Ray County Hospital

All Charges

Charge

Type

Setting

Price

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$17,053.95

Service Code	MSDRG 939
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,053.95
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$17,053.95

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$9,530.19

Service Code	MSDRG 941
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,530.19
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	$9,530.19

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$18,165.03

Service Code	MSDRG 876
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,165.03
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	$18,165.03

Orthovisc inj per dose

Facility

$1,418.82

Service Code	HCPCS J7324
Hospital Charge Code	Px0636J732401
Hospital Revenue Code	636
Min. Negotiated Rate	$808.73
Max. Negotiated Rate	$1,418.82
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,000.27
Rate for Payer: Aetna Workers' Compensation	$1,000.27
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$983.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$983.24
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$1,118.03
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$1,118.03
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$1,118.03
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$1,092.49
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$1,118.03
Rate for Payer: Cash Price	$1,418.82
Rate for Payer: Cigna Commercial	$868.32
Rate for Payer: Cigna Medicare Advantage	$808.73
Rate for Payer: Harmony Health CHIP/Medicaid	$893.86
Rate for Payer: Home State Health Plan Exchange	$808.73
Rate for Payer: Humana Medicare	$1,064.12
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$1,064.12
Rate for Payer: Provider Network of America Commercial	$1,135.06
Rate for Payer: UnitedHealthcare Commercial	$936.42
Rate for Payer: UnitedHealthcare Individual Exchange	$1,418.82

Orthovisc inj per dose

Facility

$1,418.82

Service Code	HCPCS J7324
Hospital Charge Code	Px0636J732401
Hospital Revenue Code	636
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	$1,418.82
Rate for Payer: Cash Price	$1,418.82
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	$1,064.12
Rate for Payer: Provider Network of America Commercial	$1,135.06

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$10.40

Service Code	NDC 68180067511
Hospital Revenue Code	637
Min. Negotiated Rate	$7.80
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	$10.40
Rate for Payer: Cash Price	$10.40
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	$7.80
Rate for Payer: Provider Network of America Commercial	$8.32

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$10.40

Service Code	NDC 68180067511
Hospital Revenue Code	637
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$7.33
Rate for Payer: Aetna Workers' Compensation	$7.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$7.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$7.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$8.01
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$8.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna Commercial	$6.36
Rate for Payer: Cigna Medicare Advantage	$5.93
Rate for Payer: Harmony Health CHIP/Medicaid	$6.55
Rate for Payer: Home State Health Plan Exchange	$5.93
Rate for Payer: Humana Medicare	$7.80
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$7.80
Rate for Payer: Provider Network of America Commercial	$8.32
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Individual Exchange	$10.40

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$4.80

Service Code	NDC 64380079701
Hospital Revenue Code	637
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$3.38
Rate for Payer: Aetna Workers' Compensation	$3.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$3.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$3.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3.70
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3.78
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cigna Commercial	$2.94
Rate for Payer: Cigna Medicare Advantage	$2.74
Rate for Payer: Harmony Health CHIP/Medicaid	$3.02
Rate for Payer: Home State Health Plan Exchange	$2.74
Rate for Payer: Humana Medicare	$3.60
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3.60
Rate for Payer: Provider Network of America Commercial	$3.84
Rate for Payer: UnitedHealthcare Commercial	$3.17
Rate for Payer: UnitedHealthcare Individual Exchange	$4.80

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$4.80

Service Code	NDC 64380079701
Hospital Revenue Code	637
Min. Negotiated Rate	$3.60
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	$4.80
Rate for Payer: Cash Price	$4.80
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	$3.60
Rate for Payer: Provider Network of America Commercial	$3.84

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$31.82

Service Code	NDC 60219126401
Hospital Revenue Code	637
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$31.82
Rate for Payer: Aetna Commercial/Medicare Advantage	$22.43
Rate for Payer: Aetna Workers' Compensation	$22.43
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$22.05
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$22.05
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$25.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$25.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$25.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$24.50
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$25.07
Rate for Payer: Cash Price	$31.82
Rate for Payer: Cigna Commercial	$19.47
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Harmony Health CHIP/Medicaid	$20.05
Rate for Payer: Home State Health Plan Exchange	$18.14
Rate for Payer: Humana Medicare	$23.86
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$23.86
Rate for Payer: Provider Network of America Commercial	$25.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Individual Exchange	$31.82

oseltamivir 30 mg capsule 10 Each BLIST PACK

Facility

$31.82

Service Code	NDC 60219126401
Hospital Revenue Code	637
Min. Negotiated Rate	$23.86
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	$31.82
Rate for Payer: Cash Price	$31.82
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	$23.86
Rate for Payer: Provider Network of America Commercial	$25.46

oseltamivir 75 mg capsule 10 Each BLIST PACK

Facility

$7.40

Service Code	NDC 72205004411
Hospital Revenue Code	637
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$7.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$5.22
Rate for Payer: Aetna Workers' Compensation	$5.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$5.13
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$5.13
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$5.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$5.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$5.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$5.70
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$5.83
Rate for Payer: Cash Price	$7.40
Rate for Payer: Cigna Commercial	$4.53
Rate for Payer: Cigna Medicare Advantage	$4.22
Rate for Payer: Harmony Health CHIP/Medicaid	$4.66
Rate for Payer: Home State Health Plan Exchange	$4.22
Rate for Payer: Humana Medicare	$5.55
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$5.55
Rate for Payer: Provider Network of America Commercial	$5.92
Rate for Payer: UnitedHealthcare Commercial	$4.88
Rate for Payer: UnitedHealthcare Individual Exchange	$7.40

oseltamivir 75 mg capsule 10 Each BLIST PACK

Facility

$10.40

Service Code	NDC 68180067711
Hospital Revenue Code	637
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$7.33
Rate for Payer: Aetna Workers' Compensation	$7.33
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$7.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$7.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$8.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$8.01
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$8.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cigna Commercial	$6.36
Rate for Payer: Cigna Medicare Advantage	$5.93
Rate for Payer: Harmony Health CHIP/Medicaid	$6.55
Rate for Payer: Home State Health Plan Exchange	$5.93
Rate for Payer: Humana Medicare	$7.80
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$7.80
Rate for Payer: Provider Network of America Commercial	$8.32
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Individual Exchange	$10.40

oseltamivir 75 mg capsule 10 Each BLIST PACK

Facility

$7.40

Service Code	NDC 72205004411
Hospital Revenue Code	637
Min. Negotiated Rate	$5.55
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	$7.40
Rate for Payer: Cash Price	$7.40
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	$5.55
Rate for Payer: Provider Network of America Commercial	$5.92

oseltamivir 75 mg capsule 10 Each BLIST PACK

Facility

$10.40

Service Code	NDC 68180067711
Hospital Revenue Code	637
Min. Negotiated Rate	$7.80
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	$10.40
Rate for Payer: Cash Price	$10.40
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	$7.80
Rate for Payer: Provider Network of America Commercial	$8.32

Ostectomy Complete 5th Metatarsal Head

Professional

Both

$1,248.00

Service Code	CPT 28113
Hospital Charge Code	Px00000028113
Hospital Revenue Code	520
Min. Negotiated Rate	$475.14
Max. Negotiated Rate	$475.14
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$475.14

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$24,348.13

Service Code	APR-DRG 3444
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$24,348.13
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	$24,348.13
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$24,348.13
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$24,348.13
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$24,348.13

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$10,261.24

Service Code	APR-DRG 3442
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,261.24
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: Family Health Partners Medicaid	$10,261.24
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,261.24
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,261.24
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,261.24

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$15,206.49

Service Code	APR-DRG 3443
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,206.49
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	$15,206.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,206.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,206.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,206.49

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$7,459.02

Service Code	APR-DRG 3441
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,459.02
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	$7,459.02
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,459.02
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,459.02
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,459.02

OSTEOMYELITIS WITH CC

Facility

$6,092.61

Service Code	MSDRG 540
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,092.61
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	$6,092.61

OSTEOMYELITIS WITH MCC

Facility

$9,257.59

Service Code	MSDRG 539
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,257.59
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	$9,257.59

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 541
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	$3,626.05

OTHER AFTERCARE AND CONVALESCENCE

Facility

$8,151.48

Service Code	APR-DRG 8621
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,151.48
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	$8,151.48
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,151.48
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,151.48
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,151.48

OTHER AFTERCARE AND CONVALESCENCE

Facility

$11,423.36

Service Code	APR-DRG 8622
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,423.36
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	$11,423.36
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,423.36
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,423.36
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,423.36

Know your out-of-pocket cost for care.

All Charges