Ray County Hospital

All Charges

Charge

Type

Setting

Price

ADJUSTMENT DISORDERS

Facility

$10,969.42

Service Code	APR-DRG 7554
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,969.42
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	$10,969.42
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,969.42
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,969.42
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,969.42

ADJUSTMENT DISORDERS

Facility

$9,094.49

Service Code	APR-DRG 7553
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,094.49
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	$9,094.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,094.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,094.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,094.49

ADJUSTMENT DISORDERS

Facility

$6,053.00

Service Code	APR-DRG 7551
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	$2,877.10
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$2,877.10
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$2,877.10
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$2,877.10

Adrenal 21- Hydroxylase Autoantibodies

Facility

$126.00

Service Code	CPT 83516
Hospital Charge Code	Px03018351647
Hospital Revenue Code	301
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$88.83
Rate for Payer: Aetna Workers' Compensation	$88.83
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$87.32
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$87.32
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$99.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$99.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$99.29
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$97.02
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$99.29
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cigna Commercial	$66.02
Rate for Payer: Cigna Medicare Advantage	$71.82
Rate for Payer: Family Health Partners Medicaid	$14.53
Rate for Payer: Harmony Health CHIP/Medicaid	$79.38
Rate for Payer: Healthy Blue Medicaid	$15.69
Rate for Payer: Home State Health Plan Exchange	$71.82
Rate for Payer: Home State Health Plan Medicaid	$14.53
Rate for Payer: Humana Medicare	$94.50
Rate for Payer: Mercy CarePlus Medicaid	$14.53
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$94.50
Rate for Payer: Provider Network of America Commercial	$100.80
Rate for Payer: UnitedHealthcare Commercial	$83.16
Rate for Payer: UnitedHealthcare Individual Exchange	$11.53
Rate for Payer: UnitedHealthcare Medicaid	$10.94

Adrenal 21- Hydroxylase Autoantibodies

Facility

$126.00

Service Code	CPT 83516
Hospital Charge Code	Px03018351647
Hospital Revenue Code	301
Min. Negotiated Rate	$94.50
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	$126.00
Rate for Payer: Cash Price	$126.00
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	$94.50
Rate for Payer: Provider Network of America Commercial	$100.80

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$10,301.46

Service Code	MSDRG 614
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,301.46
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	$10,301.46

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$6,576.71

Service Code	MSDRG 615
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,576.71
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	$6,576.71

Adrenalin epinephrine inject

Facility

$860.67

Service Code	HCPCS J0171
Hospital Charge Code	Px0636J017101
Hospital Revenue Code	636
Min. Negotiated Rate	$645.50
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	$860.67
Rate for Payer: Cash Price	$860.67
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	$645.50
Rate for Payer: Provider Network of America Commercial	$688.54

Adrenalin epinephrine inject

Facility

$860.67

Service Code	HCPCS J0171
Hospital Charge Code	Px0636J017101
Hospital Revenue Code	636
Min. Negotiated Rate	$490.58
Max. Negotiated Rate	$860.67
Rate for Payer: Aetna Commercial/Medicare Advantage	$606.77
Rate for Payer: Aetna Workers' Compensation	$606.77
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$596.44
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$596.44
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$678.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$678.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$678.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$662.72
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$678.21
Rate for Payer: Cash Price	$860.67
Rate for Payer: Cigna Commercial	$526.73
Rate for Payer: Cigna Medicare Advantage	$490.58
Rate for Payer: Harmony Health CHIP/Medicaid	$542.22
Rate for Payer: Home State Health Plan Exchange	$490.58
Rate for Payer: Humana Medicare	$645.50
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$645.50
Rate for Payer: Provider Network of America Commercial	$688.54
Rate for Payer: UnitedHealthcare Commercial	$568.04
Rate for Payer: UnitedHealthcare Individual Exchange	$860.67

ADRENAL PROCEDURES

Facility

$12,691.80

Service Code	APR-DRG 4011
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,691.80
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	$12,691.80
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,691.80
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,691.80
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,691.80

ADRENAL PROCEDURES

Facility

$30,426.84

Service Code	APR-DRG 4013
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$30,426.84
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	$30,426.84
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$30,426.84
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$30,426.84
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$30,426.84

ADRENAL PROCEDURES

Facility

$51,698.18

Service Code	APR-DRG 4014
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$51,698.18
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: Family Health Partners Medicaid	$51,698.18
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$51,698.18
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$51,698.18
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$51,698.18

ADRENAL PROCEDURES

Facility

$18,010.55

Service Code	APR-DRG 4012
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$18,010.55
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	$18,010.55
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$18,010.55
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$18,010.55
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$18,010.55

Afo Ankle Gauntlet Prefab Ots Pr1

Facility

$43.98

Service Code	CPT L1902
Hospital Charge Code	Px0274L190202
Hospital Revenue Code	274
Min. Negotiated Rate	$32.98
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	$43.98
Rate for Payer: Cash Price	$43.98
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	$32.98
Rate for Payer: Provider Network of America Commercial	$35.18

Afo Ankle Gauntlet Prefab Ots Pr1

Facility

$43.98

Service Code	CPT L1902
Hospital Charge Code	Px0274L190202
Hospital Revenue Code	274
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$43.98
Rate for Payer: Aetna Commercial/Medicare Advantage	$31.01
Rate for Payer: Aetna Workers' Compensation	$31.01
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$30.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$30.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$34.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$34.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$34.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$33.86
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$34.66
Rate for Payer: Cash Price	$43.98
Rate for Payer: Cigna Commercial	$26.92
Rate for Payer: Cigna Medicare Advantage	$25.07
Rate for Payer: Harmony Health CHIP/Medicaid	$27.71
Rate for Payer: Home State Health Plan Exchange	$25.07
Rate for Payer: Humana Medicare	$32.98
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$32.98
Rate for Payer: Provider Network of America Commercial	$35.18
Rate for Payer: UnitedHealthcare Commercial	$29.03
Rate for Payer: UnitedHealthcare Individual Exchange	$43.98

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$6,053.00

Service Code	MSDRG 560
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	$5,292.67

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$8,765.03

Service Code	MSDRG 559
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,765.03
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	$8,765.03

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 561
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	$3,778.33

AFTERCARE WITH CC/MCC

Facility

$6,053.00

Service Code	MSDRG 949
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	$5,591.59

AFTERCARE WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 950
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	$2,950.19

Agent Nos Assay W/Optic - Shigatoxin

Facility

$86.10

Service Code	CPT 87899
Hospital Charge Code	Px03068789903
Hospital Revenue Code	306
Min. Negotiated Rate	$15.24
Max. Negotiated Rate	$68.88
Rate for Payer: Aetna Commercial/Medicare Advantage	$60.70
Rate for Payer: Aetna Workers' Compensation	$60.70
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$59.67
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$59.67
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$67.85
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$67.85
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$67.85
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$66.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$67.85
Rate for Payer: Cash Price	$86.10
Rate for Payer: Cash Price	$86.10
Rate for Payer: Cigna Commercial	$45.12
Rate for Payer: Cigna Medicare Advantage	$49.08
Rate for Payer: Family Health Partners Medicaid	$20.24
Rate for Payer: Harmony Health CHIP/Medicaid	$54.24
Rate for Payer: Healthy Blue Medicaid	$21.86
Rate for Payer: Home State Health Plan Exchange	$49.08
Rate for Payer: Home State Health Plan Medicaid	$20.24
Rate for Payer: Humana Medicare	$64.58
Rate for Payer: Mercy CarePlus Medicaid	$20.24
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$64.58
Rate for Payer: Provider Network of America Commercial	$68.88
Rate for Payer: UnitedHealthcare Commercial	$56.83
Rate for Payer: UnitedHealthcare Individual Exchange	$16.07
Rate for Payer: UnitedHealthcare Medicaid	$15.24

Agent Nos Assay W/Optic - Shigatoxin

Facility

$86.10

Service Code	CPT 87899
Hospital Charge Code	Px03068789903
Hospital Revenue Code	306
Min. Negotiated Rate	$64.58
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	$86.10
Rate for Payer: Cash Price	$86.10
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	$64.58
Rate for Payer: Provider Network of America Commercial	$68.88

AICD GENERATOR PROCEDURES

Facility

$21,443.28

Service Code	MSDRG 245
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,443.28
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	$21,443.28

AICD LEAD PROCEDURES

Facility

$17,005.54

Service Code	MSDRG 265
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,005.54
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$17,005.54

albumin human 25 % parenteral solution 50 mL Glass Cont

Facility

$459.20

Service Code	NDC 68982064301
Hospital Revenue Code	258
Min. Negotiated Rate	$344.40
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	$459.20
Rate for Payer: Cash Price	$459.20
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	$344.40
Rate for Payer: Provider Network of America Commercial	$367.36

Know your out-of-pocket cost for care.

All Charges