Ray County Hospital

All Charges

Charge

Type

Setting

Price

US Retroperitoneal Real Time W/Image Limited

Facility

$103.74

Service Code	CPT 76775
Hospital Charge Code	Px09727677501
Hospital Revenue Code	972
Min. Negotiated Rate	$77.81
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	$103.74
Rate for Payer: Cash Price	$103.74
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	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99

US Retroperitoneal Real Time W/Image Limited

Facility

$103.74

Service Code	CPT 76775
Hospital Charge Code	Px09727677501
Hospital Revenue Code	972
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$142.49
Rate for Payer: Aetna Commercial/Medicare Advantage	$73.14
Rate for Payer: Aetna Workers' Compensation	$73.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$79.88
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$81.75
Rate for Payer: Cash Price	$103.74
Rate for Payer: Cash Price	$103.74
Rate for Payer: Cigna Commercial	$63.49
Rate for Payer: Cigna Medicare Advantage	$59.13
Rate for Payer: Family Health Partners Medicaid	$131.94
Rate for Payer: Harmony Health CHIP/Medicaid	$65.36
Rate for Payer: Healthy Blue Medicaid	$142.49
Rate for Payer: Home State Health Plan Exchange	$59.13
Rate for Payer: Home State Health Plan Medicaid	$131.94
Rate for Payer: Humana Medicare	$77.81
Rate for Payer: Mercy CarePlus Medicaid	$131.94
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99
Rate for Payer: UnitedHealthcare Commercial	$68.47
Rate for Payer: UnitedHealthcare Individual Exchange	$103.74
Rate for Payer: UnitedHealthcare Medicaid	$99.33

US Transrectal

Facility

$103.74

Service Code	CPT 76872
Hospital Charge Code	Px09827687201
Hospital Revenue Code	982
Min. Negotiated Rate	$77.81
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	$103.74
Rate for Payer: Cash Price	$103.74
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	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99

US Transrectal

Facility

$103.74

Service Code	CPT 76872
Hospital Charge Code	Px09827687201
Hospital Revenue Code	982
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$142.49
Rate for Payer: Aetna Commercial/Medicare Advantage	$73.14
Rate for Payer: Aetna Workers' Compensation	$73.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$79.88
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$81.75
Rate for Payer: Cash Price	$103.74
Rate for Payer: Cash Price	$103.74
Rate for Payer: Cigna Commercial	$63.49
Rate for Payer: Cigna Medicare Advantage	$59.13
Rate for Payer: Family Health Partners Medicaid	$131.94
Rate for Payer: Harmony Health CHIP/Medicaid	$65.36
Rate for Payer: Healthy Blue Medicaid	$142.49
Rate for Payer: Home State Health Plan Exchange	$59.13
Rate for Payer: Home State Health Plan Medicaid	$131.94
Rate for Payer: Humana Medicare	$77.81
Rate for Payer: Mercy CarePlus Medicaid	$131.94
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99
Rate for Payer: UnitedHealthcare Commercial	$68.47
Rate for Payer: UnitedHealthcare Individual Exchange	$103.74
Rate for Payer: UnitedHealthcare Medicaid	$99.33

US Vasc Access Sits Vsl Patency Ndl Entry

Facility

$103.74

Service Code	CPT 76937
Hospital Charge Code	Px09827693701
Hospital Revenue Code	982
Min. Negotiated Rate	$59.13
Max. Negotiated Rate	$103.74
Rate for Payer: Aetna Commercial/Medicare Advantage	$73.14
Rate for Payer: Aetna Workers' Compensation	$73.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$71.89
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$81.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$79.88
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$81.75
Rate for Payer: Cash Price	$103.74
Rate for Payer: Cigna Commercial	$63.49
Rate for Payer: Cigna Medicare Advantage	$59.13
Rate for Payer: Harmony Health CHIP/Medicaid	$65.36
Rate for Payer: Home State Health Plan Exchange	$59.13
Rate for Payer: Humana Medicare	$77.81
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99
Rate for Payer: UnitedHealthcare Commercial	$68.47
Rate for Payer: UnitedHealthcare Individual Exchange	$103.74

US Vasc Access Sits Vsl Patency Ndl Entry

Facility

$103.74

Service Code	CPT 76937
Hospital Charge Code	Px09827693701
Hospital Revenue Code	982
Min. Negotiated Rate	$77.81
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	$103.74
Rate for Payer: Cash Price	$103.74
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	$77.81
Rate for Payer: Provider Network of America Commercial	$82.99

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$10,206.00

Service Code	MSDRG 742
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,206.00
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 Freedom Network	$10,206.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$10,206.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$10,206.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$10,206.00
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	$8,623.56

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$10,148.00

Service Code	MSDRG 743
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,148.00
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 Freedom Network	$10,148.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$10,148.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$10,148.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$10,148.00
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	$5,831.29

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$10,312.00

Service Code	MSDRG 740
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,312.00
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 Freedom Network	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$10,312.00
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	$8,505.12

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$16,573.61

Service Code	MSDRG 739
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,573.61
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	$16,573.61

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$10,312.00

Service Code	MSDRG 741
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,312.00
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 Freedom Network	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$10,312.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$950.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$10,312.00
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	$6,702.67

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$9,684.82

Service Code	MSDRG 737
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,684.82
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$9,684.82

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$16,800.15

Service Code	MSDRG 736
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,800.15
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$16,800.15

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$6,901.95

Service Code	MSDRG 738
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,901.95
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	$6,901.95

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$8,164.37

Service Code	MSDRG 746
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,164.37
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$8,164.37

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 747
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	$3,945.65

VAGINAL DELIVERY

Facility

$6,053.00

Service Code	APR-DRG 5602
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: Family Health Partners Medicaid	$4,097.47
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$4,097.47
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$4,097.47
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$4,097.47

VAGINAL DELIVERY

Facility

$12,768.53

Service Code	APR-DRG 5604
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,768.53
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	$12,768.53
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,768.53
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,768.53
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,768.53

VAGINAL DELIVERY

Facility

$6,197.05

Service Code	APR-DRG 5603
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,197.05
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	$6,197.05
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,197.05
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,197.05
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,197.05

VAGINAL DELIVERY

Facility

$6,053.00

Service Code	APR-DRG 5601
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: Family Health Partners Medicaid	$3,551.08
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$3,551.08
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$3,551.08
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$3,551.08

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$6,053.00

Service Code	APR-DRG 5421
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: Family Health Partners Medicaid	$4,007.79
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$4,007.79
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$4,007.79
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$4,007.79

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$6,053.00

Service Code	APR-DRG 5422
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: Family Health Partners Medicaid	$4,954.50
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$4,954.50
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$4,954.50
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$4,954.50

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$9,244.27

Service Code	APR-DRG 5423
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,244.27
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	$9,244.27
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,244.27
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,244.27
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,244.27

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$26,314.58

Service Code	APR-DRG 5424
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$26,314.58
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	$26,314.58
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$26,314.58
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$26,314.58
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$26,314.58

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$6,053.00

Service Code	MSDRG 768
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	$5,036.52

Know your out-of-pocket cost for care.

All Charges