Ray County Hospital

All Charges

Charge

Type

Setting

Price

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$10,720.00

Service Code	MSDRG 416
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,720.00
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	$10,720.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$10,720.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$10,720.00
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	$10,720.00
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	$6,407.51

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$9,881.75

Service Code	MSDRG 412
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,881.75
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	$9,881.75

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$15,525.51

Service Code	MSDRG 411
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,525.51
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	$15,525.51

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$7,804.35

Service Code	MSDRG 413
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,804.35
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$7,804.35

CHRONIC KIDNEY DISEASE

Facility

$12,533.70

Service Code	APR-DRG 4703
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,533.70
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	$12,533.70
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,533.70
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,533.70
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,533.70

CHRONIC KIDNEY DISEASE

Facility

$23,633.48

Service Code	APR-DRG 4704
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$23,633.48
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	$23,633.48
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$23,633.48
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$23,633.48
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$23,633.48

CHRONIC KIDNEY DISEASE

Facility

$6,762.86

Service Code	APR-DRG 4702
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,762.86
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	$6,762.86
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,762.86
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,762.86
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,762.86

CHRONIC KIDNEY DISEASE

Facility

$6,053.00

Service Code	APR-DRG 4701
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	$5,426.93
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,426.93
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,426.93
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,426.93

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$6,682.42

Service Code	APR-DRG 1402
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,682.42
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	$6,682.42
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,682.42
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,682.42
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,682.42

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$9,486.49

Service Code	APR-DRG 1403
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,486.49
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	$9,486.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,486.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,486.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,486.49

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$16,985.26

Service Code	APR-DRG 1404
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,985.26
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	$16,985.26
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$16,985.26
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$16,985.26
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$16,985.26

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$6,053.00

Service Code	APR-DRG 1401
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	$5,316.91
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,316.91
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,316.91
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,316.91

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$7,167.00

Service Code	MSDRG 191
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,167.00
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	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$7,167.00
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	$7,167.00
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	$3,962.10

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$7,167.00

Service Code	MSDRG 190
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,167.00
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	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$7,167.00
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	$7,167.00
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	$5,206.19

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$7,167.00

Service Code	MSDRG 192
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,167.00
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	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$7,167.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$7,167.00
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	$7,167.00
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	$3,017.40

Cilastatin sodium injection

Facility

$32.25

Service Code	HCPCS J0743
Hospital Charge Code	Px0636J074301
Hospital Revenue Code	636
Min. Negotiated Rate	$24.19
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	$32.25
Rate for Payer: Cash Price	$32.25
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	$24.19
Rate for Payer: Provider Network of America Commercial	$25.80

Cilastatin sodium injection

Facility

$32.25

Service Code	HCPCS J0743
Hospital Charge Code	Px0636J074301
Hospital Revenue Code	636
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$32.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$22.74
Rate for Payer: Aetna Workers' Compensation	$22.74
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$22.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$22.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$25.41
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$25.41
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$25.41
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$24.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$25.41
Rate for Payer: Cash Price	$32.25
Rate for Payer: Cigna Commercial	$19.74
Rate for Payer: Cigna Medicare Advantage	$18.38
Rate for Payer: Harmony Health CHIP/Medicaid	$20.32
Rate for Payer: Home State Health Plan Exchange	$18.38
Rate for Payer: Humana Medicare	$24.19
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$24.19
Rate for Payer: Provider Network of America Commercial	$25.80
Rate for Payer: UnitedHealthcare Commercial	$21.29
Rate for Payer: UnitedHealthcare Individual Exchange	$32.25

ciprofloxacin 0.3 % drops 2.5 mL DROP BTL

Facility

$45.00

Service Code	NDC 69315030802
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

ciprofloxacin 0.3 % drops 2.5 mL DROP BTL

Facility

$45.00

Service Code	NDC 69315030802
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

ciprofloxacin 400 mg/200 mL piggyback 200 mL Bag

Facility

$35.00

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$24.68
Rate for Payer: Aetna Workers' Compensation	$24.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$24.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$24.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$26.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$27.58
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cigna Commercial	$21.42
Rate for Payer: Cigna Medicare Advantage	$19.95
Rate for Payer: Harmony Health CHIP/Medicaid	$22.05
Rate for Payer: Home State Health Plan Exchange	$19.95
Rate for Payer: Humana Medicare	$26.25
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: UnitedHealthcare Individual Exchange	$35.00

ciprofloxacin 400 mg/200 mL piggyback 200 mL Bag

Facility

$35.00

Service Code	NDC 00409330001
Hospital Revenue Code	250
Min. Negotiated Rate	$26.25
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	$35.00
Rate for Payer: Cash Price	$35.00
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	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00

ciprofloxacin 400 mg/200 mL piggyback 200 mL Bag

Facility

$35.00

Service Code	NDC 00409330001
Hospital Revenue Code	250
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$24.68
Rate for Payer: Aetna Workers' Compensation	$24.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$24.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$24.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$27.58
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$26.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$27.58
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cigna Commercial	$21.42
Rate for Payer: Cigna Medicare Advantage	$19.95
Rate for Payer: Harmony Health CHIP/Medicaid	$22.05
Rate for Payer: Home State Health Plan Exchange	$19.95
Rate for Payer: Humana Medicare	$26.25
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00
Rate for Payer: UnitedHealthcare Commercial	$23.10
Rate for Payer: UnitedHealthcare Individual Exchange	$35.00

ciprofloxacin 400 mg/200 mL piggyback 200 mL Bag

Facility

$35.00

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$26.25
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	$35.00
Rate for Payer: Cash Price	$35.00
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	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00

ciprofloxacin 500 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904708361
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

ciprofloxacin 500 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904708361
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

Know your out-of-pocket cost for care.

All Charges