Ray County Hospital

All Charges

Charge

Type

Setting

Price

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$51,108.27

Service Code	MSDRG 212
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$51,108.27
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	$51,108.27

CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$31,426.55

Service Code	MSDRG 317
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$31,426.55
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	$31,426.55

CONCUSSION WITH CC

Facility

$6,053.00

Service Code	MSDRG 089
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	$5,163.42

CONCUSSION WITH MCC

Facility

$6,353.46

Service Code	MSDRG 088
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,353.46
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	$6,353.46

CONCUSSION WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 090
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	$3,869.04

CONNECTIVE TISSUE DISORDERS

Facility

$7,811.26

Service Code	APR-DRG 3461
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,811.26
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	$7,811.26
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,811.26
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,811.26
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,811.26

CONNECTIVE TISSUE DISORDERS

Facility

$31,841.36

Service Code	APR-DRG 3464
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$31,841.36
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: Family Health Partners Medicaid	$31,841.36
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$31,841.36
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$31,841.36
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$31,841.36

CONNECTIVE TISSUE DISORDERS

Facility

$16,946.43

Service Code	APR-DRG 3463
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,946.43
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	$16,946.43
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$16,946.43
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$16,946.43
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$16,946.43

CONNECTIVE TISSUE DISORDERS

Facility

$10,696.68

Service Code	APR-DRG 3462
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,696.68
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	$10,696.68
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,696.68
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,696.68
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,696.68

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$6,053.00

Service Code	MSDRG 546
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	$5,420.98

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$11,663.99

Service Code	MSDRG 545
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,663.99
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	$11,663.99

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 547
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	$3,930.14

Continuous Glucose Monitoring Analysis I&R

Professional

Both

$112.09

Service Code	CPT 95251
Hospital Charge Code	Px00000095251
Hospital Revenue Code	520
Min. Negotiated Rate	$41.94
Max. Negotiated Rate	$41.94
Rate for Payer: Cash Price	$112.09
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$41.94

Continuous Inhalation Treatment 1st Hr

Facility

$262.98

Service Code	CPT 94644
Hospital Charge Code	Px04109464401
Hospital Revenue Code	410
Min. Negotiated Rate	$197.24
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	$262.98
Rate for Payer: Cash Price	$262.98
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	$197.24
Rate for Payer: Provider Network of America Commercial	$210.38

Continuous Inhalation Treatment 1st Hr

Professional

Both

$274.00

Service Code	CPT 94644
Hospital Charge Code	Px00000094644
Hospital Revenue Code	520
Min. Negotiated Rate	$67.40
Max. Negotiated Rate	$67.40
Rate for Payer: Cash Price	$274.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$67.40

Continuous Inhalation Treatment 1st Hr

Facility

$262.98

Service Code	CPT 94644
Hospital Charge Code	Px04109464401
Hospital Revenue Code	410
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$262.98
Rate for Payer: Aetna Commercial/Medicare Advantage	$185.40
Rate for Payer: Aetna Workers' Compensation	$185.40
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$182.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$182.25
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$207.23
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$207.23
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$207.23
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$202.49
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$207.23
Rate for Payer: Cash Price	$262.98
Rate for Payer: Cash Price	$262.98
Rate for Payer: Cash Price	$262.98
Rate for Payer: Cigna Commercial	$160.94
Rate for Payer: Cigna Medicare Advantage	$149.90
Rate for Payer: Family Health Partners Medicaid	$167.92
Rate for Payer: Harmony Health CHIP/Medicaid	$165.68
Rate for Payer: Healthy Blue Medicaid	$181.35
Rate for Payer: Home State Health Plan Exchange	$149.90
Rate for Payer: Home State Health Plan Medicaid	$167.92
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Mercy CarePlus Medicaid	$167.92
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$197.24
Rate for Payer: Provider Network of America Commercial	$210.38
Rate for Payer: UnitedHealthcare Commercial	$173.57
Rate for Payer: UnitedHealthcare Individual Exchange	$262.98
Rate for Payer: UnitedHealthcare Medicaid	$126.42

Continuous Inhalation Treatment Ea Addl Hr

Facility

$120.75

Service Code	CPT 94645
Hospital Charge Code	Px04109464501
Hospital Revenue Code	410
Min. Negotiated Rate	$90.56
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	$120.75
Rate for Payer: Cash Price	$120.75
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	$90.56
Rate for Payer: Provider Network of America Commercial	$96.60

Continuous Inhalation Treatment Ea Addl Hr

Facility

$120.75

Service Code	CPT 94645
Hospital Charge Code	Px04109464501
Hospital Revenue Code	410
Min. Negotiated Rate	$68.83
Max. Negotiated Rate	$120.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$85.13
Rate for Payer: Aetna Workers' Compensation	$85.13
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$83.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$83.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$95.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$95.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$95.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$92.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$95.15
Rate for Payer: Cash Price	$120.75
Rate for Payer: Cash Price	$120.75
Rate for Payer: Cigna Commercial	$73.90
Rate for Payer: Cigna Medicare Advantage	$68.83
Rate for Payer: Harmony Health CHIP/Medicaid	$76.07
Rate for Payer: Home State Health Plan Exchange	$68.83
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$90.56
Rate for Payer: Provider Network of America Commercial	$96.60
Rate for Payer: UnitedHealthcare Commercial	$79.69
Rate for Payer: UnitedHealthcare Individual Exchange	$120.75

Continuous Inhalation Treatment Ea Addl Hr

Professional

Both

$126.00

Service Code	CPT 94645
Hospital Charge Code	Px00000094645
Hospital Revenue Code	520
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$18.04
Rate for Payer: Cash Price	$126.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$18.04

Control Nasal Hemorrhage Anterior Complex

Professional

Both

$256.00

Service Code	CPT 30903
Hospital Charge Code	Px00000030903
Hospital Revenue Code	520
Min. Negotiated Rate	$85.17
Max. Negotiated Rate	$85.17
Rate for Payer: Cash Price	$256.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$85.17

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$9,045.49

Service Code	APR-DRG 3842
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,045.49
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	$9,045.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,045.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,045.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,045.49

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$7,505.25

Service Code	APR-DRG 3841
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,505.25
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	$7,505.25
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,505.25
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,505.25
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,505.25

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$12,744.49

Service Code	APR-DRG 3843
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,744.49
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	$12,744.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,744.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,744.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,744.49

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$22,923.45

Service Code	APR-DRG 3844
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$22,923.45
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	$22,923.45
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$22,923.45
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$22,923.45
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$22,923.45

copper 380 square mm intrauterine device 1 Each Packet

Facility

$4,748.00

Service Code	HCPCS J7300
Hospital Revenue Code	250
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	$4,748.00
Rate for Payer: Cash Price	$4,748.00
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	$3,561.00
Rate for Payer: Provider Network of America Commercial	$3,798.40

Know your out-of-pocket cost for care.

All Charges