Ray County Hospital

All Charges

Charge

Type

Setting

Price

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$6,053.00

Service Code	MSDRG 147
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	$5,976.05

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$9,951.78

Service Code	MSDRG 146
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,951.78
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	$9,951.78

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$6,053.00

Service Code	MSDRG 148
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	$3,746.37

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$8,889.25

Service Code	APR-DRG 1101
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$8,889.25
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	$8,889.25
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$8,889.25
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$8,889.25
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$8,889.25

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$15,552.26

Service Code	APR-DRG 1103
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,552.26
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: Family Health Partners Medicaid	$15,552.26
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$15,552.26
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$15,552.26
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$15,552.26

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$26,446.79

Service Code	APR-DRG 1104
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$26,446.79
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	$26,446.79
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$26,446.79
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$26,446.79
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$26,446.79

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$9,757.37

Service Code	APR-DRG 1102
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$9,757.37
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: Family Health Partners Medicaid	$9,757.37
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$9,757.37
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$9,757.37
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$9,757.37

EATING DISORDERS

Facility

$13,781.80

Service Code	APR-DRG 7592
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$13,781.80
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	$13,781.80
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$13,781.80
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$13,781.80
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$13,781.80

EATING DISORDERS

Facility

$38,913.93

Service Code	APR-DRG 7594
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$38,913.93
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	$38,913.93
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$38,913.93
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$38,913.93
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$38,913.93

EATING DISORDERS

Facility

$19,165.28

Service Code	APR-DRG 7593
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$19,165.28
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: Family Health Partners Medicaid	$19,165.28
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$19,165.28
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$19,165.28
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$19,165.28

EATING DISORDERS

Facility

$10,993.46

Service Code	APR-DRG 7591
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$10,993.46
Rate for Payer: Humana Medicare	$1,185.00
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	$10,993.46
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$10,993.46
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$10,993.46
Rate for Payer: Mercy CarePlus Medicaid	$10,993.46

Echo Tthrc R-T 2d W/Wom-Mode Compl Spec&Colr D

Facility

$30.03

Service Code	CPT 93306
Hospital Charge Code	Px09609330601
Hospital Revenue Code	960
Min. Negotiated Rate	$22.52
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	$30.03
Rate for Payer: Cash Price	$30.03
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	$22.52
Rate for Payer: Provider Network of America Commercial	$24.02

Echo Tthrc R-T 2d W/Wom-Mode Compl Spec&Colr D

Facility

$30.03

Service Code	CPT 93306
Hospital Charge Code	Px09609330601
Hospital Revenue Code	960
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$744.77
Rate for Payer: Aetna Commercial/Medicare Advantage	$21.17
Rate for Payer: Aetna Workers' Compensation	$21.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$20.81
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$20.81
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$23.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$23.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$23.66
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$23.12
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$23.66
Rate for Payer: Cash Price	$30.03
Rate for Payer: Cash Price	$30.03
Rate for Payer: Cigna Commercial	$18.38
Rate for Payer: Cigna Medicare Advantage	$17.12
Rate for Payer: Family Health Partners Medicaid	$689.60
Rate for Payer: Harmony Health CHIP/Medicaid	$18.92
Rate for Payer: Healthy Blue Medicaid	$744.77
Rate for Payer: Home State Health Plan Exchange	$17.12
Rate for Payer: Home State Health Plan Medicaid	$689.60
Rate for Payer: Humana Medicare	$22.52
Rate for Payer: Mercy CarePlus Medicaid	$689.60
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$22.52
Rate for Payer: Provider Network of America Commercial	$24.02
Rate for Payer: UnitedHealthcare Commercial	$19.82
Rate for Payer: UnitedHealthcare Individual Exchange	$30.03
Rate for Payer: UnitedHealthcare Medicaid	$519.17

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$99,758.44

Service Code	MSDRG 003
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$99,758.44
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	$99,758.44

ELECTIVE HIP JOINT REPLACEMENT

Facility

$14,341.14

Service Code	APR-DRG 3241
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$14,341.14
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	$14,341.14
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$14,341.14
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$14,341.14
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$14,341.14

ELECTIVE HIP JOINT REPLACEMENT

Facility

$17,651.84

Service Code	APR-DRG 3242
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$17,651.84
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	$17,651.84
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$17,651.84
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$17,651.84
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$17,651.84

ELECTIVE HIP JOINT REPLACEMENT

Facility

$25,200.54

Service Code	APR-DRG 3243
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$25,200.54
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	$25,200.54
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$25,200.54
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$25,200.54
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$25,200.54

ELECTIVE HIP JOINT REPLACEMENT

Facility

$38,538.57

Service Code	APR-DRG 3244
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$38,538.57
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	$38,538.57
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$38,538.57
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$38,538.57
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$38,538.57

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$21,321.26

Service Code	APR-DRG 3263
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$21,321.26
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: Family Health Partners Medicaid	$21,321.26
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$21,321.26
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$21,321.26
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$21,321.26

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$16,165.21

Service Code	APR-DRG 3262
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$16,165.21
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	$16,165.21
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$16,165.21
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$16,165.21
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$16,165.21

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$14,073.95

Service Code	APR-DRG 3261
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$14,073.95
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: Family Health Partners Medicaid	$14,073.95
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$14,073.95
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$14,073.95
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$14,073.95

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$35,330.49

Service Code	APR-DRG 3264
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$35,330.49
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	$35,330.49
Rate for Payer: Harmony Health CHIP/Medicaid	$1,826.00
Rate for Payer: Healthy Blue Medicaid	$35,330.49
Rate for Payer: Home State Health Plan Exchange	$6,053.00
Rate for Payer: Home State Health Plan Medicaid	$35,330.49
Rate for Payer: Humana Medicare	$1,185.00
Rate for Payer: Mercy CarePlus Medicaid	$35,330.49

Electrode Cloth Adult

Facility

$6.07

Hospital Charge Code	Px02700002590
Hospital Revenue Code	270
Min. Negotiated Rate	$4.55
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	$6.07
Rate for Payer: Cash Price	$6.07
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	$4.55
Rate for Payer: Provider Network of America Commercial	$4.86

Electrode Cloth Adult

Facility

$6.07

Hospital Charge Code	Px02700002590
Hospital Revenue Code	270
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial/Medicare Advantage	$4.28
Rate for Payer: Aetna Workers' Compensation	$4.28
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$4.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$4.21
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$4.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$4.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$4.78
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$4.67
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$4.78
Rate for Payer: Cash Price	$6.07
Rate for Payer: Cigna Commercial	$3.71
Rate for Payer: Cigna Medicare Advantage	$3.46
Rate for Payer: Harmony Health CHIP/Medicaid	$3.82
Rate for Payer: Home State Health Plan Exchange	$3.46
Rate for Payer: Humana Medicare	$4.55
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$4.55
Rate for Payer: Provider Network of America Commercial	$4.86
Rate for Payer: UnitedHealthcare Commercial	$4.01
Rate for Payer: UnitedHealthcare Individual Exchange	$6.07

electrolytes-dextrose solution 1,000 mL Bottle

Facility

$17.56

Service Code	NDC 80681001400
Hospital Revenue Code	250
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna Commercial/Medicare Advantage	$12.38
Rate for Payer: Aetna Workers' Compensation	$12.38
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO)	$12.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO)	$12.17
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network	$13.84
Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select	$13.84
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care	$13.84
Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO)	$13.52
Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional	$13.84
Rate for Payer: Cash Price	$17.56
Rate for Payer: Cigna Commercial	$10.75
Rate for Payer: Cigna Medicare Advantage	$10.01
Rate for Payer: Harmony Health CHIP/Medicaid	$11.06
Rate for Payer: Home State Health Plan Exchange	$10.01
Rate for Payer: Humana Medicare	$13.17
Rate for Payer: Oscar Health EPO/HMO/POS/PPO	$13.17
Rate for Payer: Provider Network of America Commercial	$14.05
Rate for Payer: UnitedHealthcare Commercial	$11.59
Rate for Payer: UnitedHealthcare Individual Exchange	$17.56

Know your out-of-pocket cost for care.

All Charges