|
HUMIRA (1mg)40MG KIT
|
Facility
|
OP
|
$18,864.14
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
25001825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$18,109.57 |
| Rate for Payer: Aetna Commercial |
$14,525.39
|
| Rate for Payer: Anthem Medicaid |
$6,487.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$91.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,714.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$128.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.84
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cigna Commercial |
$15,657.24
|
| Rate for Payer: First Health Commercial |
$17,920.93
|
| Rate for Payer: Humana Commercial |
$16,034.52
|
| Rate for Payer: Humana KY Medicaid |
$6,487.38
|
| Rate for Payer: Humana Medicare Advantage |
$91.73
|
| Rate for Payer: Kentucky WC Medicaid |
$6,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,468.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,921.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,617.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,600.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,148.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,091.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,411.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,016.26
|
| Rate for Payer: PHCS Commercial |
$18,109.57
|
| Rate for Payer: United Healthcare All Payer |
$16,600.44
|
|
|
HUMIRA (1mg)40MG KIT
|
Facility
|
IP
|
$18,864.14
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
25001825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,659.24 |
| Max. Negotiated Rate |
$18,109.57 |
| Rate for Payer: Aetna Commercial |
$14,525.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,714.03
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cigna Commercial |
$15,657.24
|
| Rate for Payer: First Health Commercial |
$17,920.93
|
| Rate for Payer: Humana Commercial |
$16,034.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,468.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,921.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,659.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,600.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,148.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,091.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,411.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,016.26
|
| Rate for Payer: PHCS Commercial |
$18,109.57
|
| Rate for Payer: United Healthcare All Payer |
$16,600.44
|
|
|
HUMIRA (1mg)80MG/0.8ML
|
Facility
|
IP
|
$37,728.39
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
25003787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,318.52 |
| Max. Negotiated Rate |
$36,219.25 |
| Rate for Payer: Aetna Commercial |
$29,050.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,428.14
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cigna Commercial |
$31,314.56
|
| Rate for Payer: First Health Commercial |
$35,841.97
|
| Rate for Payer: Humana Commercial |
$32,069.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,937.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,843.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,318.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,200.98
|
| Rate for Payer: Ohio Health Group HMO |
$28,296.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,182.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,823.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,032.59
|
| Rate for Payer: PHCS Commercial |
$36,219.25
|
| Rate for Payer: United Healthcare All Payer |
$33,200.98
|
|
|
HUMIRA (1mg)80MG/0.8ML
|
Facility
|
OP
|
$37,728.39
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
25003787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$36,219.25 |
| Rate for Payer: Aetna Commercial |
$29,050.86
|
| Rate for Payer: Anthem Medicaid |
$12,974.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$91.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,428.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$128.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.84
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cigna Commercial |
$31,314.56
|
| Rate for Payer: First Health Commercial |
$35,841.97
|
| Rate for Payer: Humana Commercial |
$32,069.13
|
| Rate for Payer: Humana KY Medicaid |
$12,974.79
|
| Rate for Payer: Humana Medicare Advantage |
$91.73
|
| Rate for Payer: Kentucky WC Medicaid |
$13,106.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,937.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,843.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,235.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,200.98
|
| Rate for Payer: Ohio Health Group HMO |
$28,296.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,182.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,823.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,032.59
|
| Rate for Payer: PHCS Commercial |
$36,219.25
|
| Rate for Payer: United Healthcare All Payer |
$33,200.98
|
|
|
HUMULIN 5 UNITS [70/30 PEN]
|
Facility
|
IP
|
$72.92
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$56.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.88
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cigna Commercial |
$60.52
|
| Rate for Payer: First Health Commercial |
$69.27
|
| Rate for Payer: Humana Commercial |
$61.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.17
|
| Rate for Payer: Ohio Health Group HMO |
$54.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.31
|
| Rate for Payer: PHCS Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Payer |
$64.17
|
|
|
HUMULIN 5 UNITS [70/30 PEN]
|
Facility
|
OP
|
$72.92
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$56.15
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.88
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cigna Commercial |
$60.52
|
| Rate for Payer: First Health Commercial |
$69.27
|
| Rate for Payer: Humana Commercial |
$61.98
|
| Rate for Payer: Humana KY Medicaid |
$25.08
|
| Rate for Payer: Kentucky WC Medicaid |
$25.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.17
|
| Rate for Payer: Ohio Health Group HMO |
$54.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.31
|
| Rate for Payer: PHCS Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Payer |
$64.17
|
|
|
HUMULIN 70/30 5U (10ML VIAL)
|
Facility
|
IP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.75
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN 70/30 5U (10ML VIAL)
|
Facility
|
OP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem Medicaid |
$83.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Humana KY Medicaid |
$83.61
|
| Rate for Payer: Kentucky WC Medicaid |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.75
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN 70/30 KWIKPEN
|
Facility
|
OP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25003751
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna Commercial |
$48.75
|
| Rate for Payer: Anthem Medicaid |
$21.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.38
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.55
|
| Rate for Payer: First Health Commercial |
$60.14
|
| Rate for Payer: Humana Commercial |
$53.81
|
| Rate for Payer: Humana KY Medicaid |
$21.77
|
| Rate for Payer: Kentucky WC Medicaid |
$21.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.71
|
| Rate for Payer: Ohio Health Group HMO |
$47.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.68
|
| Rate for Payer: PHCS Commercial |
$60.78
|
| Rate for Payer: United Healthcare All Payer |
$55.71
|
|
|
HUMULIN 70/30 KWIKPEN
|
Facility
|
IP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25003751
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.99 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna Commercial |
$48.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.38
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.55
|
| Rate for Payer: First Health Commercial |
$60.14
|
| Rate for Payer: Humana Commercial |
$53.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.71
|
| Rate for Payer: Ohio Health Group HMO |
$47.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.68
|
| Rate for Payer: PHCS Commercial |
$60.78
|
| Rate for Payer: United Healthcare All Payer |
$55.71
|
|
|
HUMULIN N 5u(1000unit/10mL)MDV
|
Facility
|
OP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem Medicaid |
$83.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Humana KY Medicaid |
$83.61
|
| Rate for Payer: Kentucky WC Medicaid |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.75
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN N 5u(1000unit/10mL)MDV
|
Facility
|
IP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.75
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN N KWIKPEN
|
Facility
|
OP
|
$184.28
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$176.91 |
| Rate for Payer: Aetna Commercial |
$141.90
|
| Rate for Payer: Anthem Medicaid |
$63.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$92.14
|
| Rate for Payer: Cigna Commercial |
$152.95
|
| Rate for Payer: First Health Commercial |
$175.07
|
| Rate for Payer: Humana Commercial |
$156.64
|
| Rate for Payer: Humana KY Medicaid |
$63.37
|
| Rate for Payer: Kentucky WC Medicaid |
$64.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.17
|
| Rate for Payer: Ohio Health Group HMO |
$138.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.15
|
| Rate for Payer: PHCS Commercial |
$176.91
|
| Rate for Payer: United Healthcare All Payer |
$162.17
|
|
|
HUMULIN N KWIKPEN
|
Facility
|
IP
|
$184.28
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$176.91 |
| Rate for Payer: Aetna Commercial |
$141.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$92.14
|
| Rate for Payer: Cigna Commercial |
$152.95
|
| Rate for Payer: First Health Commercial |
$175.07
|
| Rate for Payer: Humana Commercial |
$156.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.17
|
| Rate for Payer: Ohio Health Group HMO |
$138.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.15
|
| Rate for Payer: PHCS Commercial |
$176.91
|
| Rate for Payer: United Healthcare All Payer |
$162.17
|
|
|
HUMULIN R U 500 KWIKPEN (3ML)
|
Facility
|
OP
|
$63.19
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$48.66
|
| Rate for Payer: Anthem Medicaid |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.29
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cigna Commercial |
$52.45
|
| Rate for Payer: First Health Commercial |
$60.03
|
| Rate for Payer: Humana Commercial |
$53.71
|
| Rate for Payer: Humana KY Medicaid |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.61
|
| Rate for Payer: Ohio Health Group HMO |
$47.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.60
|
| Rate for Payer: PHCS Commercial |
$60.66
|
| Rate for Payer: United Healthcare All Payer |
$55.61
|
|
|
HUMULIN R U 500 KWIKPEN (3ML)
|
Facility
|
IP
|
$63.19
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$48.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.29
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cigna Commercial |
$52.45
|
| Rate for Payer: First Health Commercial |
$60.03
|
| Rate for Payer: Humana Commercial |
$53.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.61
|
| Rate for Payer: Ohio Health Group HMO |
$47.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.60
|
| Rate for Payer: PHCS Commercial |
$60.66
|
| Rate for Payer: United Healthcare All Payer |
$55.61
|
|
|
HYBRID GLEN BASE LG 4MM
|
Facility
|
OP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem Medicaid |
$2,920.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Humana KY Medicaid |
$2,920.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID GLEN BASE LG 4MM
|
Facility
|
IP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID GLEN BASE MD 4MM
|
Facility
|
IP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID GLEN BASE MD 4MM
|
Facility
|
OP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem Medicaid |
$2,920.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Humana KY Medicaid |
$2,920.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID GLEN BASE SM 4MM
|
Facility
|
OP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem Medicaid |
$2,920.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Humana KY Medicaid |
$2,920.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID GLEN BASE SM 4MM
|
Facility
|
IP
|
$8,493.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.97 |
| Max. Negotiated Rate |
$8,153.52 |
| Rate for Payer: Aetna Commercial |
$6,539.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,624.73
|
| Rate for Payer: Cash Price |
$4,246.62
|
| Rate for Payer: Cigna Commercial |
$7,049.40
|
| Rate for Payer: First Health Commercial |
$8,068.59
|
| Rate for Payer: Humana Commercial |
$7,219.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,964.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,547.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,794.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,389.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,860.34
|
| Rate for Payer: PHCS Commercial |
$8,153.52
|
| Rate for Payer: United Healthcare All Payer |
$7,474.06
|
|
|
HYBRID KNEE FIBERTAK ANCHOR
|
Facility
|
IP
|
$13,133.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.12 |
| Max. Negotiated Rate |
$12,608.40 |
| Rate for Payer: Aetna Commercial |
$10,112.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.33
|
| Rate for Payer: Cash Price |
$6,566.88
|
| Rate for Payer: Cigna Commercial |
$10,901.01
|
| Rate for Payer: First Health Commercial |
$12,477.06
|
| Rate for Payer: Humana Commercial |
$11,163.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,769.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,692.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,426.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.29
|
| Rate for Payer: PHCS Commercial |
$12,608.40
|
| Rate for Payer: United Healthcare All Payer |
$11,557.70
|
|
|
HYBRID KNEE FIBERTAK ANCHOR
|
Facility
|
OP
|
$13,133.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.12 |
| Max. Negotiated Rate |
$12,608.40 |
| Rate for Payer: Aetna Commercial |
$10,112.99
|
| Rate for Payer: Anthem Medicaid |
$4,516.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.33
|
| Rate for Payer: Cash Price |
$6,566.88
|
| Rate for Payer: Cigna Commercial |
$10,901.01
|
| Rate for Payer: First Health Commercial |
$12,477.06
|
| Rate for Payer: Humana Commercial |
$11,163.69
|
| Rate for Payer: Humana KY Medicaid |
$4,516.70
|
| Rate for Payer: Kentucky WC Medicaid |
$4,562.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,769.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,692.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,607.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,426.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.29
|
| Rate for Payer: PHCS Commercial |
$12,608.40
|
| Rate for Payer: United Healthcare All Payer |
$11,557.70
|
|
|
HYCAMTIN 0.1 MG ( 4MG VIAL)
|
Facility
|
IP
|
$1,280.75
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
25002683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.23 |
| Max. Negotiated Rate |
$1,229.52 |
| Rate for Payer: Aetna Commercial |
$986.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.99
|
| Rate for Payer: Cash Price |
$640.38
|
| Rate for Payer: Cigna Commercial |
$1,063.02
|
| Rate for Payer: First Health Commercial |
$1,216.71
|
| Rate for Payer: Humana Commercial |
$1,088.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,050.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$945.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,127.06
|
| Rate for Payer: Ohio Health Group HMO |
$960.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.72
|
| Rate for Payer: PHCS Commercial |
$1,229.52
|
| Rate for Payer: United Healthcare All Payer |
$1,127.06
|
|
