Ray County Hospital

All Charges

Charge

Type

Setting

Price

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$6,053.00

Service Code	APR-DRG 2821
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	$5,539.72
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,539.72
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,539.72
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,539.72

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

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$12,930.32

Service Code	APR-DRG 2823
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$12,930.32
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	$12,930.32
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$12,930.32
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$12,930.32
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$12,930.32

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$6,053.00

Service Code	MSDRG 439
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	$3,953.64

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$7,661.94

Service Code	MSDRG 438
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,661.94
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	$7,661.94

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 440
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	$2,920.58

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$9,241.61

Service Code	MSDRG 883
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,241.61
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	$9,241.61

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$6,053.00

Service Code	MSDRG 445
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 Freedom Network	$3,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,593.00
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	$3,593.00
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	$5,143.68

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$7,853.23

Service Code	MSDRG 444
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,853.23
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	$7,853.23

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 446
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 Freedom Network	$3,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$3,593.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$3,593.00
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	$3,593.00
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	$3,888.31

divalproex 250 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904686061
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

divalproex 250 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904686061
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

divalproex 500 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904686161
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

divalproex 500 mg tablet,delayed release (DR/EC) 100 Each BLIST PACK

Facility

$4.00

Service Code	NDC 00904686161
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

divalproex sprinkle 125 mg capsule, delayed rel sprinkle 100 Each Bottle

Facility

$4.00

Service Code	NDC 68382010601
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

divalproex sprinkle 125 mg capsule, delayed rel sprinkle 100 Each Bottle

Facility

$4.00

Service Code	NDC 68382010601
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

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$11,751.56

Service Code	APR-DRG 2443
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$11,751.56
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	$11,751.56
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$11,751.56
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$11,751.56
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$11,751.56

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$7,491.38

Service Code	APR-DRG 2442
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$7,491.38
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	$7,491.38
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$7,491.38
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$7,491.38
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$7,491.38

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$21,544.07

Service Code	APR-DRG 2444
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,544.07
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	$21,544.07
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$21,544.07
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$21,544.07
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$21,544.07

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$6,053.00

Service Code	APR-DRG 2441
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	$5,340.95
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$5,340.95
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$5,340.95
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$5,340.95

DOBUTamine 250 mg/250 mL (1 mg/mL) parenteral solution 250 mL Bag

Facility

$89.79

Service Code	HCPCS J1250
Hospital Revenue Code	250
Min. Negotiated Rate	$67.34
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	$89.79
Rate for Payer: Cash Price	$89.79
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	$67.34
Rate for Payer: Provider Network of America Commercial	$71.83

DOBUTamine 250 mg/250 mL (1 mg/mL) parenteral solution 250 mL Bag

Facility

$89.79

Service Code	NDC 00338107302
Hospital Revenue Code	250
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$89.79
Rate for Payer: Aetna Commercial/Medicare Advantage	$63.30
Rate for Payer: Aetna Workers' Compensation	$63.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$62.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$62.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$69.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$70.75
Rate for Payer: Cash Price	$89.79
Rate for Payer: Cigna Commercial	$54.95
Rate for Payer: Cigna Medicare Advantage	$51.18
Rate for Payer: Harmony Health CHIP/Medicaid	$56.57
Rate for Payer: Home State Health Plan Exchange	$51.18
Rate for Payer: Humana Medicare	$67.34
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$67.34
Rate for Payer: Provider Network of America Commercial	$71.83
Rate for Payer: UnitedHealthcare Commercial	$59.26
Rate for Payer: UnitedHealthcare Individual Exchange	$89.79

DOBUTamine 250 mg/250 mL (1 mg/mL) parenteral solution 250 mL Bag

Facility

$89.79

Service Code	HCPCS J1250
Hospital Revenue Code	250
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$89.79
Rate for Payer: Aetna Commercial/Medicare Advantage	$63.30
Rate for Payer: Aetna Workers' Compensation	$63.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$62.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$62.22
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$70.75
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$69.14
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$70.75
Rate for Payer: Cash Price	$89.79
Rate for Payer: Cigna Commercial	$54.95
Rate for Payer: Cigna Medicare Advantage	$51.18
Rate for Payer: Harmony Health CHIP/Medicaid	$56.57
Rate for Payer: Home State Health Plan Exchange	$51.18
Rate for Payer: Humana Medicare	$67.34
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$67.34
Rate for Payer: Provider Network of America Commercial	$71.83
Rate for Payer: UnitedHealthcare Commercial	$59.26
Rate for Payer: UnitedHealthcare Individual Exchange	$89.79

DOBUTamine 250 mg/250 mL (1 mg/mL) parenteral solution 250 mL Bag

Facility

$89.79

Service Code	NDC 00338107302
Hospital Revenue Code	250
Min. Negotiated Rate	$67.34
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	$89.79
Rate for Payer: Cash Price	$89.79
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	$67.34
Rate for Payer: Provider Network of America Commercial	$71.83

DOCEtaxel 20 mg/mL (1 mL) solution 1 mL Vial

Facility

$100.00

Service Code	NDC 25021024501
Hospital Revenue Code	250
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$70.50
Rate for Payer: Aetna Workers' Compensation	$70.50
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$69.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$69.30
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$78.80
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$78.80
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$78.80
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$77.00
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$78.80
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cigna Commercial	$61.20
Rate for Payer: Cigna Medicare Advantage	$57.00
Rate for Payer: Harmony Health CHIP/Medicaid	$63.00
Rate for Payer: Home State Health Plan Exchange	$57.00
Rate for Payer: Humana Medicare	$75.00
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$75.00
Rate for Payer: Provider Network of America Commercial	$80.00
Rate for Payer: UnitedHealthcare Commercial	$66.00
Rate for Payer: UnitedHealthcare Individual Exchange	$100.00

Know your out-of-pocket cost for care.

All Charges