|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$30,180.92
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$30,180.92 |
| Rate for Payer: Mercy CarePlus Medicaid |
$30,180.92
|
| 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 |
$30,180.92
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$30,180.92
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$30,180.92
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$12,434.78
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,434.78 |
| 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 |
$12,434.78
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,434.78
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,434.78
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,434.78
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$8,436.50
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,436.50 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$8,436.50
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 672
|
| 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 |
$5,073.65
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 697
|
| 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 |
$5,065.66
|
|
|
Urethrocystography Voiding Rs&I
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
Px09727445501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$325.22 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$21.17
|
| Rate for Payer: Aetna Workers' Compensation |
$21.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$23.66
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$18.38
|
| Rate for Payer: Cigna Medicare Advantage |
$17.12
|
| Rate for Payer: Family Health Partners Medicaid |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$19.82
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$30.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.70
|
|
|
Urethrocystography Voiding Rs&I
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
Px09727445501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.52 |
| 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 |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| 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 |
$22.52
|
| Rate for Payer: Provider Network of America Commercial |
$24.02
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$12,300.73
|
|
|
Service Code
|
APR-DRG 4653
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$12,300.73 |
| 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 |
$12,300.73
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$12,300.73
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$12,300.73
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$12,300.73
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$22,924.37
|
|
|
Service Code
|
APR-DRG 4654
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$22,924.37 |
| 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 |
$22,924.37
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$22,924.37
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$22,924.37
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$22,924.37
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
APR-DRG 4651
|
| 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: Family Health Partners Medicaid |
$4,641.09
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$4,641.09
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$4,641.09
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$4,641.09
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$8,044.24
|
|
|
Service Code
|
APR-DRG 4652
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,044.24 |
| 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 |
$8,044.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,044.24
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,044.24
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,044.24
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$6,319.15
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,319.15 |
| Rate for Payer: Cigna Medicare Advantage |
$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 Freedom Network |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,786.00
|
| 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 |
$6,319.15
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 694
|
| 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 Freedom Network |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,786.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,786.00
|
| 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 |
$3,673.99
|
|
|
Urine Pregnancy Test - Pregnancy Urine
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
Px03078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
|
|
Urine Pregnancy Test - Pregnancy Urine
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
Px03078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$88.83
|
| Rate for Payer: Aetna Workers' Compensation |
$88.83
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$87.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$99.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$97.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$99.29
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Cigna Medicare Advantage |
$71.82
|
| Rate for Payer: Family Health Partners Medicaid |
$10.85
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$79.38
|
| Rate for Payer: Healthy Blue Medicaid |
$11.72
|
| Rate for Payer: Home State Health Plan Exchange |
$71.82
|
| Rate for Payer: Home State Health Plan Medicaid |
$10.85
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10.85
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$94.50
|
| Rate for Payer: Provider Network of America Commercial |
$100.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$83.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.17
|
|
|
US Biopsy Salivary Gland
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
Px09724240001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
US Biopsy Salivary Gland
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 42400
|
| Hospital Charge Code |
Px09724240001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$965.17 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$893.68
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$965.17
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$893.68
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$893.68
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$672.81
|
|
|
US Breast Uni Real Time With Image Limited
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
Px09727664201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$118.62 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$109.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$118.62
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$109.83
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$109.83
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.69
|
|
|
US Breast Uni Real Time With Image Limited
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
Px09727664201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
US Guidance Needle Placement Img S&I
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
Px09737694201
|
|
Hospital Revenue Code
|
973
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
|
|
US Guidance Needle Placement Img S&I
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
Px09737694201
|
|
Hospital Revenue Code
|
973
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
US, Head/Neck Tissues,Real Time - US Head Neck Soft Tissue
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
Px09727653605
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
US, Head/Neck Tissues,Real Time - US Head Neck Soft Tissue
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
Px09727653605
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
US Lmtd Jt/Fcl Eval Nonvasc Xtr Strux R-T W/Img
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
Px09727688201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$71.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
US Lmtd Jt/Fcl Eval Nonvasc Xtr Strux R-T W/Img
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
Px09727688201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.81 |
| 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 |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| 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 |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
