Ray County Hospital

All Charges

Charge

Type

Setting

Price

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 (e.g., interphalangeal fusion, partial or total phalangectomy)

Facility

$4,459.70

Service Code	CPT 28285
Hospital Revenue Code	361
Min. Negotiated Rate	$3,108.82
Max. Negotiated Rate	$4,459.70
Rate for Payer: Family Health Partners Medicaid	$4,129.36
Rate for Payer: Healthy Blue Medicaid	$4,459.70
Rate for Payer: Home State Health Plan Medicaid	$4,129.36
Rate for Payer: Mercy CarePlus Medicaid	$4,129.36
Rate for Payer: UnitedHealthcare Medicaid	$3,108.82

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Facility

$6,987.75

Service Code	CPT 28292
Hospital Charge Code	Px05102829201
Hospital Revenue Code	510
Min. Negotiated Rate	$3,108.82
Max. Negotiated Rate	$6,987.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$4,926.36
Rate for Payer: Aetna Workers' Compensation	$4,926.36
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$4,842.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$4,842.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$5,506.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$5,506.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$5,506.35
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$5,380.57
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$5,506.35
Rate for Payer: Cash Price	$6,987.75
Rate for Payer: Cash Price	$6,987.75
Rate for Payer: Cigna Medicare Advantage	$3,983.02
Rate for Payer: Family Health Partners Medicaid	$4,129.36
Rate for Payer: Harmony Health CHIP/Medicaid	$4,402.28
Rate for Payer: Healthy Blue Medicaid	$4,459.70
Rate for Payer: Home State Health Plan Exchange	$3,983.02
Rate for Payer: Home State Health Plan Medicaid	$4,129.36
Rate for Payer: Humana Medicare	$5,240.81
Rate for Payer: Mercy CarePlus Medicaid	$4,129.36
Rate for Payer: Provider Network of America Commercial	$5,590.20
Rate for Payer: UnitedHealthcare Commercial	$4,611.91
Rate for Payer: UnitedHealthcare Individual Exchange	$6,987.75
Rate for Payer: UnitedHealthcare Medicaid	$3,108.82

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Facility

$6,987.75

Service Code	CPT 28292
Hospital Charge Code	Px05102829201
Hospital Revenue Code	510
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	$6,987.75
Rate for Payer: Cash Price	$6,987.75
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: Provider Network of America Commercial	$5,590.20

cosyntropin 0.25 mg recon soln 1 Each Vial

Facility

$320.80

Service Code	NDC 00781344071
Hospital Revenue Code	250
Min. Negotiated Rate	$182.86
Max. Negotiated Rate	$320.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$226.16
Rate for Payer: Aetna Workers' Compensation	$226.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$222.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$222.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$247.02
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$252.79
Rate for Payer: Cash Price	$320.80
Rate for Payer: Cigna Commercial	$196.33
Rate for Payer: Cigna Medicare Advantage	$182.86
Rate for Payer: Harmony Health CHIP/Medicaid	$202.10
Rate for Payer: Home State Health Plan Exchange	$182.86
Rate for Payer: Humana Medicare	$240.60
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$240.60
Rate for Payer: Provider Network of America Commercial	$256.64
Rate for Payer: UnitedHealthcare Commercial	$211.73
Rate for Payer: UnitedHealthcare Individual Exchange	$320.80

cosyntropin 0.25 mg recon soln 1 Each Vial

Facility

$320.80

Service Code	NDC 00781344071
Hospital Revenue Code	250
Min. Negotiated Rate	$240.60
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	$320.80
Rate for Payer: Cash Price	$320.80
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	$240.60
Rate for Payer: Provider Network of America Commercial	$256.64

cosyntropin 0.25 mg recon soln 1 Each Vial

Facility

$320.80

Service Code	HCPCS J0834
Hospital Revenue Code	250
Min. Negotiated Rate	$182.86
Max. Negotiated Rate	$320.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$226.16
Rate for Payer: Aetna Workers' Compensation	$226.16
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$222.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$222.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$252.79
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$247.02
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$252.79
Rate for Payer: Cash Price	$320.80
Rate for Payer: Cigna Commercial	$196.33
Rate for Payer: Cigna Medicare Advantage	$182.86
Rate for Payer: Harmony Health CHIP/Medicaid	$202.10
Rate for Payer: Home State Health Plan Exchange	$182.86
Rate for Payer: Humana Medicare	$240.60
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$240.60
Rate for Payer: Provider Network of America Commercial	$256.64
Rate for Payer: UnitedHealthcare Commercial	$211.73
Rate for Payer: UnitedHealthcare Individual Exchange	$320.80

cosyntropin 0.25 mg recon soln 1 Each Vial

Facility

$320.80

Service Code	HCPCS J0834
Hospital Revenue Code	250
Min. Negotiated Rate	$240.60
Max. Negotiated Rate	$6,053.00
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 Advantage (HMO)	$875.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Cash Price	$320.80
Rate for Payer: Cash Price	$320.80
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	$240.60
Rate for Payer: Provider Network of America Commercial	$256.64

Cpap Ventilation Cpap Initiation&Mgmt

Professional

Both

$1,092.00

Service Code	CPT 94660
Hospital Charge Code	Px00000094660
Hospital Revenue Code	520
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$39.45
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$39.45

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$7,540.21

Service Code	MSDRG 073
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,540.21
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	$7,540.21

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$6,053.00

Service Code	MSDRG 074
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	$4,844.76

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$14,613.24

Service Code	MSDRG 026
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$14,613.24
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	$14,613.24

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$21,369.49

Service Code	MSDRG 025
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,369.49
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$21,369.49

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$11,857.63

Service Code	MSDRG 027
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,857.63
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$11,857.63

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$71,009.53

Service Code	APR-DRG 9104
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$71,009.53
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: Family Health Partners Medicaid	$71,009.53
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$71,009.53
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$71,009.53
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$71,009.53

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$25,975.29

Service Code	APR-DRG 9101
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,975.29
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	$25,975.29
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,975.29
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,975.29
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,975.29

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$32,960.95

Service Code	APR-DRG 9102
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$32,960.95
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	$32,960.95
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$32,960.95
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$32,960.95
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$32,960.95

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$31,636.17

Service Code	MSDRG 955
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$31,636.17
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	$31,636.17

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$47,576.67

Service Code	APR-DRG 9103
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$47,576.67
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	$47,576.67
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$47,576.67
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$47,576.67
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$47,576.67

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$26,932.41

Service Code	MSDRG 023
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$26,932.41
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	$26,932.41

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$18,385.93

Service Code	MSDRG 024
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,385.93
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	$18,385.93

Critical Care 30-74 Minutes

Facility

$2,200.00

Service Code	CPT 99291
Hospital Charge Code	Px04509929102
Hospital Revenue Code	450
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: UnitedHealthcare Medicaid	$784.84
Rate for Payer: Aetna Commercial/Medicare Advantage	$781.00
Rate for Payer: Aetna Workers' Compensation	$781.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$1,524.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$1,524.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$1,733.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$1,733.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$1,733.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$1,694.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$1,733.60
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Cash Price	$2,200.00
Rate for Payer: Cigna Commercial	$1,346.40
Rate for Payer: Cigna Medicare Advantage	$1,254.00
Rate for Payer: Family Health Partners Medicaid	$1,042.48
Rate for Payer: Harmony Health CHIP/Medicaid	$1,386.00
Rate for Payer: Healthy Blue Medicaid	$1,125.88
Rate for Payer: Home State Health Plan Exchange	$1,254.00
Rate for Payer: Home State Health Plan Medicaid	$1,042.48
Rate for Payer: Humana Medicare	$550.00
Rate for Payer: Mercy CarePlus Medicaid	$1,042.48
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$1,650.00
Rate for Payer: Provider Network of America Commercial	$1,760.00
Rate for Payer: UnitedHealthcare Commercial	$1,452.00
Rate for Payer: UnitedHealthcare Individual Exchange	$2,200.00

Critical Care 30-74 Minutes

Facility

$2,200.00

Service Code	CPT 99291
Hospital Charge Code	Px04509929102
Hospital Revenue Code	450
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	$2,200.00
Rate for Payer: Cash Price	$2,200.00
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	$1,650.00
Rate for Payer: Provider Network of America Commercial	$1,760.00

Critical Care, E/M 30-74 Minutes

Facility

$2,700.00

Service Code	CPT 99291
Hospital Charge Code	Px09839929101
Hospital Revenue Code	983
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 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	$2,835.00
Rate for Payer: Cash Price	$2,835.00
Rate for Payer: Cash Price	$2,700.00
Rate for Payer: Cash Price	$2,700.00
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	$2,126.25
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$2,025.00
Rate for Payer: Provider Network of America Commercial	$2,160.00
Rate for Payer: Provider Network of America Commercial	$2,268.00

Critical Care, E/M 30-74 Minutes

Facility

$2,700.00

Service Code	CPT 99291
Hospital Charge Code	Px09839929101
Hospital Revenue Code	983
Min. Negotiated Rate	$784.84
Max. Negotiated Rate	$2,700.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,903.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,998.67
Rate for Payer: Aetna Workers' Compensation	$1,998.67
Rate for Payer: Aetna Workers' Compensation	$1,903.50
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$1,964.65
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$1,871.10
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$1,964.65
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$1,871.10
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$2,127.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$2,233.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$2,233.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$2,127.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$2,127.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$2,233.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$2,079.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$2,182.95
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$2,127.60
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$2,233.98
Rate for Payer: Cash Price	$2,835.00
Rate for Payer: Cash Price	$2,700.00
Rate for Payer: Cash Price	$2,700.00
Rate for Payer: Cash Price	$2,835.00
Rate for Payer: Cigna Commercial	$1,735.02
Rate for Payer: Cigna Commercial	$1,652.40
Rate for Payer: Cigna Medicare Advantage	$1,539.00
Rate for Payer: Cigna Medicare Advantage	$1,615.95
Rate for Payer: Family Health Partners Medicaid	$1,042.48
Rate for Payer: Family Health Partners Medicaid	$1,042.48
Rate for Payer: Harmony Health CHIP/Medicaid	$1,786.05
Rate for Payer: Harmony Health CHIP/Medicaid	$1,701.00
Rate for Payer: Healthy Blue Medicaid	$1,125.88
Rate for Payer: Healthy Blue Medicaid	$1,125.88
Rate for Payer: Home State Health Plan Exchange	$1,615.95
Rate for Payer: Home State Health Plan Exchange	$1,539.00
Rate for Payer: Home State Health Plan Medicaid	$1,042.48
Rate for Payer: Home State Health Plan Medicaid	$1,042.48
Rate for Payer: Humana Medicare	$2,025.00
Rate for Payer: Humana Medicare	$2,126.25
Rate for Payer: Mercy CarePlus Medicaid	$1,042.48
Rate for Payer: Mercy CarePlus Medicaid	$1,042.48
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$2,025.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$2,126.25
Rate for Payer: Provider Network of America Commercial	$2,160.00
Rate for Payer: Provider Network of America Commercial	$2,268.00
Rate for Payer: UnitedHealthcare Commercial	$1,871.10
Rate for Payer: UnitedHealthcare Commercial	$1,782.00
Rate for Payer: UnitedHealthcare Individual Exchange	$2,835.00
Rate for Payer: UnitedHealthcare Individual Exchange	$2,700.00
Rate for Payer: UnitedHealthcare Medicaid	$784.84
Rate for Payer: UnitedHealthcare Medicaid	$784.84

Know your out-of-pocket cost for care.

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