Ray County Hospital

All Charges

Charge

Type

Setting

Price

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$22,580.21

Service Code	MSDRG 837
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$22,580.21
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$22,580.21

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$9,810.78

Service Code	MSDRG 838
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,810.78
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$9,810.78

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$6,786.33

Service Code	MSDRG 839
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,786.33
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	$6,786.33

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$6,148.54

Service Code	MSDRG 847
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,148.54
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	$6,148.54

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$12,184.75

Service Code	MSDRG 846
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,184.75
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	$12,184.75

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 848
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	$3,992.18

CHEST PAIN

Facility

$6,053.00

Service Code	MSDRG 313
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	$3,950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,950.00
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	$3,950.00
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	$3,384.00

CHEST PAIN

Facility

$6,144.35

Service Code	APR-DRG 2031
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,144.35
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	$6,144.35
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,144.35
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,144.35
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,144.35

CHEST PAIN

Facility

$6,982.89

Service Code	APR-DRG 2032
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,982.89
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	$6,982.89
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,982.89
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,982.89
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,982.89

CHEST PAIN

Facility

$8,755.19

Service Code	APR-DRG 2033
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,755.19
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,755.19
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	$8,755.19
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,755.19
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,755.19

CHEST PAIN

Facility

$15,212.96

Service Code	APR-DRG 2034
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,212.96
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	$15,212.96
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,212.96
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,212.96
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,212.96

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$330,224.32

Service Code	APR-DRG 0114
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$330,224.32
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: Family Health Partners Medicaid	$330,224.32
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$330,224.32
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$330,224.32
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$330,224.32

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$254,437.80

Service Code	APR-DRG 0113
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$254,437.80
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	$254,437.80
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$254,437.80
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$254,437.80
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$254,437.80

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$202,959.16

Service Code	MSDRG 018
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$202,959.16
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$202,959.16

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$215,896.45

Service Code	APR-DRG 0112
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$215,896.45
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	$215,896.45
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$215,896.45
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$215,896.45
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$215,896.45

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$99,621.54

Service Code	APR-DRG 0111
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$99,621.54
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	$99,621.54
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$99,621.54
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$99,621.54
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$99,621.54

chlordiazePOXIDE 25 mg capsule 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 51079014101
Hospital Revenue Code	637
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$2.82
Rate for Payer: Aetna Workers' Compensation	$2.82
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$2.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$2.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3.08
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3.15
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$2.45
Rate for Payer: Cigna Medicare Advantage	$2.28
Rate for Payer: Harmony Health CHIP/Medicaid	$2.52
Rate for Payer: Home State Health Plan Exchange	$2.28
Rate for Payer: Humana Medicare	$3.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3.00
Rate for Payer: Provider Network of America Commercial	$3.20
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Individual Exchange	$4.00

chlordiazePOXIDE 25 mg capsule 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 51079014101
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
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	$4.00
Rate for Payer: Cash Price	$4.00
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	$3.00
Rate for Payer: Provider Network of America Commercial	$3.20

chlorhexidine 0.12 % mouthwash 15 mL Cup

Facility

$45.00

Service Code	NDC 00904703588
Hospital Revenue Code	250
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

chlorhexidine 0.12 % mouthwash 15 mL Cup

Facility

$45.00

Service Code	NDC 00904703588
Hospital Revenue Code	250
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

Chloroprocaine hcl injection

Facility

$54.76

Service Code	HCPCS J2401
Hospital Charge Code	Px0636J240101
Hospital Revenue Code	636
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$54.76
Rate for Payer: Aetna Commercial/Medicare Advantage	$38.61
Rate for Payer: Aetna Workers' Compensation	$38.61
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$37.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$37.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$43.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$43.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$43.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$42.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$43.15
Rate for Payer: Cash Price	$54.76
Rate for Payer: Cigna Commercial	$33.51
Rate for Payer: Cigna Medicare Advantage	$31.21
Rate for Payer: Harmony Health CHIP/Medicaid	$34.50
Rate for Payer: Home State Health Plan Exchange	$31.21
Rate for Payer: Humana Medicare	$41.07
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$41.07
Rate for Payer: Provider Network of America Commercial	$43.81
Rate for Payer: UnitedHealthcare Commercial	$36.14
Rate for Payer: UnitedHealthcare Individual Exchange	$54.76

Chloroprocaine hcl injection

Facility

$54.76

Service Code	HCPCS J2401
Hospital Charge Code	Px0636J240101
Hospital Revenue Code	636
Min. Negotiated Rate	$41.07
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	$54.76
Rate for Payer: Cash Price	$54.76
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	$41.07
Rate for Payer: Provider Network of America Commercial	$43.81

chloroprocaine (pf) per 30 mL

Facility

$85.24

Service Code	HCPCS J2401
Hospital Revenue Code	250
Min. Negotiated Rate	$63.93
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	$85.24
Rate for Payer: Cash Price	$85.24
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	$63.93
Rate for Payer: Provider Network of America Commercial	$68.19

chloroprocaine (pf) per 30 mL

Facility

$85.24

Service Code	NDC 00143920901
Hospital Revenue Code	250
Min. Negotiated Rate	$48.59
Max. Negotiated Rate	$85.24
Rate for Payer: Aetna Commercial/Medicare Advantage	$60.09
Rate for Payer: Aetna Workers' Compensation	$60.09
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$59.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$59.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$65.63
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$67.17
Rate for Payer: Cash Price	$85.24
Rate for Payer: Cigna Commercial	$52.17
Rate for Payer: Cigna Medicare Advantage	$48.59
Rate for Payer: Harmony Health CHIP/Medicaid	$53.70
Rate for Payer: Home State Health Plan Exchange	$48.59
Rate for Payer: Humana Medicare	$63.93
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$63.93
Rate for Payer: Provider Network of America Commercial	$68.19
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: UnitedHealthcare Individual Exchange	$85.24

chloroprocaine (pf) per 30 mL

Facility

$85.24

Service Code	HCPCS J2401
Hospital Revenue Code	250
Min. Negotiated Rate	$48.59
Max. Negotiated Rate	$85.24
Rate for Payer: Aetna Commercial/Medicare Advantage	$60.09
Rate for Payer: Aetna Workers' Compensation	$60.09
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$59.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$59.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$67.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$65.63
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$67.17
Rate for Payer: Cash Price	$85.24
Rate for Payer: Cigna Commercial	$52.17
Rate for Payer: Cigna Medicare Advantage	$48.59
Rate for Payer: Harmony Health CHIP/Medicaid	$53.70
Rate for Payer: Home State Health Plan Exchange	$48.59
Rate for Payer: Humana Medicare	$63.93
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$63.93
Rate for Payer: Provider Network of America Commercial	$68.19
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: UnitedHealthcare Individual Exchange	$85.24

Know your out-of-pocket cost for care.

All Charges