Ray County Hospital

All Charges

Charge

Type

Setting

Price

diphenhydrAMINE 50 mg/mL solution 1 mL Vial

Facility

$35.00

Service Code	HCPCS J1200
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

diphenhydrAMINE 50 mg/mL solution 1 mL Vial

Facility

$35.00

Service Code	NDC 00641037621
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

diphenhydrAMINE 50 mg/mL solution 1 mL Vial

Facility

$35.00

Service Code	NDC 00641628201
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

diphenhydrAMINE HCl 25 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 68094001861
Hospital Revenue Code	250
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

diphenhydrAMINE HCl 25 mg tablet 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 68094001861
Hospital Revenue Code	250
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

diphenhydrAMINE HCl 25 mg tablet 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 68094001859
Hospital Revenue Code	250
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

diphenhydrAMINE HCl 25 mg tablet 1 Each BLIST PACK

Facility

$4.00

Service Code	NDC 68094001859
Hospital Revenue Code	250
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

Diphenhydramine Hcl Injectio

Facility

$26.25

Service Code	CPT J1200
Hospital Charge Code	Px0636J120001
Hospital Revenue Code	636
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$18.51
Rate for Payer: Aetna Workers' Compensation	$18.51
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$18.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$18.19
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$20.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$20.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$20.68
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$20.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$20.68
Rate for Payer: Cash Price	$26.25
Rate for Payer: Cigna Commercial	$16.07
Rate for Payer: Cigna Medicare Advantage	$14.96
Rate for Payer: Harmony Health CHIP/Medicaid	$16.54
Rate for Payer: Home State Health Plan Exchange	$14.96
Rate for Payer: Humana Medicare	$19.69
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$19.69
Rate for Payer: Provider Network of America Commercial	$21.00
Rate for Payer: UnitedHealthcare Commercial	$17.32
Rate for Payer: UnitedHealthcare Individual Exchange	$26.25

Diphenhydramine Hcl Injectio

Facility

$26.25

Service Code	CPT J1200
Hospital Charge Code	Px0636J120001
Hospital Revenue Code	636
Min. Negotiated Rate	$19.69
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	$26.25
Rate for Payer: Cash Price	$26.25
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	$19.69
Rate for Payer: Provider Network of America Commercial	$21.00

diphenhydramine-zinc acetate 2-0.1 % cream 28 g Tube

Facility

$45.00

Service Code	NDC 00904535431
Hospital Revenue Code	637
Min. Negotiated Rate	$33.75
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	$45.00
Rate for Payer: Cash Price	$45.00
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	$33.75
Rate for Payer: Provider Network of America Commercial	$36.00

diphenhydramine-zinc acetate 2-0.1 % cream 28 g Tube

Facility

$45.00

Service Code	NDC 00904535431
Hospital Revenue Code	637
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$31.73
Rate for Payer: Aetna Workers' Compensation	$31.73
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$31.18
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$31.18
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$35.46
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$34.65
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$35.46
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial	$27.54
Rate for Payer: Cigna Medicare Advantage	$25.65
Rate for Payer: Harmony Health CHIP/Medicaid	$28.35
Rate for Payer: Home State Health Plan Exchange	$25.65
Rate for Payer: Humana Medicare	$33.75
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$33.75
Rate for Payer: Provider Network of America Commercial	$36.00
Rate for Payer: UnitedHealthcare Commercial	$29.70
Rate for Payer: UnitedHealthcare Individual Exchange	$45.00

Dipyridamole injection

Facility

$220.11

Service Code	HCPCS J1245
Hospital Charge Code	Px0636J124501
Hospital Revenue Code	636
Min. Negotiated Rate	$165.08
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	$220.11
Rate for Payer: Cash Price	$220.11
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	$165.08
Rate for Payer: Provider Network of America Commercial	$176.09

Dipyridamole injection

Facility

$220.11

Service Code	HCPCS J1245
Hospital Charge Code	Px0636J124501
Hospital Revenue Code	636
Min. Negotiated Rate	$125.46
Max. Negotiated Rate	$220.11
Rate for Payer: Aetna Commercial/Medicare Advantage	$155.18
Rate for Payer: Aetna Workers' Compensation	$155.18
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$152.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$152.54
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$173.45
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$173.45
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$173.45
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$169.48
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$173.45
Rate for Payer: Cash Price	$220.11
Rate for Payer: Cigna Commercial	$134.71
Rate for Payer: Cigna Medicare Advantage	$125.46
Rate for Payer: Harmony Health CHIP/Medicaid	$138.67
Rate for Payer: Home State Health Plan Exchange	$125.46
Rate for Payer: Humana Medicare	$165.08
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$165.08
Rate for Payer: Provider Network of America Commercial	$176.09
Rate for Payer: UnitedHealthcare Commercial	$145.27
Rate for Payer: UnitedHealthcare Individual Exchange	$220.11

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$6,185.03

Service Code	APR-DRG 2841
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,185.03
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: Family Health Partners Medicaid	$6,185.03
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,185.03
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,185.03
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,185.03

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$13,898.29

Service Code	APR-DRG 2843
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,898.29
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	$13,898.29
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$13,898.29
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$13,898.29
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$13,898.29

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$23,088.01

Service Code	APR-DRG 2844
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$23,088.01
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	$23,088.01
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$23,088.01
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$23,088.01
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$23,088.01

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$9,943.20

Service Code	APR-DRG 2842
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,943.20
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	$9,943.20
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,943.20
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,943.20
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,943.20

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$35,116.93

Service Code	APR-DRG 7584
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$35,116.93
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	$35,116.93
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$35,116.93
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$35,116.93
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$35,116.93

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$6,369.01

Service Code	APR-DRG 7582
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$6,369.01
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	$6,369.01
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$6,369.01
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$6,369.01
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$6,369.01

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$6,053.00

Service Code	APR-DRG 7581
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	$4,766.82
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$4,766.82
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$4,766.82
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$4,766.82

DISORDERS OF IMPULSE CONTROL & DEVELOPMENT

Facility

$10,337.05

Service Code	APR-DRG 7583
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,337.05
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	$10,337.05
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,337.05
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,337.05
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$10,337.05

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$6,053.00

Service Code	MSDRG 442
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	$4,536.91

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$8,435.09

Service Code	MSDRG 441
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,435.09
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: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Humana Medicare	$8,435.09

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 443
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	$3,288.59

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$26,751.88

Service Code	APR-DRG 2824
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$26,751.88
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	$26,751.88
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$26,751.88
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$26,751.88
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$26,751.88

Know your out-of-pocket cost for care.

All Charges