Ray County Hospital

All Charges

Charge

Type

Setting

Price

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$6,053.00

Service Code	APR-DRG 5661
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	$3,048.14
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$3,048.14
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$3,048.14
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$3,048.14

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$6,053.00

Service Code	APR-DRG 5662
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	$4,520.90
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$4,520.90
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$4,520.90
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$4,520.90

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$8,184.77

Service Code	APR-DRG 5663
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,184.77
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	$8,184.77
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,184.77
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,184.77
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,184.77

Antineutrophil Cytoplasmic Antb Titer Ea Antb

Facility

$200.45

Service Code	CPT 86037
Hospital Charge Code	Px03028603701
Hospital Revenue Code	302
Min. Negotiated Rate	$150.34
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	$200.45
Rate for Payer: Cash Price	$200.45
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	$150.34
Rate for Payer: Provider Network of America Commercial	$160.36

Antineutrophil Cytoplasmic Antb Titer Ea Antb

Facility

$200.45

Service Code	CPT 86037
Hospital Charge Code	Px03028603701
Hospital Revenue Code	302
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$160.36
Rate for Payer: Aetna Commercial/Medicare Advantage	$141.32
Rate for Payer: Aetna Workers' Compensation	$141.32
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$138.91
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$138.91
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$157.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$157.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$157.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$154.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$157.95
Rate for Payer: Cash Price	$200.45
Rate for Payer: Cash Price	$200.45
Rate for Payer: Cigna Commercial	$105.04
Rate for Payer: Cigna Medicare Advantage	$114.26
Rate for Payer: Family Health Partners Medicaid	$15.19
Rate for Payer: Harmony Health CHIP/Medicaid	$126.28
Rate for Payer: Healthy Blue Medicaid	$16.41
Rate for Payer: Home State Health Plan Exchange	$114.26
Rate for Payer: Home State Health Plan Medicaid	$15.19
Rate for Payer: Humana Medicare	$150.34
Rate for Payer: Mercy CarePlus Medicaid	$15.19
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$150.34
Rate for Payer: Provider Network of America Commercial	$160.36
Rate for Payer: UnitedHealthcare Commercial	$132.30
Rate for Payer: UnitedHealthcare Individual Exchange	$12.05
Rate for Payer: UnitedHealthcare Medicaid	$11.44

Antipsychotics Not Otherwise Specified 1-3

Professional

Both

$197.92

Service Code	CPT 80342
Hospital Charge Code	Px00000080342
Hospital Revenue Code	520
Min. Negotiated Rate	$69.27
Max. Negotiated Rate	$69.27
Rate for Payer: Cash Price	$197.92
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$69.27

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$32,326.13

Service Code	MSDRG 268
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$32,326.13
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$32,326.13

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$19,849.04

Service Code	MSDRG 269
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,849.04
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	$19,849.04

apixaban 2.5 mg tablet 100 Each BLIST PACK

Facility

$23.04

Service Code	NDC 00003089331
Hospital Revenue Code	637
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna Commercial/Medicare Advantage	$16.24
Rate for Payer: Aetna Workers' Compensation	$16.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$15.97
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$15.97
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$17.74
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$18.16
Rate for Payer: Cash Price	$23.04
Rate for Payer: Cigna Commercial	$14.10
Rate for Payer: Cigna Medicare Advantage	$13.13
Rate for Payer: Harmony Health CHIP/Medicaid	$14.52
Rate for Payer: Home State Health Plan Exchange	$13.13
Rate for Payer: Humana Medicare	$17.28
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$17.28
Rate for Payer: Provider Network of America Commercial	$18.43
Rate for Payer: UnitedHealthcare Commercial	$15.21
Rate for Payer: UnitedHealthcare Individual Exchange	$23.04

apixaban 2.5 mg tablet 100 Each BLIST PACK

Facility

$23.04

Service Code	NDC 00003089331
Hospital Revenue Code	637
Min. Negotiated Rate	$17.28
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	$23.04
Rate for Payer: Cash Price	$23.04
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	$17.28
Rate for Payer: Provider Network of America Commercial	$18.43

apixaban 5 mg tablet 100 Each BLIST PACK

Facility

$23.04

Service Code	NDC 00003089431
Hospital Revenue Code	637
Min. Negotiated Rate	$17.28
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	$23.04
Rate for Payer: Cash Price	$23.04
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	$17.28
Rate for Payer: Provider Network of America Commercial	$18.43

apixaban 5 mg tablet 100 Each BLIST PACK

Facility

$23.04

Service Code	NDC 00003089431
Hospital Revenue Code	637
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$23.04
Rate for Payer: Aetna Commercial/Medicare Advantage	$16.24
Rate for Payer: Aetna Workers' Compensation	$16.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$15.97
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$15.97
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$18.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$17.74
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$18.16
Rate for Payer: Cash Price	$23.04
Rate for Payer: Cigna Commercial	$14.10
Rate for Payer: Cigna Medicare Advantage	$13.13
Rate for Payer: Harmony Health CHIP/Medicaid	$14.52
Rate for Payer: Home State Health Plan Exchange	$13.13
Rate for Payer: Humana Medicare	$17.28
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$17.28
Rate for Payer: Provider Network of America Commercial	$18.43
Rate for Payer: UnitedHealthcare Commercial	$15.21
Rate for Payer: UnitedHealthcare Individual Exchange	$23.04

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$10,856.63

Service Code	APR-DRG 2331
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,856.63
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	$10,856.63
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,856.63
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,856.63
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,856.63

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$13,642.20

Service Code	APR-DRG 2332
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,642.20
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	$13,642.20
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$13,642.20
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$13,642.20
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$13,642.20

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$33,870.68

Service Code	APR-DRG 2334
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$33,870.68
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	$33,870.68
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$33,870.68
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$33,870.68
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$33,870.68

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$21,005.07

Service Code	APR-DRG 2333
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,005.07
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	$21,005.07
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$21,005.07
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$21,005.07
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$21,005.07

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$10,352.76

Service Code	APR-DRG 2341
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,352.76
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: Family Health Partners Medicaid	$10,352.76
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,352.76
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,352.76
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,352.76

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$26,883.16

Service Code	APR-DRG 2344
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$26,883.16
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	$26,883.16
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$26,883.16
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$26,883.16
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$26,883.16

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$19,624.76

Service Code	APR-DRG 2343
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,624.76
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: Family Health Partners Medicaid	$19,624.76
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$19,624.76
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$19,624.76
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$19,624.76

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$12,631.70

Service Code	APR-DRG 2342
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,631.70
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	$12,631.70
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,631.70
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,631.70
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,631.70

APPENDIX PROCEDURES WITH CC

Facility

$7,113.92

Service Code	MSDRG 398
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,113.92
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$7,113.92

APPENDIX PROCEDURES WITH MCC

Facility

$11,256.03

Service Code	MSDRG 397
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,256.03
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	$11,256.03

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 399
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	$5,380.09

Application Cast Elbow Finger Short Arm

Facility

$777.00

Service Code	CPT 29075
Hospital Charge Code	Px07612907501
Hospital Revenue Code	761
Min. Negotiated Rate	$265.75
Max. Negotiated Rate	$777.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$547.78
Rate for Payer: Aetna Commercial/Medicare Advantage	$377.77
Rate for Payer: Aetna Workers' Compensation	$547.78
Rate for Payer: Aetna Workers' Compensation	$377.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$538.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$371.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$538.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$371.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$612.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$422.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$612.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$422.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$422.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$612.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$412.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$598.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$612.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$422.24
Rate for Payer: Cash Price	$777.00
Rate for Payer: Cash Price	$777.00
Rate for Payer: Cash Price	$535.84
Rate for Payer: Cash Price	$535.84
Rate for Payer: Cigna Commercial	$475.52
Rate for Payer: Cigna Commercial	$327.93
Rate for Payer: Cigna Medicare Advantage	$305.43
Rate for Payer: Cigna Medicare Advantage	$442.89
Rate for Payer: Family Health Partners Medicaid	$352.98
Rate for Payer: Family Health Partners Medicaid	$352.98
Rate for Payer: Harmony Health CHIP/Medicaid	$489.51
Rate for Payer: Harmony Health CHIP/Medicaid	$337.58
Rate for Payer: Healthy Blue Medicaid	$381.22
Rate for Payer: Healthy Blue Medicaid	$381.22
Rate for Payer: Home State Health Plan Exchange	$442.89
Rate for Payer: Home State Health Plan Exchange	$305.43
Rate for Payer: Home State Health Plan Medicaid	$352.98
Rate for Payer: Home State Health Plan Medicaid	$352.98
Rate for Payer: Humana Medicare	$401.88
Rate for Payer: Humana Medicare	$582.75
Rate for Payer: Mercy CarePlus Medicaid	$352.98
Rate for Payer: Mercy CarePlus Medicaid	$352.98
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$401.88
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$582.75
Rate for Payer: Provider Network of America Commercial	$428.67
Rate for Payer: Provider Network of America Commercial	$621.60
Rate for Payer: UnitedHealthcare Commercial	$353.65
Rate for Payer: UnitedHealthcare Commercial	$512.82
Rate for Payer: UnitedHealthcare Individual Exchange	$535.84
Rate for Payer: UnitedHealthcare Individual Exchange	$777.00
Rate for Payer: UnitedHealthcare Medicaid	$265.75
Rate for Payer: UnitedHealthcare Medicaid	$265.75

Application Cast Elbow Finger Short Arm

Facility

$777.00

Service Code	CPT 29075
Hospital Charge Code	Px07612907501
Hospital Revenue Code	761
Min. Negotiated Rate	$582.75
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 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	$535.84
Rate for Payer: Cash Price	$777.00
Rate for Payer: Cash Price	$777.00
Rate for Payer: Cash Price	$535.84
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	$582.75
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$401.88
Rate for Payer: Provider Network of America Commercial	$621.60
Rate for Payer: Provider Network of America Commercial	$428.67

Know your out-of-pocket cost for care.

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