Ray County Hospital

All Charges

Charge

Type

Setting

Price

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$23,766.61

Service Code	APR-DRG 3212
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$23,766.61
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: Family Health Partners Medicaid	$23,766.61
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$23,766.61
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$23,766.61
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$23,766.61

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$28,026.57

Service Code	MSDRG 457
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$28,026.57
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$28,026.57

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$39,495.98

Service Code	MSDRG 456
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$39,495.98
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	$39,495.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$19,611.22

Service Code	MSDRG 458
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,611.22
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	$19,611.22

SPINAL PROCEDURES

Facility

$40,519.82

Service Code	APR-DRG 0233
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$40,519.82
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	$40,519.82
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$40,519.82
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$40,519.82
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$40,519.82

SPINAL PROCEDURES

Facility

$25,110.86

Service Code	APR-DRG 0232
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,110.86
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	$25,110.86
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,110.86
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,110.86
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,110.86

SPINAL PROCEDURES

Facility

$17,739.67

Service Code	APR-DRG 0231
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,739.67
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	$17,739.67
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$17,739.67
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$17,739.67
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$17,739.67

SPINAL PROCEDURES

Facility

$60,939.67

Service Code	APR-DRG 0234
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$60,939.67
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	$60,939.67
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$60,939.67
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$60,939.67
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$60,939.67

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$16,034.52

Service Code	MSDRG 029
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,034.52
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	$16,034.52

SPINAL PROCEDURES WITH MCC

Facility

$28,239.01

Service Code	MSDRG 028
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$28,239.01
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$28,239.01

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$10,317.44

Service Code	MSDRG 030
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,317.44
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	$10,317.44

Spirometry With Bronchodilator

Facility

$88.00

Service Code	CPT 94060 26
Hospital Charge Code	Px09839406001
Hospital Revenue Code	983
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$508.61
Rate for Payer: Aetna Commercial/Medicare Advantage	$62.04
Rate for Payer: Aetna Workers' Compensation	$62.04
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$60.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$60.98
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$69.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$69.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$69.34
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$67.76
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$69.34
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cigna Commercial	$53.86
Rate for Payer: Cigna Medicare Advantage	$50.16
Rate for Payer: Family Health Partners Medicaid	$470.93
Rate for Payer: Harmony Health CHIP/Medicaid	$55.44
Rate for Payer: Healthy Blue Medicaid	$508.61
Rate for Payer: Home State Health Plan Exchange	$50.16
Rate for Payer: Home State Health Plan Medicaid	$470.93
Rate for Payer: Humana Medicare	$66.00
Rate for Payer: Mercy CarePlus Medicaid	$470.93
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$66.00
Rate for Payer: Provider Network of America Commercial	$70.40
Rate for Payer: UnitedHealthcare Commercial	$58.08
Rate for Payer: UnitedHealthcare Individual Exchange	$88.00
Rate for Payer: UnitedHealthcare Medicaid	$354.54

Spirometry With Bronchodilator

Facility

$88.00

Service Code	CPT 94060 26
Hospital Charge Code	Px09839406001
Hospital Revenue Code	983
Min. Negotiated Rate	$66.00
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	$88.00
Rate for Payer: Cash Price	$88.00
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	$66.00
Rate for Payer: Provider Network of America Commercial	$70.40

spironolactone 25 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904692761
Hospital Revenue Code	637
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$2.82
Rate for Payer: Aetna Workers' Compensation	$2.82
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$2.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$2.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3.15
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3.08
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3.15
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$2.45
Rate for Payer: Cigna Medicare Advantage	$2.28
Rate for Payer: Harmony Health CHIP/Medicaid	$2.52
Rate for Payer: Home State Health Plan Exchange	$2.28
Rate for Payer: Humana Medicare	$3.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3.00
Rate for Payer: Provider Network of America Commercial	$3.20
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Individual Exchange	$4.00

spironolactone 25 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904692761
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
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	$4.00
Rate for Payer: Cash Price	$4.00
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	$3.00
Rate for Payer: Provider Network of America Commercial	$3.20

SPLENIC PROCEDURES

Facility

$29,151.01

Service Code	APR-DRG 6503
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$29,151.01
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	$29,151.01
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$29,151.01
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$29,151.01
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$29,151.01

SPLENIC PROCEDURES

Facility

$44,446.25

Service Code	APR-DRG 6504
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$44,446.25
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	$44,446.25
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$44,446.25
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$44,446.25
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$44,446.25

SPLENIC PROCEDURES

Facility

$22,151.48

Service Code	APR-DRG 6502
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$22,151.48
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	$22,151.48
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$22,151.48
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$22,151.48
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$22,151.48

SPLENIC PROCEDURES

Facility

$15,758.43

Service Code	APR-DRG 6501
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,758.43
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	$15,758.43
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,758.43
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,758.43
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,758.43

SPLENIC PROCEDURES WITH CC

Facility

$13,204.18

Service Code	MSDRG 800
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,204.18
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	$13,204.18

SPLENIC PROCEDURES WITH MCC

Facility

$21,285.83

Service Code	MSDRG 799
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,285.83
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	$21,285.83

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$8,971.83

Service Code	MSDRG 801
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,971.83
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	$8,971.83

Splint-Ankle Stirrup

Facility

$40.95

Service Code	CPT L4350
Hospital Charge Code	Px0274L435001
Hospital Revenue Code	274
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$40.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$28.87
Rate for Payer: Aetna Workers' Compensation	$28.87
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$28.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$28.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$32.27
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$32.27
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$32.27
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$31.53
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$32.27
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cigna Commercial	$25.06
Rate for Payer: Cigna Medicare Advantage	$23.34
Rate for Payer: Harmony Health CHIP/Medicaid	$25.80
Rate for Payer: Home State Health Plan Exchange	$23.34
Rate for Payer: Humana Medicare	$30.71
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$30.71
Rate for Payer: Provider Network of America Commercial	$32.76
Rate for Payer: UnitedHealthcare Commercial	$27.03
Rate for Payer: UnitedHealthcare Individual Exchange	$40.95

Splint-Ankle Stirrup

Facility

$40.95

Service Code	CPT L4350
Hospital Charge Code	Px0274L435001
Hospital Revenue Code	274
Min. Negotiated Rate	$30.71
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	$40.95
Rate for Payer: Cash Price	$40.95
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	$30.71
Rate for Payer: Provider Network of America Commercial	$32.76

Splint-Clavicle

Facility

$33.64

Service Code	CPT L3671
Hospital Charge Code	Px0274L367101
Hospital Revenue Code	274
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$33.64
Rate for Payer: Aetna Commercial/Medicare Advantage	$23.72
Rate for Payer: Aetna Commercial/Medicare Advantage	$24.90
Rate for Payer: Aetna Workers' Compensation	$23.72
Rate for Payer: Aetna Workers' Compensation	$24.90
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$23.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$24.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$23.31
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$24.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$27.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$26.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$27.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$26.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$26.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$27.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$25.90
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$27.20
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$27.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$26.51
Rate for Payer: Cash Price	$35.32
Rate for Payer: Cash Price	$33.64
Rate for Payer: Cigna Commercial	$20.59
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: Cigna Medicare Advantage	$19.17
Rate for Payer: Cigna Medicare Advantage	$20.13
Rate for Payer: Harmony Health CHIP/Medicaid	$21.19
Rate for Payer: Harmony Health CHIP/Medicaid	$22.25
Rate for Payer: Home State Health Plan Exchange	$19.17
Rate for Payer: Home State Health Plan Exchange	$20.13
Rate for Payer: Humana Medicare	$25.23
Rate for Payer: Humana Medicare	$26.49
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$25.23
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$26.49
Rate for Payer: Provider Network of America Commercial	$26.91
Rate for Payer: Provider Network of America Commercial	$28.26
Rate for Payer: UnitedHealthcare Commercial	$22.20
Rate for Payer: UnitedHealthcare Commercial	$23.31
Rate for Payer: UnitedHealthcare Individual Exchange	$33.64
Rate for Payer: UnitedHealthcare Individual Exchange	$35.32

Know your out-of-pocket cost for care.

All Charges