|
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-bmwo 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$13,109.00
|
|
|
Service Code
|
HCPCS Q5157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,472.13 |
| Max. Negotiated Rate |
$13,109.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,241.84
|
| Rate for Payer: Aetna Workers' Compensation |
$9,241.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,084.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,084.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,093.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,329.89
|
| Rate for Payer: Cash Price |
$13,109.00
|
| Rate for Payer: Cigna Commercial |
$8,022.71
|
| Rate for Payer: Cigna Medicare Advantage |
$7,472.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,258.67
|
| Rate for Payer: Home State Health Plan Exchange |
$7,472.13
|
| Rate for Payer: Humana Medicare |
$9,831.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,831.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,487.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,651.94
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13,109.00
|
|
|
denosumab-bmwo 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$13,109.00
|
|
|
Service Code
|
HCPCS Q5157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,487.20 |
| 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: Cash Price |
$13,109.00
|
| Rate for Payer: Cash Price |
$13,109.00
|
| 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 |
$9,831.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,487.20
|
|
|
denosumab-bmwo 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$13,109.00
|
|
|
Service Code
|
NDC 72606003801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,487.20 |
| 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: Cash Price |
$13,109.00
|
| Rate for Payer: Cash Price |
$13,109.00
|
| 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 |
$9,831.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,487.20
|
|
|
denosumab-bmwo 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$13,109.00
|
|
|
Service Code
|
NDC 72606003801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,472.13 |
| Max. Negotiated Rate |
$13,109.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,241.84
|
| Rate for Payer: Aetna Workers' Compensation |
$9,241.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,084.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,084.54
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,329.89
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,093.93
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,329.89
|
| Rate for Payer: Cash Price |
$13,109.00
|
| Rate for Payer: Cigna Commercial |
$8,022.71
|
| Rate for Payer: Cigna Medicare Advantage |
$7,472.13
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,258.67
|
| Rate for Payer: Home State Health Plan Exchange |
$7,472.13
|
| Rate for Payer: Humana Medicare |
$9,831.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$9,831.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,487.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,651.94
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13,109.00
|
|
|
denosumab-bmwo 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,126.64
|
|
|
Service Code
|
HCPCS Q5157
|
|
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 |
$7,126.64
|
| Rate for Payer: Cash Price |
$7,126.64
|
| 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 |
$5,344.98
|
| Rate for Payer: Provider Network of America Commercial |
$5,701.31
|
|
|
denosumab-bmwo 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,126.64
|
|
|
Service Code
|
HCPCS Q5157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,062.18 |
| Max. Negotiated Rate |
$7,126.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,024.28
|
| Rate for Payer: Aetna Workers' Compensation |
$5,024.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,938.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,938.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,487.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,615.79
|
| Rate for Payer: Cash Price |
$7,126.64
|
| Rate for Payer: Cigna Commercial |
$4,361.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4,062.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,489.78
|
| Rate for Payer: Home State Health Plan Exchange |
$4,062.18
|
| Rate for Payer: Humana Medicare |
$5,344.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,344.98
|
| Rate for Payer: Provider Network of America Commercial |
$5,701.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,703.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,126.64
|
|
|
denosumab-bmwo 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,126.64
|
|
|
Service Code
|
NDC 72606003701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,062.18 |
| Max. Negotiated Rate |
$7,126.64 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,024.28
|
| Rate for Payer: Aetna Workers' Compensation |
$5,024.28
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,938.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,938.76
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,487.51
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,615.79
|
| Rate for Payer: Cash Price |
$7,126.64
|
| Rate for Payer: Cigna Commercial |
$4,361.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4,062.18
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,489.78
|
| Rate for Payer: Home State Health Plan Exchange |
$4,062.18
|
| Rate for Payer: Humana Medicare |
$5,344.98
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,344.98
|
| Rate for Payer: Provider Network of America Commercial |
$5,701.31
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,703.58
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,126.64
|
|
|
denosumab-bmwo 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,126.64
|
|
|
Service Code
|
NDC 72606003701
|
|
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 |
$7,126.64
|
| Rate for Payer: Cash Price |
$7,126.64
|
| 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 |
$5,344.98
|
| Rate for Payer: Provider Network of America Commercial |
$5,701.31
|
|
|
denosumab-bnht 120 mg/1.7 mL (70 mg/mL) syringe 1.7 mL Syringe
|
Facility
|
OP
|
$13,385.00
|
|
|
Service Code
|
HCPCS Q5158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,629.45 |
| Max. Negotiated Rate |
$13,385.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,436.42
|
| Rate for Payer: Aetna Workers' Compensation |
$9,436.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,275.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,275.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,306.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,547.38
|
| Rate for Payer: Cash Price |
$13,385.00
|
| Rate for Payer: Cigna Commercial |
$8,191.62
|
| Rate for Payer: Cigna Medicare Advantage |
$7,629.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,432.55
|
| Rate for Payer: Home State Health Plan Exchange |
$7,629.45
|
| Rate for Payer: Humana Medicare |
$10,038.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10,038.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,708.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,834.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13,385.00
|
|
|
denosumab-bnht 120 mg/1.7 mL (70 mg/mL) syringe 1.7 mL Syringe
|
Facility
|
IP
|
$13,385.00
|
|
|
Service Code
|
HCPCS Q5158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,708.00 |
| 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 |
$13,385.00
|
| Rate for Payer: Cash Price |
$13,385.00
|
| 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 |
$10,038.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,708.00
|
|
|
denosumab-bnht 120 mg/1.7 mL (70 mg/mL) syringe 1.7 mL Syringe
|
Facility
|
OP
|
$13,385.00
|
|
|
Service Code
|
NDC 65219067201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,629.45 |
| Max. Negotiated Rate |
$13,385.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$9,436.42
|
| Rate for Payer: Aetna Workers' Compensation |
$9,436.42
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$9,275.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$9,275.81
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$10,547.38
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$10,306.45
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$10,547.38
|
| Rate for Payer: Cash Price |
$13,385.00
|
| Rate for Payer: Cigna Commercial |
$8,191.62
|
| Rate for Payer: Cigna Medicare Advantage |
$7,629.45
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$8,432.55
|
| Rate for Payer: Home State Health Plan Exchange |
$7,629.45
|
| Rate for Payer: Humana Medicare |
$10,038.75
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$10,038.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,708.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,834.10
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$13,385.00
|
|
|
denosumab-bnht 120 mg/1.7 mL (70 mg/mL) syringe 1.7 mL Syringe
|
Facility
|
IP
|
$13,385.00
|
|
|
Service Code
|
NDC 65219067201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$10,708.00 |
| 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 |
$13,385.00
|
| Rate for Payer: Cash Price |
$13,385.00
|
| 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 |
$10,038.75
|
| Rate for Payer: Provider Network of America Commercial |
$10,708.00
|
|
|
denosumab-bnht 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,276.68
|
|
|
Service Code
|
HCPCS Q5158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,147.71 |
| Max. Negotiated Rate |
$7,276.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,130.06
|
| Rate for Payer: Aetna Workers' Compensation |
$5,130.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,042.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,042.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,603.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,734.02
|
| Rate for Payer: Cash Price |
$7,276.68
|
| Rate for Payer: Cigna Commercial |
$4,453.33
|
| Rate for Payer: Cigna Medicare Advantage |
$4,147.71
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,584.31
|
| Rate for Payer: Home State Health Plan Exchange |
$4,147.71
|
| Rate for Payer: Humana Medicare |
$5,457.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,457.51
|
| Rate for Payer: Provider Network of America Commercial |
$5,821.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,802.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,276.68
|
|
|
denosumab-bnht 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$7,276.68
|
|
|
Service Code
|
NDC 65219066801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,147.71 |
| Max. Negotiated Rate |
$7,276.68 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$5,130.06
|
| Rate for Payer: Aetna Workers' Compensation |
$5,130.06
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,042.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,042.74
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,734.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,603.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,734.02
|
| Rate for Payer: Cash Price |
$7,276.68
|
| Rate for Payer: Cigna Commercial |
$4,453.33
|
| Rate for Payer: Cigna Medicare Advantage |
$4,147.71
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,584.31
|
| Rate for Payer: Home State Health Plan Exchange |
$4,147.71
|
| Rate for Payer: Humana Medicare |
$5,457.51
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,457.51
|
| Rate for Payer: Provider Network of America Commercial |
$5,821.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,802.61
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$7,276.68
|
|
|
denosumab-bnht 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,276.68
|
|
|
Service Code
|
HCPCS Q5158
|
|
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 |
$7,276.68
|
| Rate for Payer: Cash Price |
$7,276.68
|
| 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 |
$5,457.51
|
| Rate for Payer: Provider Network of America Commercial |
$5,821.34
|
|
|
denosumab-bnht 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$7,276.68
|
|
|
Service Code
|
NDC 65219066801
|
|
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 |
$7,276.68
|
| Rate for Payer: Cash Price |
$7,276.68
|
| 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 |
$5,457.51
|
| Rate for Payer: Provider Network of America Commercial |
$5,821.34
|
|
|
Denosumab injection
|
Facility
|
IP
|
$8,530.11
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
Px0636J089701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$6,824.09 |
| 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: Cash Price |
$8,530.11
|
| Rate for Payer: Cash Price |
$8,530.11
|
| 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 |
$6,397.58
|
| Rate for Payer: Provider Network of America Commercial |
$6,824.09
|
|
|
Denosumab injection
|
Facility
|
OP
|
$8,530.11
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
Px0636J089701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,862.16 |
| Max. Negotiated Rate |
$8,530.11 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$6,013.73
|
| Rate for Payer: Aetna Workers' Compensation |
$6,013.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$5,911.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$5,911.37
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$6,721.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$6,721.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$6,721.73
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$6,568.18
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$6,721.73
|
| Rate for Payer: Cash Price |
$8,530.11
|
| Rate for Payer: Cigna Commercial |
$5,220.43
|
| Rate for Payer: Cigna Medicare Advantage |
$4,862.16
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$5,373.97
|
| Rate for Payer: Home State Health Plan Exchange |
$4,862.16
|
| Rate for Payer: Humana Medicare |
$6,397.58
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$6,397.58
|
| Rate for Payer: Provider Network of America Commercial |
$6,824.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,629.87
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$8,530.11
|
|
|
denosumab-nxxp 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$6,752.00
|
|
|
Service Code
|
HCPCS Q5162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,848.64 |
| Max. Negotiated Rate |
$6,752.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,760.16
|
| Rate for Payer: Aetna Workers' Compensation |
$4,760.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,679.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,679.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,199.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,320.58
|
| Rate for Payer: Cash Price |
$6,752.00
|
| Rate for Payer: Cigna Commercial |
$4,132.22
|
| Rate for Payer: Cigna Medicare Advantage |
$3,848.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,253.76
|
| Rate for Payer: Home State Health Plan Exchange |
$3,848.64
|
| Rate for Payer: Humana Medicare |
$5,064.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,064.00
|
| Rate for Payer: Provider Network of America Commercial |
$5,401.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,456.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,752.00
|
|
|
denosumab-nxxp 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$6,752.00
|
|
|
Service Code
|
NDC 78206019501
|
|
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 |
$6,752.00
|
| Rate for Payer: Cash Price |
$6,752.00
|
| 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 |
$5,064.00
|
| Rate for Payer: Provider Network of America Commercial |
$5,401.60
|
|
|
denosumab-nxxp 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
OP
|
$6,752.00
|
|
|
Service Code
|
NDC 78206019501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,848.64 |
| Max. Negotiated Rate |
$6,752.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$4,760.16
|
| Rate for Payer: Aetna Workers' Compensation |
$4,760.16
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$4,679.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$4,679.14
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$5,320.58
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$5,199.04
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$5,320.58
|
| Rate for Payer: Cash Price |
$6,752.00
|
| Rate for Payer: Cigna Commercial |
$4,132.22
|
| Rate for Payer: Cigna Medicare Advantage |
$3,848.64
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$4,253.76
|
| Rate for Payer: Home State Health Plan Exchange |
$3,848.64
|
| Rate for Payer: Humana Medicare |
$5,064.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$5,064.00
|
| Rate for Payer: Provider Network of America Commercial |
$5,401.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$4,456.32
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$6,752.00
|
|
|
denosumab-nxxp 120 mg/1.7 mL (70 mg/mL) solution 1.7 mL Vial
|
Facility
|
IP
|
$6,752.00
|
|
|
Service Code
|
HCPCS Q5162
|
|
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 |
$6,752.00
|
| Rate for Payer: Cash Price |
$6,752.00
|
| 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 |
$5,064.00
|
| Rate for Payer: Provider Network of America Commercial |
$5,401.60
|
|
|
denosumab-nxxp 60 mg/mL syringe 1 mL Syringe
|
Facility
|
IP
|
$3,376.00
|
|
|
Service Code
|
HCPCS Q5162
|
|
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 |
$3,376.00
|
| Rate for Payer: Cash Price |
$3,376.00
|
| 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 |
$2,532.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,700.80
|
|
|
denosumab-nxxp 60 mg/mL syringe 1 mL Syringe
|
Facility
|
OP
|
$3,376.00
|
|
|
Service Code
|
HCPCS Q5162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,924.32 |
| Max. Negotiated Rate |
$3,376.00 |
| Rate for Payer: Aetna Commercial/Medicare Advantage |
$2,380.08
|
| Rate for Payer: Aetna Workers' Compensation |
$2,380.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Advantage (HMO) |
$2,339.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Blue Care (HMO) |
$2,339.57
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Freedom Network Select |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care |
$2,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Preferred Care Blue Risk (PPO) |
$2,599.52
|
| Rate for Payer: Blue Cross Blue Shield of Kansas City Traditional |
$2,660.29
|
| Rate for Payer: Cash Price |
$3,376.00
|
| Rate for Payer: Cigna Commercial |
$2,066.11
|
| Rate for Payer: Cigna Medicare Advantage |
$1,924.32
|
| Rate for Payer: Harmony Health CHIP/Medicaid |
$2,126.88
|
| Rate for Payer: Home State Health Plan Exchange |
$1,924.32
|
| Rate for Payer: Humana Medicare |
$2,532.00
|
| Rate for Payer: Oscar Health EPO/HMO/POS/PPO |
$2,532.00
|
| Rate for Payer: Provider Network of America Commercial |
$2,700.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,228.16
|
| Rate for Payer: UnitedHealthcare Individual Exchange |
$3,376.00
|
|
