|
MRI Spinal Canal Lumbar W/O Contrast Material
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
Px00000072148
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$215.35 |
| Max. Negotiated Rate |
$215.35 |
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$215.35
|
|
|
MRI Spinal Canal Lumbar W/O Contrast Material
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
Px09727214801
|
|
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/O Contrast Material
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
Px09727214801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Cigna Medicare Advantage |
$152.50
|
| 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: 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 Lumbar W/O & W/Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
Px09727215801
|
|
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 Lumbar W/O & W/Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
Px09727215801
|
|
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 Thoracic W/O Contrast Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
Px09727214601
|
|
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 Thoracic W/O Contrast Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
Px09727214601
|
|
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 Thoracic W/O & W/Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
Px09727215701
|
|
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 Thoracic W/O & W/Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
Px09727215701
|
|
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 Temporomandibular Joint
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
Px09727033601
|
|
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 Temporomandibular Joint
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 70336
|
| Hospital Charge Code |
Px09727033601
|
|
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 Upper Extremity Oth Than Jt W/O Contr Matrl
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
Px09727321801
|
|
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 Upper Extremity Oth Than Jt W/O Contr Matrl
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
Px09727321801
|
|
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 Upper Extrem Other Than Jt W/O & W/Contras
|
Facility
|
IP
|
$267.54
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
Px09727322001
|
|
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 Upper Extrem Other Than Jt W/O & W/Contras
|
Facility
|
OP
|
$267.54
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
Px09727322001
|
|
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
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$64,140.35
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$64,140.35 |
| Rate for Payer: Healthy Blue Medicaid |
$64,140.35
|
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$64,140.35
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$64,140.35
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$64,140.35
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$38,490.50
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$38,490.50 |
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$38,490.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$38,490.50
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$38,490.50
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$38,490.50
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$46,470.95
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$46,470.95 |
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$46,470.95
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$46,470.95
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$46,470.95
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$46,470.95
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$84,466.83
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$84,466.83 |
| 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: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Family Health Partners Medicaid |
$84,466.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$84,466.83
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$84,466.83
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$84,466.83
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$33,927.42
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$33,927.42 |
| 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: 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 |
$33,927.42
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$51,799.64
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$51,799.64 |
| 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: 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 |
$51,799.64
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$26,423.40
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$26,423.40 |
| 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: 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 |
$26,423.40
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$31,403.52
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$31,403.52 |
| 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: 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 |
$31,403.52
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$19,931.76
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$19,931.76 |
| 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: 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 |
$19,931.76
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 059
|
| 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: 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 |
$5,832.23
|
|
