Ray County Hospital

All Charges

Charge

Type

Setting

Price

ANAL AND PERINEAL PROCEDURES

Facility

$17,290.35

Service Code	APR-DRG 2263
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,290.35
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	$17,290.35
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$17,290.35
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$17,290.35
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$17,290.35

ANAL AND PERINEAL PROCEDURES

Facility

$9,166.61

Service Code	APR-DRG 2261
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,166.61
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	$9,166.61
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,166.61
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,166.61
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,166.61

ANAL AND PERINEAL PROCEDURES

Facility

$27,948.21

Service Code	APR-DRG 2264
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$27,948.21
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	$27,948.21
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$27,948.21
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$27,948.21
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$27,948.21

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$6,151.36

Service Code	MSDRG 348
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,151.36
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	$6,151.36

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$10,789.32

Service Code	MSDRG 347
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,789.32
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	$10,789.32

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 349
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	$4,091.82

anastrozole 1 mg tablet 1 Each BLIST PACK

Facility

$45.00

Service Code	NDC 60687011211
Hospital Revenue Code	637
Min. Negotiated Rate	$33.75
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	$45.00
Rate for Payer: Cash Price	$45.00
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	$33.75
Rate for Payer: Provider Network of America Commercial	$36.00

anastrozole 1 mg tablet 1 Each BLIST PACK

Facility

$45.00

Service Code	NDC 60687011211
Hospital Revenue Code	637
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$31.73
Rate for Payer: Aetna Workers' Compensation	$31.73
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$31.18
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$31.18
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$34.65
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$35.46
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial	$27.54
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Harmony Health CHIP/Medicaid	$28.35
Rate for Payer: Home State Health Plan Exchange	$25.65
Rate for Payer: Humana Medicare	$33.75
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$33.75
Rate for Payer: Provider Network of America Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$29.70
Rate for Payer: UnitedHealthcare Individual Exchange	$45.00

Anesthesia Lower Intst Endoscopic Px Scr Colsc

Professional

Both

$57.63

Service Code	CPT 812
Hospital Charge Code	Px00000000812
Hospital Revenue Code	370
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$20.17
Rate for Payer: Cash Price	$57.63
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$20.17

ANGINA PECTORIS

Facility

$6,053.00

Service Code	MSDRG 311
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	$4,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$4,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$4,593.00
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	$4,593.00
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	$3,298.93

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$19,558.20

Service Code	APR-DRG 1984
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,558.20
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	$19,558.20
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$19,558.20
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$19,558.20
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$19,558.20

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$6,053.00

Service Code	APR-DRG 1981
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	$5,984.41
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,984.41
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,984.41
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,984.41

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$7,059.63

Service Code	APR-DRG 1982
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,059.63
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	$7,059.63
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,059.63
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,059.63
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,059.63

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$9,341.34

Service Code	APR-DRG 1983
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,341.34
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	$9,341.34
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,341.34
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,341.34
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,341.34

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$11,720.13

Service Code	APR-DRG 0592
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,720.13
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	$11,720.13
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,720.13
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,720.13
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,720.13

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$25,025.80

Service Code	APR-DRG 0594
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,025.80
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	$25,025.80
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,025.80
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,025.80
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,025.80

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$7,319.42

Service Code	APR-DRG 0591
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,319.42
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: Family Health Partners Medicaid	$7,319.42
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,319.42
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,319.42
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,319.42

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$15,151.94

Service Code	APR-DRG 0593
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,151.94
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	$15,151.94
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,151.94
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,151.94
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,151.94

Antepartum Care Only 4-6 Visits

Facility

$1,292.55

Service Code	CPT 59425
Hospital Charge Code	Px05105942501
Hospital Revenue Code	510
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,053.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$875.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$900.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Cash Price	$1,292.55
Rate for Payer: Cash Price	$1,292.55
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: Provider Network of America Commercial	$1,034.04

Antepartum Care Only 4-6 Visits

Facility

$1,292.55

Service Code	CPT 59425
Hospital Charge Code	Px05105942501
Hospital Revenue Code	510
Min. Negotiated Rate	$736.75
Max. Negotiated Rate	$1,292.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$911.25
Rate for Payer: Aetna Workers' Compensation	$911.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$895.74
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$895.74
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$1,018.53
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$1,018.53
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$1,018.53
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$995.26
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$1,018.53
Rate for Payer: Cash Price	$1,292.55
Rate for Payer: Cigna Medicare Advantage	$736.75
Rate for Payer: Harmony Health CHIP/Medicaid	$814.31
Rate for Payer: Home State Health Plan Exchange	$736.75
Rate for Payer: Humana Medicare	$969.41
Rate for Payer: Provider Network of America Commercial	$1,034.04
Rate for Payer: UnitedHealthcare Commercial	$853.08
Rate for Payer: UnitedHealthcare Individual Exchange	$1,292.55

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$11,125.66

Service Code	APR-DRG 5472
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,125.66
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	$11,125.66
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,125.66
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,125.66
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,125.66

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$6,053.00

Service Code	APR-DRG 5471
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	$5,870.70
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,870.70
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,870.70
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,870.70

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$16,851.21

Service Code	APR-DRG 5473
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,851.21
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	$16,851.21
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$16,851.21
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$16,851.21
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$16,851.21

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$32,152.92

Service Code	APR-DRG 5474
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$32,152.92
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	$32,152.92
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$32,152.92
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$32,152.92
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$32,152.92

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$18,469.12

Service Code	APR-DRG 5664
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,469.12
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	$18,469.12
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$18,469.12
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$18,469.12
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$18,469.12

Know your out-of-pocket cost for care.

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