canal Cervical W/O Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
Px09727214101
|
|
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 Spinal Canal Cervical W/O & W/Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
Px09727215601
|
|
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 Spinal Canal Cervical W/O & W/Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
Px09727215601
|
|
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 Spinal Canal Lumbar W/Contrast Material
|
Professional
|
Both
|
$3,604.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
Px00000072149
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$301.02 |
| Max. Negotiated Rate |
$301.02 |
| Rate for Payer: Cash Price |
$3,604.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$301.02
|
|
