|
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora
|
Facility
|
OP
|
$4,095.23
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
Px07616463301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,855.34 |
| Max. Negotiated Rate |
$4,095.23 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,887.14
|
| Rate for Payer: Aetna Workers' Compensation |
$2,887.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$3,227.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$3,153.33
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$3,227.04
|
| Rate for Payer: Cash Price |
$4,095.23
|
| Rate for Payer: Cash Price |
$4,095.23
|
| Rate for Payer: Cigna Commercial |
$2,506.28
|
| Rate for Payer: Cigna Medicare Advantage |
$2,334.28
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,579.99
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Home State Health Plan Exchange |
$2,334.28
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Humana Medicare |
$3,071.42
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$3,071.42
|
| Rate for Payer: Provider Network of America Commercial |
$3,276.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,702.85
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$4,095.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral
|
Facility
|
OP
|
$474.60
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
Px09836463501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$270.52 |
| Max. Negotiated Rate |
$2,661.54 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$334.59
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$318.66
|
| Rate for Payer: Aetna Workers' Compensation |
$334.59
|
| Rate for Payer: Aetna Workers' Compensation |
$318.66
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$328.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$313.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$328.90
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$313.24
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$373.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$356.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$373.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$356.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$356.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$373.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$348.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$365.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$373.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$356.18
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cigna Commercial |
$290.46
|
| Rate for Payer: Cigna Commercial |
$276.62
|
| Rate for Payer: Cigna Medicare Advantage |
$257.64
|
| Rate for Payer: Cigna Medicare Advantage |
$270.52
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Family Health Partners Medicaid |
$2,464.39
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$299.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$284.76
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Healthy Blue Medicaid |
$2,661.54
|
| Rate for Payer: Home State Health Plan Exchange |
$270.52
|
| Rate for Payer: Home State Health Plan Exchange |
$257.64
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Home State Health Plan Medicaid |
$2,464.39
|
| Rate for Payer: Humana Medicare |
$339.00
|
| Rate for Payer: Humana Medicare |
$355.95
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Mercy CarePlus Medicaid |
$2,464.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$339.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$355.95
|
| Rate for Payer: Provider Network of America Commercial |
$361.60
|
| Rate for Payer: Provider Network of America Commercial |
$379.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$298.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$313.24
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$452.00
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$474.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,855.34
|
|
|
Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral
|
Facility
|
IP
|
$474.60
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
Px09836463501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$355.95 |
| 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 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 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: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$950.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$355.95
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$339.00
|
| Rate for Payer: Provider Network of America Commercial |
$379.68
|
| Rate for Payer: Provider Network of America Commercial |
$361.60
|
|
|
DULoxetine 30 mg capsule,delayed release(DR/EC) 100 Each BLIST PACK
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
NDC 00904704461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4.05
|
| Rate for Payer: Aetna Workers' Compensation |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$3.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$3.98
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$4.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$4.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$4.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$4.52
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: Cigna Medicare Advantage |
$3.27
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$3.62
|
| Rate for Payer: Home State Health Plan Exchange |
$3.27
|
| Rate for Payer: Humana Medicare |
$4.30
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4.30
|
| Rate for Payer: Provider Network of America Commercial |
$4.59
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.79
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$5.74
|
|
|
DULoxetine 30 mg capsule,delayed release(DR/EC) 100 Each BLIST PACK
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 00904704461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| 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 |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| 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 |
$4.30
|
| Rate for Payer: Provider Network of America Commercial |
$4.59
|
|
|
Duo Derm Thin 4x4
|
Facility
|
IP
|
$16.73
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
Px0272A623403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| 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 |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| 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 |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
|
|
Duo Derm Thin 4x4
|
Facility
|
OP
|
$16.73
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
Px0272A623403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$11.79
|
| Rate for Payer: Aetna Workers' Compensation |
$11.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$13.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$13.18
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$10.24
|
| Rate for Payer: Cigna Medicare Advantage |
$9.54
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$10.54
|
| Rate for Payer: Home State Health Plan Exchange |
$9.54
|
| Rate for Payer: Humana Medicare |
$12.55
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$12.55
|
| Rate for Payer: Provider Network of America Commercial |
$13.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.04
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$16.73
|
|
|
Duplex Extrem Venous,Uni or Ltd
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
Px09729397101
|
|
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
|
|
|
Duplex Extrem Venous,Uni or Ltd
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
Px09729397101
|
|
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
|
|
|
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
Px09729397801
|
|
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
|
|
|
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
Px09729397801
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$325.22 |
| 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 |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| 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 |
$226.70
|
|
|
Dup-Scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Com
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
Px09729397501
|
|
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
|
|
|
Dup-Scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Com
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
Px09729397501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$325.22 |
| 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 |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| 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 |
$226.70
|
|
|
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
Px09729392501
|
|
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
|
|
|
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
Px09729392501
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$325.22 |
| 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 |
$301.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$325.22
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$301.13
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Mercy CarePlus Medicaid |
$301.13
|
| 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 |
$226.70
|
|
|
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
Px09729392601
|
|
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
|
|
|
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
Px09729392601
|
|
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
|
|
|
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
Px00000093926
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$153.99 |
| Max. Negotiated Rate |
$153.99 |
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$153.99
|
|
|
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study
|
Facility
|
IP
|
$98.80
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
Px09839393101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$74.10 |
| 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 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 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: 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 |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cigna Medicare Advantage |
$6,053.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.10
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
|
|
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study
|
Facility
|
OP
|
$98.80
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
Px09839393101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$142.49 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$69.65
|
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$73.14
|
| Rate for Payer: Aetna Workers' Compensation |
$69.65
|
| Rate for Payer: Aetna Workers' Compensation |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$68.47
|
| 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) |
$68.47
|
| 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 |
$77.85
|
| 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 |
$77.85
|
| 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 |
$77.85
|
| 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 Preferred Care Blue Risk (PPO) |
$76.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$77.85
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$81.75
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Cigna Commercial |
$63.49
|
| Rate for Payer: Cigna Medicare Advantage |
$59.13
|
| Rate for Payer: Cigna Medicare Advantage |
$56.32
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Family Health Partners Medicaid |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$62.24
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$65.36
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$56.32
|
| Rate for Payer: Home State Health Plan Exchange |
$59.13
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$77.81
|
| Rate for Payer: Humana Medicare |
$74.10
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$77.81
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$74.10
|
| Rate for Payer: Provider Network of America Commercial |
$82.99
|
| Rate for Payer: Provider Network of America Commercial |
$79.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$65.21
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$103.74
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$98.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.33
|
|
|
DXA Bone Density Study 1/>Sites Appendiclr Skel
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
Px09727708101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$118.62 |
| 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 |
$109.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$118.62
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$109.83
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$109.83
|
| 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 |
$82.69
|
|
|
DXA Bone Density Study 1/>Sites Appendiclr Skel
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
Px09727708101
|
|
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
|
|
|
DXA Bone Density Study 1/> Sites Axial Skel
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
Px09727708001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$142.49 |
| 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 |
$131.94
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$18.92
|
| Rate for Payer: Healthy Blue Medicaid |
$142.49
|
| Rate for Payer: Home State Health Plan Exchange |
$17.12
|
| Rate for Payer: Home State Health Plan Medicaid |
$131.94
|
| Rate for Payer: Humana Medicare |
$22.52
|
| Rate for Payer: Mercy CarePlus Medicaid |
$131.94
|
| 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 |
$99.33
|
|
|
DXA Bone Density Study 1/> Sites Axial Skel
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
Px09727708001
|
|
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
|
|
|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
MSDRG 149
|
| 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 |
$3,532.52
|
|
