Ray County Hospital

All Charges

Charge

Type

Setting

Price

Njx Anes Stellate Ganglion Crv Sympathetic

Facility

$1,919.91

Service Code	CPT 64510
Hospital Charge Code	Px07616451001
Hospital Revenue Code	761
Min. Negotiated Rate	$840.36
Max. Negotiated Rate	$1,919.91
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,353.54
Rate for Payer: Aetna Workers' Compensation	$1,353.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$1,330.50
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$1,330.50
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$1,512.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$1,512.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$1,512.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$1,478.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$1,512.89
Rate for Payer: Cash Price	$1,919.91
Rate for Payer: Cash Price	$1,919.91
Rate for Payer: Cigna Commercial	$1,174.98
Rate for Payer: Cigna Medicare Advantage	$1,094.35
Rate for Payer: Family Health Partners Medicaid	$1,116.23
Rate for Payer: Harmony Health CHIP/Medicaid	$1,209.54
Rate for Payer: Healthy Blue Medicaid	$1,205.53
Rate for Payer: Home State Health Plan Exchange	$1,094.35
Rate for Payer: Home State Health Plan Medicaid	$1,116.23
Rate for Payer: Humana Medicare	$1,439.93
Rate for Payer: Mercy CarePlus Medicaid	$1,116.23
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$1,439.93
Rate for Payer: Provider Network of America Commercial	$1,535.93
Rate for Payer: UnitedHealthcare Commercial	$1,267.14
Rate for Payer: UnitedHealthcare Individual Exchange	$1,919.91
Rate for Payer: UnitedHealthcare Medicaid	$840.36

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 3+ Level

Facility

$861.00

Service Code	CPT 64492
Hospital Charge Code	Px07616449201
Hospital Revenue Code	761
Min. Negotiated Rate	$645.75
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	$861.00
Rate for Payer: Cash Price	$861.00
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	$645.75
Rate for Payer: Provider Network of America Commercial	$688.80

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 3+ Level

Facility

$861.00

Service Code	CPT 64492
Hospital Charge Code	Px07616449201
Hospital Revenue Code	761
Min. Negotiated Rate	$490.77
Max. Negotiated Rate	$861.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$645.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$607.00
Rate for Payer: Aetna Workers' Compensation	$607.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$596.67
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$596.67
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$678.47
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$678.47
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$678.47
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$662.97
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$678.47
Rate for Payer: Cash Price	$861.00
Rate for Payer: Cigna Commercial	$526.93
Rate for Payer: Cigna Medicare Advantage	$490.77
Rate for Payer: Harmony Health CHIP/Medicaid	$542.43
Rate for Payer: Home State Health Plan Exchange	$490.77
Rate for Payer: Humana Medicare	$645.75
Rate for Payer: Provider Network of America Commercial	$688.80
Rate for Payer: UnitedHealthcare Commercial	$568.26
Rate for Payer: UnitedHealthcare Individual Exchange	$861.00

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$10,786.03

Service Code	MSDRG 098
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,786.03
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	$10,786.03

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$16,975.46

Service Code	MSDRG 097
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,975.46
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	$16,975.46

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$6,403.28

Service Code	MSDRG 099
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,403.28
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	$6,403.28

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$8,040.54

Service Code	APR-DRG 0501
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,040.54
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	$8,040.54
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,040.54
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,040.54
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,040.54

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$14,453.01

Service Code	APR-DRG 0502
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$14,453.01
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	$14,453.01
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$14,453.01
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$14,453.01
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$14,453.01

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$23,761.99

Service Code	APR-DRG 0503
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$23,761.99
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: Family Health Partners Medicaid	$23,761.99
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$23,761.99
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$23,761.99
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$23,761.99

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$40,342.31

Service Code	APR-DRG 0504
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$40,342.31
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	$40,342.31
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$40,342.31
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$40,342.31
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$40,342.31

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$25,864.34

Service Code	APR-DRG 3233
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,864.34
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	$25,864.34
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,864.34
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,864.34
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,864.34

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$37,430.08

Service Code	APR-DRG 3234
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$37,430.08
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	$37,430.08
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$37,430.08
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$37,430.08
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$37,430.08

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$19,570.22

Service Code	APR-DRG 3232
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,570.22
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: Family Health Partners Medicaid	$19,570.22
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$19,570.22
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$19,570.22
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$19,570.22

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$16,184.63

Service Code	APR-DRG 3231
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,184.63
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: Family Health Partners Medicaid	$16,184.63
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$16,184.63
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$16,184.63
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$16,184.63

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$21,143.75

Service Code	APR-DRG 3251
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,143.75
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: Family Health Partners Medicaid	$21,143.75
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$21,143.75
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$21,143.75
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$21,143.75

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$32,075.26

Service Code	APR-DRG 3253
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$32,075.26
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	$32,075.26
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$32,075.26
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$32,075.26
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$32,075.26

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$25,793.16

Service Code	APR-DRG 3252
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,793.16
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: Family Health Partners Medicaid	$25,793.16
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,793.16
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,793.16
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,793.16

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$39,920.73

Service Code	APR-DRG 3254
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$39,920.73
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	$39,920.73
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$39,920.73
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$39,920.73
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$39,920.73

NON-EXTENSIVE BURNS

Facility

$9,682.00

Service Code	MSDRG 935
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,682.00
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	$9,682.00

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$18,237.06

Service Code	APR-DRG 7943
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,237.06
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	$18,237.06
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$18,237.06
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$18,237.06
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$18,237.06

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$9,497.58

Service Code	APR-DRG 7941
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,497.58
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	$9,497.58
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,497.58
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,497.58
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,497.58

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$36,603.56

Service Code	APR-DRG 7944
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$36,603.56
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	$36,603.56
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$36,603.56
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$36,603.56
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$36,603.56

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$12,820.30

Service Code	APR-DRG 7942
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,820.30
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	$12,820.30
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,820.30
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,820.30
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,820.30

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$7,724.92

Service Code	MSDRG 988
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,724.92
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	$7,724.92

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$16,113.48

Service Code	MSDRG 987
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,113.48
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$16,113.48

Know your out-of-pocket cost for care.

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