Ray County Hospital

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$35,566.25

Service Code	APR-DRG 0303
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$35,566.25
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	$35,566.25
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$35,566.25
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$35,566.25
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$35,566.25

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$40,027.97

Service Code	APR-DRG 1832
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$40,027.97
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	$40,027.97
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$40,027.97
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$40,027.97
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$40,027.97

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$36,627.59

Service Code	APR-DRG 1831
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$36,627.59
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$36,627.59
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: Family Health Partners Medicaid	$36,627.59
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$36,627.59
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$36,627.59

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$50,521.27

Service Code	APR-DRG 1833
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$50,521.27
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: Family Health Partners Medicaid	$50,521.27
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$50,521.27
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$50,521.27
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$50,521.27

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$71,066.85

Service Code	APR-DRG 1834
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$71,066.85
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	$71,066.85
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$71,066.85
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$71,066.85
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$71,066.85

perflutren protein-a microsphr 0.22 mg/mL suspension 3 mL Vial

Facility

$561.60

Service Code	HCPCS Q9956
Hospital Revenue Code	250
Min. Negotiated Rate	$421.20
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	$561.60
Rate for Payer: Cash Price	$561.60
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	$421.20
Rate for Payer: Provider Network of America Commercial	$449.28

perflutren protein-a microsphr 0.22 mg/mL suspension 3 mL Vial

Facility

$561.60

Service Code	HCPCS Q9956
Hospital Revenue Code	250
Min. Negotiated Rate	$320.11
Max. Negotiated Rate	$561.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$395.93
Rate for Payer: Aetna Workers' Compensation	$395.93
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$389.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$389.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$432.43
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$442.54
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cigna Commercial	$343.70
Rate for Payer: Cigna Medicare Advantage	$320.11
Rate for Payer: Harmony Health CHIP/Medicaid	$353.81
Rate for Payer: Home State Health Plan Exchange	$320.11
Rate for Payer: Humana Medicare	$421.20
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$421.20
Rate for Payer: Provider Network of America Commercial	$449.28
Rate for Payer: UnitedHealthcare Commercial	$370.66
Rate for Payer: UnitedHealthcare Individual Exchange	$561.60

perflutren protein-a microsphr 0.22 mg/mL suspension 3 mL Vial

Facility

$561.60

Service Code	NDC 00407270703
Hospital Revenue Code	250
Min. Negotiated Rate	$421.20
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	$561.60
Rate for Payer: Cash Price	$561.60
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	$421.20
Rate for Payer: Provider Network of America Commercial	$449.28

perflutren protein-a microsphr 0.22 mg/mL suspension 3 mL Vial

Facility

$561.60

Service Code	NDC 00407270703
Hospital Revenue Code	250
Min. Negotiated Rate	$320.11
Max. Negotiated Rate	$561.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$395.93
Rate for Payer: Aetna Workers' Compensation	$395.93
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$389.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$389.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$442.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$432.43
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$442.54
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cigna Commercial	$343.70
Rate for Payer: Cigna Medicare Advantage	$320.11
Rate for Payer: Harmony Health CHIP/Medicaid	$353.81
Rate for Payer: Home State Health Plan Exchange	$320.11
Rate for Payer: Humana Medicare	$421.20
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$421.20
Rate for Payer: Provider Network of America Commercial	$449.28
Rate for Payer: UnitedHealthcare Commercial	$370.66
Rate for Payer: UnitedHealthcare Individual Exchange	$561.60

Periodic Preventive Med Est Patient 12-17yrs

Facility

$315.00

Service Code	CPT 99394
Hospital Charge Code	Px05109939401
Hospital Revenue Code	510
Min. Negotiated Rate	$96.77
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$222.07
Rate for Payer: Aetna Workers' Compensation	$222.07
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$218.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$218.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$248.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$248.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$248.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$242.55
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$248.22
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Medicare Advantage	$179.55
Rate for Payer: Family Health Partners Medicaid	$128.53
Rate for Payer: Harmony Health CHIP/Medicaid	$198.45
Rate for Payer: Healthy Blue Medicaid	$138.82
Rate for Payer: Home State Health Plan Exchange	$179.55
Rate for Payer: Home State Health Plan Medicaid	$128.53
Rate for Payer: Humana Medicare	$236.25
Rate for Payer: Mercy CarePlus Medicaid	$128.53
Rate for Payer: Provider Network of America Commercial	$252.00
Rate for Payer: UnitedHealthcare Commercial	$207.90
Rate for Payer: UnitedHealthcare Individual Exchange	$315.00
Rate for Payer: UnitedHealthcare Medicaid	$96.77

Periodic Preventive Med Est Patient 12-17yrs

Facility

$315.00

Service Code	CPT 99394
Hospital Charge Code	Px05109939401
Hospital Revenue Code	510
Min. Negotiated Rate	$252.00
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	$315.00
Rate for Payer: Cash Price	$315.00
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: Provider Network of America Commercial	$252.00

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$8,034.99

Service Code	APR-DRG 1972
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,034.99
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	$8,034.99
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,034.99
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,034.99
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,034.99

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$23,218.37

Service Code	APR-DRG 1974
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$23,218.37
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	$23,218.37
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$23,218.37
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$23,218.37
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$23,218.37

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$6,221.09

Service Code	APR-DRG 1971
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,221.09
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	$6,221.09
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,221.09
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,221.09
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,221.09

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$13,067.15

Service Code	APR-DRG 1973
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,067.15
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	$13,067.15
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$13,067.15
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$13,067.15
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$13,067.15

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$9,120.38

Service Code	APR-DRG 0482
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,120.38
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	$9,120.38
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,120.38
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,120.38
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,120.38

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$13,424.02

Service Code	APR-DRG 0483
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,424.02
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	$13,424.02
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$13,424.02
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$13,424.02
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$13,424.02

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$22,292.00

Service Code	APR-DRG 0484
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$22,292.00
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: Family Health Partners Medicaid	$22,292.00
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$22,292.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$22,292.00
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$22,292.00

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$7,472.89

Service Code	APR-DRG 0481
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,472.89
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	$7,472.89
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,472.89
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,472.89
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,472.89

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$10,333.89

Service Code	MSDRG 041
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,333.89
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$10,333.89

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$18,147.64

Service Code	MSDRG 040
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,147.64
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	$18,147.64

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$8,120.19

Service Code	MSDRG 042
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,120.19
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	$8,120.19

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$6,053.00

Service Code	MSDRG 300
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	$5,017.25

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$7,673.69

Service Code	MSDRG 299
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,673.69
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	$7,673.69

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 301
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,053.00
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
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: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$3,382.59

Know your out-of-pocket cost for care.

All Charges