Ray County Hospital

All Charges

Charge

Type

Setting

Price

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

copper 380 square mm intrauterine device 1 Each Packet

Facility

$4,748.00

Service Code	NDC 59365512801
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

copper 380 square mm intrauterine device 1 Each Packet

Facility

$4,748.00

Service Code	NDC 59365512801
Hospital Revenue Code	250
Min. Negotiated Rate	$2,706.36
Max. Negotiated Rate	$4,748.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$3,347.34
Rate for Payer: Aetna Workers' Compensation	$3,347.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$3,290.36
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$3,290.36
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3,741.42
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,741.42
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,741.42
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3,655.96
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3,741.42
Rate for Payer: Cash Price	$4,748.00
Rate for Payer: Cigna Commercial	$2,905.78
Rate for Payer: Cigna Medicare Advantage	$2,706.36
Rate for Payer: Harmony Health CHIP/Medicaid	$2,991.24
Rate for Payer: Home State Health Plan Exchange	$2,706.36
Rate for Payer: Humana Medicare	$3,561.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3,561.00
Rate for Payer: Provider Network of America Commercial	$3,798.40
Rate for Payer: UnitedHealthcare Commercial	$3,133.68
Rate for Payer: UnitedHealthcare Individual Exchange	$4,748.00

Core Needle Bx Lung/Mediastinum Perq W/Img

Facility

$207.48

Service Code	CPT 32408
Hospital Charge Code	Px09723240801
Hospital Revenue Code	972
Min. Negotiated Rate	$155.61
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	$207.48
Rate for Payer: Cash Price	$207.48
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	$155.61
Rate for Payer: Provider Network of America Commercial	$165.98

Core Needle Bx Lung/Mediastinum Perq W/Img

Facility

$207.48

Service Code	CPT 32408
Hospital Charge Code	Px09723240801
Hospital Revenue Code	972
Min. Negotiated Rate	$118.26
Max. Negotiated Rate	$2,251.11
Rate for Payer: Aetna Commercial/Medicare Advantage	$146.27
Rate for Payer: Aetna Workers' Compensation	$146.27
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$143.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$143.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$163.49
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$163.49
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$163.49
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$159.76
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$163.49
Rate for Payer: Cash Price	$207.48
Rate for Payer: Cash Price	$207.48
Rate for Payer: Cigna Commercial	$126.98
Rate for Payer: Cigna Medicare Advantage	$118.26
Rate for Payer: Family Health Partners Medicaid	$2,084.36
Rate for Payer: Harmony Health CHIP/Medicaid	$130.71
Rate for Payer: Healthy Blue Medicaid	$2,251.11
Rate for Payer: Home State Health Plan Exchange	$118.26
Rate for Payer: Home State Health Plan Medicaid	$2,084.36
Rate for Payer: Humana Medicare	$155.61
Rate for Payer: Mercy CarePlus Medicaid	$2,084.36
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$155.61
Rate for Payer: Provider Network of America Commercial	$165.98
Rate for Payer: UnitedHealthcare Commercial	$136.94
Rate for Payer: UnitedHealthcare Individual Exchange	$207.48
Rate for Payer: UnitedHealthcare Medicaid	$1,569.23

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$44,736.55

Service Code	APR-DRG 1652
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$44,736.55
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: Family Health Partners Medicaid	$44,736.55
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$44,736.55
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$44,736.55
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$44,736.55

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$55,174.37

Service Code	APR-DRG 1653
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$55,174.37
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	$55,174.37
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$55,174.37
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$55,174.37
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$55,174.37

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$75,357.54

Service Code	APR-DRG 1654
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$75,357.54
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	$75,357.54
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$75,357.54
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$75,357.54
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$75,357.54

CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$39,281.89

Service Code	APR-DRG 1651
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$39,281.89
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	$39,281.89
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$39,281.89
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$39,281.89
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$39,281.89

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$35,932.44

Service Code	MSDRG 233
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$35,932.44
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	$35,932.44

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$25,674.69

Service Code	MSDRG 234
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,674.69
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	$25,674.69

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$65,369.96

Service Code	APR-DRG 1664
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$65,369.96
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	$65,369.96
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$65,369.96
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$65,369.96
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$65,369.96

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$33,155.10

Service Code	APR-DRG 1661
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$33,155.10
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	$33,155.10
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$33,155.10
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$33,155.10
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$33,155.10

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$38,587.57

Service Code	APR-DRG 1662
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$38,587.57
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	$38,587.57
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$38,587.57
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$38,587.57
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$38,587.57

CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$47,743.09

Service Code	APR-DRG 1663
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$47,743.09
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	$47,743.09
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$47,743.09
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$47,743.09
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$47,743.09

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$27,582.42

Service Code	MSDRG 235
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$27,582.42
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$27,582.42

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$19,687.36

Service Code	MSDRG 236
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,687.36
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	$19,687.36

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$39,620.53

Service Code	MSDRG 231
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$39,620.53
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	$39,620.53

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$28,494.22

Service Code	MSDRG 232
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$28,494.22
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	$28,494.22

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$20,338.78

Service Code	MSDRG 323
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$20,338.78
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	$20,338.78

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$14,809.70

Service Code	MSDRG 324
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$14,809.70
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$14,809.70

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$15,088.88

Service Code	MSDRG 325
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,088.88
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	$15,088.88

Correction Hammertoe

Facility

$6,604.87

Service Code	CPT 28285
Hospital Charge Code	Px07612828501
Hospital Revenue Code	761
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	$6,604.87
Rate for Payer: Cash Price	$6,604.87
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	$4,953.65
Rate for Payer: Provider Network of America Commercial	$5,283.90

Correction Hammertoe

Facility

$388.50

Service Code	CPT 28285
Hospital Charge Code	Px09752828501
Hospital Revenue Code	975
Min. Negotiated Rate	$221.44
Max. Negotiated Rate	$4,459.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$273.89
Rate for Payer: Aetna Workers' Compensation	$273.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$269.23
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$269.23
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$306.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$306.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$306.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$299.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$306.14
Rate for Payer: Cash Price	$388.50
Rate for Payer: Cash Price	$388.50
Rate for Payer: Cigna Commercial	$237.76
Rate for Payer: Cigna Medicare Advantage	$221.44
Rate for Payer: Family Health Partners Medicaid	$4,129.36
Rate for Payer: Harmony Health CHIP/Medicaid	$244.75
Rate for Payer: Healthy Blue Medicaid	$4,459.70
Rate for Payer: Home State Health Plan Exchange	$221.44
Rate for Payer: Home State Health Plan Medicaid	$4,129.36
Rate for Payer: Humana Medicare	$291.38
Rate for Payer: Mercy CarePlus Medicaid	$4,129.36
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$291.38
Rate for Payer: Provider Network of America Commercial	$310.80
Rate for Payer: UnitedHealthcare Commercial	$256.41
Rate for Payer: UnitedHealthcare Individual Exchange	$388.50
Rate for Payer: UnitedHealthcare Medicaid	$3,108.82

Correction Hammertoe

Facility

$388.50

Service Code	CPT 28285
Hospital Charge Code	Px09752828501
Hospital Revenue Code	975
Min. Negotiated Rate	$291.38
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	$388.50
Rate for Payer: Cash Price	$388.50
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	$291.38
Rate for Payer: Provider Network of America Commercial	$310.80

Know your out-of-pocket cost for care.

All Charges