|
Degarelix injection
|
Facility
|
OP
|
$2,324.07
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
Px0636J915501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.72 |
| Max. Negotiated Rate |
$2,324.07 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$1,638.47
|
| Rate for Payer: Aetna Workers' Compensation |
$1,638.47
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$1,610.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$1,610.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$1,831.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$1,789.53
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$1,831.37
|
| Rate for Payer: Cash Price |
$2,324.07
|
| Rate for Payer: Cigna Commercial |
$1,422.33
|
| Rate for Payer: Cigna Medicare Advantage |
$1,324.72
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,464.16
|
| Rate for Payer: Home State Health Plan Exchange |
$1,324.72
|
| Rate for Payer: Humana Medicare |
$1,743.05
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$1,743.05
|
| Rate for Payer: Provider Network of America Commercial |
$1,859.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,533.89
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$2,324.07
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$14,940.23
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$14,940.23 |
| 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: Family Health Partners Medicaid |
$14,940.23
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$14,940.23
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$14,940.23
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$14,940.23
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$10,380.50
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,380.50 |
| 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 |
$10,380.50
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$10,380.50
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$10,380.50
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$10,380.50
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$27,408.29
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$27,408.29 |
| 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 |
$27,408.29
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$27,408.29
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$27,408.29
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$27,408.29
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$8,076.60
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,076.60 |
| 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 |
$8,076.60
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Healthy Blue Medicaid |
$8,076.60
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Home State Health Plan Medicaid |
$8,076.60
|
| Rate for Payer: Humana Medicare |
$1,185.00
|
| Rate for Payer: Mercy CarePlus Medicaid |
$8,076.60
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$10,918.57
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,918.57 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$10,918.57
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$6,089.32
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,089.32 |
| 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: Harmony Health CHIP/Medicaid |
$1,826.00
|
| Rate for Payer: Home State Health Plan Exchange |
$6,053.00
|
| Rate for Payer: Humana Medicare |
$6,089.32
|
|
|
Demo&/Eval of Pt Utiliz Aersl Gen/Neb/Inhlr/IP
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
Px00000094664
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$21.69 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$21.69
|
|
|
denosumab 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$14,212.92
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,370.34 |
| 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 |
$14,212.92
|
| Rate for Payer: Cash Price |
$14,212.92
|
| 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 |
$10,659.69
|
| Rate for Payer: Provider Network of America Commercial |
$11,370.34
|
|
|
denosumab 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$14,212.92
|
|
|
Service Code
|
NDC 55513073001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$11,370.34 |
| 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 |
$14,212.92
|
| Rate for Payer: Cash Price |
$14,212.92
|
| 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 |
$10,659.69
|
| Rate for Payer: Provider Network of America Commercial |
$11,370.34
|
|
|
denosumab 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$14,212.92
|
|
|
Service Code
|
NDC 55513073001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,101.36 |
| Max. Negotiated Rate |
$14,212.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$10,020.11
|
| Rate for Payer: Aetna Workers' Compensation |
$10,020.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,849.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,849.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,943.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$11,199.78
|
| Rate for Payer: Cash Price |
$14,212.92
|
| Rate for Payer: Cigna Commercial |
$8,698.31
|
| Rate for Payer: Cigna Medicare Advantage |
$8,101.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,954.14
|
| Rate for Payer: Home State Health Plan Exchange |
$8,101.36
|
| Rate for Payer: Humana Medicare |
$10,659.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10,659.69
|
| Rate for Payer: Provider Network of America Commercial |
$11,370.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,380.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14,212.92
|
|
|
denosumab 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$14,212.92
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,101.36 |
| Max. Negotiated Rate |
$14,212.92 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$10,020.11
|
| Rate for Payer: Aetna Workers' Compensation |
$10,020.11
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,849.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,849.55
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$11,199.78
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,943.95
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$11,199.78
|
| Rate for Payer: Cash Price |
$14,212.92
|
| Rate for Payer: Cigna Commercial |
$8,698.31
|
| Rate for Payer: Cigna Medicare Advantage |
$8,101.36
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,954.14
|
| Rate for Payer: Home State Health Plan Exchange |
$8,101.36
|
| Rate for Payer: Humana Medicare |
$10,659.69
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10,659.69
|
| Rate for Payer: Provider Network of America Commercial |
$11,370.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,380.53
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$14,212.92
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,726.76
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,404.25 |
| Max. Negotiated Rate |
$7,726.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,447.37
|
| Rate for Payer: Aetna Workers' Compensation |
$5,447.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,949.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,088.69
|
| Rate for Payer: Cash Price |
$7,726.76
|
| Rate for Payer: Cigna Commercial |
$4,728.78
|
| Rate for Payer: Cigna Medicare Advantage |
$4,404.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,867.86
|
| Rate for Payer: Home State Health Plan Exchange |
$4,404.25
|
| Rate for Payer: Humana Medicare |
$5,795.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,099.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,726.76
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,726.76
|
|
|
Service Code
|
NDC 55513071021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,404.25 |
| Max. Negotiated Rate |
$7,726.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,447.37
|
| Rate for Payer: Aetna Workers' Compensation |
$5,447.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,949.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,088.69
|
| Rate for Payer: Cash Price |
$7,726.76
|
| Rate for Payer: Cigna Commercial |
$4,728.78
|
| Rate for Payer: Cigna Medicare Advantage |
$4,404.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,867.86
|
| Rate for Payer: Home State Health Plan Exchange |
$4,404.25
|
| Rate for Payer: Humana Medicare |
$5,795.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,099.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,726.76
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,726.76
|
|
|
Service Code
|
NDC 55513071001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,181.41 |
| 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 |
$7,726.76
|
| Rate for Payer: Cash Price |
$7,726.76
|
| 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 |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,726.76
|
|
|
Service Code
|
NDC 55513071001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,404.25 |
| Max. Negotiated Rate |
$7,726.76 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,447.37
|
| Rate for Payer: Aetna Workers' Compensation |
$5,447.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,354.64
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,088.69
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,949.61
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,088.69
|
| Rate for Payer: Cash Price |
$7,726.76
|
| Rate for Payer: Cigna Commercial |
$4,728.78
|
| Rate for Payer: Cigna Medicare Advantage |
$4,404.25
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,867.86
|
| Rate for Payer: Home State Health Plan Exchange |
$4,404.25
|
| Rate for Payer: Humana Medicare |
$5,795.07
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,099.66
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,726.76
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,726.76
|
|
|
Service Code
|
NDC 55513071021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,181.41 |
| 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 |
$7,726.76
|
| Rate for Payer: Cash Price |
$7,726.76
|
| 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 |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
|
|
denosumab 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,726.76
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,181.41 |
| 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 |
$7,726.76
|
| Rate for Payer: Cash Price |
$7,726.76
|
| 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 |
$5,795.07
|
| Rate for Payer: Provider Network of America Commercial |
$6,181.41
|
|
|
denosumab-bbdz 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$12,833.04
|
|
|
Service Code
|
NDC 61314022894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,314.83 |
| Max. Negotiated Rate |
$12,833.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,047.29
|
| Rate for Payer: Aetna Workers' Compensation |
$9,047.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8,893.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8,893.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9,881.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,112.44
|
| Rate for Payer: Cash Price |
$12,833.04
|
| Rate for Payer: Cigna Commercial |
$7,853.82
|
| Rate for Payer: Cigna Medicare Advantage |
$7,314.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,084.82
|
| Rate for Payer: Home State Health Plan Exchange |
$7,314.83
|
| Rate for Payer: Humana Medicare |
$9,624.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,624.78
|
| Rate for Payer: Provider Network of America Commercial |
$10,266.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,469.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12,833.04
|
|
|
denosumab-bbdz 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$12,833.04
|
|
|
Service Code
|
NDC 61314022894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,266.43 |
| 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 |
$12,833.04
|
| Rate for Payer: Cash Price |
$12,833.04
|
| 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 |
$9,624.78
|
| Rate for Payer: Provider Network of America Commercial |
$10,266.43
|
|
|
denosumab-bbdz 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$12,833.04
|
|
|
Service Code
|
HCPCS Q5136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,266.43 |
| 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 |
$12,833.04
|
| Rate for Payer: Cash Price |
$12,833.04
|
| 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 |
$9,624.78
|
| Rate for Payer: Provider Network of America Commercial |
$10,266.43
|
|
|
denosumab-bbdz 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$12,833.04
|
|
|
Service Code
|
HCPCS Q5136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,314.83 |
| Max. Negotiated Rate |
$12,833.04 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,047.29
|
| Rate for Payer: Aetna Workers' Compensation |
$9,047.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$8,893.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$8,893.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,112.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$9,881.44
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,112.44
|
| Rate for Payer: Cash Price |
$12,833.04
|
| Rate for Payer: Cigna Commercial |
$7,853.82
|
| Rate for Payer: Cigna Medicare Advantage |
$7,314.83
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,084.82
|
| Rate for Payer: Home State Health Plan Exchange |
$7,314.83
|
| Rate for Payer: Humana Medicare |
$9,624.78
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,624.78
|
| Rate for Payer: Provider Network of America Commercial |
$10,266.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,469.81
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$12,833.04
|
|
|
denosumab-bbdz 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$6,416.52
|
|
|
Service Code
|
HCPCS Q5136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,657.42 |
| Max. Negotiated Rate |
$6,416.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,523.65
|
| Rate for Payer: Aetna Workers' Compensation |
$4,523.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,446.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,446.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,940.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,056.22
|
| Rate for Payer: Cash Price |
$6,416.52
|
| Rate for Payer: Cigna Commercial |
$3,926.91
|
| Rate for Payer: Cigna Medicare Advantage |
$3,657.42
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,042.41
|
| Rate for Payer: Home State Health Plan Exchange |
$3,657.42
|
| Rate for Payer: Humana Medicare |
$4,812.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.39
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,234.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,416.52
|
|
|
denosumab-bbdz 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$6,416.52
|
|
|
Service Code
|
NDC 61314024063
|
|
Hospital Revenue Code
|
250
|
| 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: Cash Price |
$6,416.52
|
| Rate for Payer: Cash Price |
$6,416.52
|
| 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 |
$4,812.39
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.22
|
|
|
denosumab-bbdz 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$6,416.52
|
|
|
Service Code
|
NDC 61314024063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,657.42 |
| Max. Negotiated Rate |
$6,416.52 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,523.65
|
| Rate for Payer: Aetna Workers' Compensation |
$4,523.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,446.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,446.65
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,056.22
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$4,940.72
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,056.22
|
| Rate for Payer: Cash Price |
$6,416.52
|
| Rate for Payer: Cigna Commercial |
$3,926.91
|
| Rate for Payer: Cigna Medicare Advantage |
$3,657.42
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,042.41
|
| Rate for Payer: Home State Health Plan Exchange |
$3,657.42
|
| Rate for Payer: Humana Medicare |
$4,812.39
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$4,812.39
|
| Rate for Payer: Provider Network of America Commercial |
$5,133.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,234.90
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,416.52
|
|
