Ray County Hospital

All Charges

Charge

Type

Setting

Price

tranexamic acid 1,000 mg/10 mL (100 mg/mL) solution 10 mL Vial

Facility

$35.00

Service Code	NDC 72485051001
Hospital Revenue Code	250
Min. Negotiated Rate	$26.25
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	$35.00
Rate for Payer: Cash Price	$35.00
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	$26.25
Rate for Payer: Provider Network of America Commercial	$28.00

TRANSIENT ISCHEMIA

Facility

$18,861.11

Service Code	APR-DRG 0474
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,861.11
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	$18,861.11
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$18,861.11
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$18,861.11
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$18,861.11

TRANSIENT ISCHEMIA

Facility

$7,521.89

Service Code	APR-DRG 0471
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,521.89
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	$7,521.89
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,521.89
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,521.89
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,521.89

TRANSIENT ISCHEMIA

Facility

$11,739.54

Service Code	APR-DRG 0473
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,739.54
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	$11,739.54
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,739.54
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,739.54
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,739.54

TRANSIENT ISCHEMIA

Facility

$8,702.50

Service Code	APR-DRG 0472
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,702.50
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	$8,702.50
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,702.50
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,702.50
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,702.50

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$6,053.00

Service Code	MSDRG 069
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	$3,754.36

Transport Charge (Intrafacility)

Facility

$33.60

Service Code	CPT 94799
Hospital Charge Code	Px04109479904
Hospital Revenue Code	410
Min. Negotiated Rate	$25.20
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	$33.60
Rate for Payer: Cash Price	$33.60
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	$25.20
Rate for Payer: Provider Network of America Commercial	$26.88

Transport Charge (Intrafacility)

Facility

$33.60

Service Code	CPT 94799
Hospital Charge Code	Px04109479904
Hospital Revenue Code	410
Min. Negotiated Rate	$19.15
Max. Negotiated Rate	$175.39
Rate for Payer: Aetna Commercial/Medicare Advantage	$23.69
Rate for Payer: Aetna Workers' Compensation	$23.69
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$23.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$23.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$26.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$26.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$26.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$25.87
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$26.48
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cigna Commercial	$20.56
Rate for Payer: Cigna Medicare Advantage	$19.15
Rate for Payer: Family Health Partners Medicaid	$162.40
Rate for Payer: Harmony Health CHIP/Medicaid	$21.17
Rate for Payer: Healthy Blue Medicaid	$175.39
Rate for Payer: Home State Health Plan Exchange	$19.15
Rate for Payer: Home State Health Plan Medicaid	$162.40
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Mercy CarePlus Medicaid	$162.40
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$25.20
Rate for Payer: Provider Network of America Commercial	$26.88
Rate for Payer: UnitedHealthcare Commercial	$22.18
Rate for Payer: UnitedHealthcare Individual Exchange	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$122.26

TRANSURETHRAL PROCEDURES WITH CC

Facility

$7,294.40

Service Code	MSDRG 669
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,294.40
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	$7,294.40

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$13,724.00

Service Code	MSDRG 668
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,724.00
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	$13,724.00

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 670
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	$4,593.31

TRANSURETHRAL PROSTATECTOMY

Facility

$29,388.61

Service Code	APR-DRG 4824
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$29,388.61
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	$29,388.61
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$29,388.61
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$29,388.61
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$29,388.61

TRANSURETHRAL PROSTATECTOMY

Facility

$19,005.34

Service Code	APR-DRG 4823
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,005.34
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	$19,005.34
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$19,005.34
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$19,005.34
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$19,005.34

TRANSURETHRAL PROSTATECTOMY

Facility

$8,769.06

Service Code	APR-DRG 4821
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,769.06
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	$8,769.06
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,769.06
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,769.06
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,769.06

TRANSURETHRAL PROSTATECTOMY

Facility

$11,871.75

Service Code	APR-DRG 4822
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,871.75
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	$11,871.75
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,871.75
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,871.75
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,871.75

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$7,065.98

Service Code	MSDRG 713
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,065.98
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	$7,065.98

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 714
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	$4,969.78

trastuzumab-qyyp 150 mg recon soln 1 Each Vial

Facility

$4,844.40

Service Code	NDC 00069030801
Hospital Revenue Code	250
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	$4,844.40
Rate for Payer: Cash Price	$4,844.40
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	$3,633.30
Rate for Payer: Provider Network of America Commercial	$3,875.52

trastuzumab-qyyp 150 mg recon soln 1 Each Vial

Facility

$4,844.40

Service Code	NDC 00069030801
Hospital Revenue Code	250
Min. Negotiated Rate	$2,761.31
Max. Negotiated Rate	$4,844.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$3,415.30
Rate for Payer: Aetna Workers' Compensation	$3,415.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$3,357.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$3,357.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3,730.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3,817.39
Rate for Payer: Cash Price	$4,844.40
Rate for Payer: Cigna Commercial	$2,964.77
Rate for Payer: Cigna Medicare Advantage	$2,761.31
Rate for Payer: Harmony Health CHIP/Medicaid	$3,051.97
Rate for Payer: Home State Health Plan Exchange	$2,761.31
Rate for Payer: Humana Medicare	$3,633.30
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3,633.30
Rate for Payer: Provider Network of America Commercial	$3,875.52
Rate for Payer: UnitedHealthcare Commercial	$3,197.30
Rate for Payer: UnitedHealthcare Individual Exchange	$4,844.40

trastuzumab-qyyp 150 mg recon soln 1 Each Vial

Facility

$4,844.40

Service Code	HCPCS Q5116
Hospital Revenue Code	250
Min. Negotiated Rate	$2,761.31
Max. Negotiated Rate	$4,844.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$3,415.30
Rate for Payer: Aetna Workers' Compensation	$3,415.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$3,357.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$3,357.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,817.39
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$3,730.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$3,817.39
Rate for Payer: Cash Price	$4,844.40
Rate for Payer: Cigna Commercial	$2,964.77
Rate for Payer: Cigna Medicare Advantage	$2,761.31
Rate for Payer: Harmony Health CHIP/Medicaid	$3,051.97
Rate for Payer: Home State Health Plan Exchange	$2,761.31
Rate for Payer: Humana Medicare	$3,633.30
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$3,633.30
Rate for Payer: Provider Network of America Commercial	$3,875.52
Rate for Payer: UnitedHealthcare Commercial	$3,197.30
Rate for Payer: UnitedHealthcare Individual Exchange	$4,844.40

trastuzumab-qyyp 150 mg recon soln 1 Each Vial

Facility

$4,844.40

Service Code	HCPCS Q5116
Hospital Revenue Code	250
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	$4,844.40
Rate for Payer: Cash Price	$4,844.40
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	$3,633.30
Rate for Payer: Provider Network of America Commercial	$3,875.52

TRAUMATIC INJURY WITH MCC

Facility

$7,682.62

Service Code	MSDRG 913
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,682.62
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	$7,682.62

TRAUMATIC INJURY WITHOUT MCC

Facility

$6,053.00

Service Code	MSDRG 914
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	$4,161.85

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$6,122.69

Service Code	MSDRG 086
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,122.69
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	$6,122.69

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$6,560.26

Service Code	MSDRG 083
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,560.26
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$6,560.26

Know your out-of-pocket cost for care.

All Charges