|
INTUBATION(P
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410P0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$171.24
|
| Rate for Payer: Ambetter Exchange |
$135.14
|
| Rate for Payer: Anthem Medicaid |
$102.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.17
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$166.53
|
| Rate for Payer: Healthspan PPO |
$144.41
|
| Rate for Payer: Humana Medicaid |
$102.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.40
|
| Rate for Payer: Molina Healthcare Passport |
$102.35
|
| Rate for Payer: Multiplan PHCS |
$130.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.68
|
| Rate for Payer: UHCCP Medicaid |
$76.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.14
|
|
|
INTUBATION(T
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410T0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$791.04 |
| Rate for Payer: Aetna Commercial |
$634.48
|
| Rate for Payer: Anthem Medicaid |
$283.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$683.92
|
| Rate for Payer: First Health Commercial |
$782.80
|
| Rate for Payer: Humana Commercial |
$700.40
|
| Rate for Payer: Humana KY Medicaid |
$283.37
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$286.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.12
|
| Rate for Payer: Ohio Health Group HMO |
$618.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.56
|
| Rate for Payer: PHCS Commercial |
$791.04
|
| Rate for Payer: United Healthcare All Payer |
$725.12
|
|
|
INTUBATION(T
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
410T0002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$247.20 |
| Max. Negotiated Rate |
$791.04 |
| Rate for Payer: Aetna Commercial |
$634.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.72
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cigna Commercial |
$683.92
|
| Rate for Payer: First Health Commercial |
$782.80
|
| Rate for Payer: Humana Commercial |
$700.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.12
|
| Rate for Payer: Ohio Health Group HMO |
$618.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.56
|
| Rate for Payer: PHCS Commercial |
$791.04
|
| Rate for Payer: United Healthcare All Payer |
$725.12
|
|
|
INTUITRAK AAA .014 GUIDEWIRE
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
INTUITRAK AAA .014 GUIDEWIRE
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
INTUITRAK AAA .035 GUIDEWIRE
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem Medicaid |
$662.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Humana KY Medicaid |
$662.70
|
| Rate for Payer: Kentucky WC Medicaid |
$669.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
INTUITRAK AAA .035 GUIDEWIRE
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
INTUSSUSCEPTION US
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
INTUSSUSCEPTION US
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
INTUSSUSCEPTION US
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
INTUSSUSCEPTION US(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
INTUSSUSCEPTION US(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
INTUSSUSCEPTION US(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
INVANZ 1GM/10ML VIAL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25003904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
INVANZ 1GM/10ML VIAL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25003904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
INVANZ 1GM/3.2ML IM
|
Facility
|
OP
|
$545.07
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25003905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.27 |
| Rate for Payer: Aetna Commercial |
$419.70
|
| Rate for Payer: Anthem Medicaid |
$187.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.15
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.41
|
| Rate for Payer: First Health Commercial |
$517.82
|
| Rate for Payer: Humana Commercial |
$463.31
|
| Rate for Payer: Humana KY Medicaid |
$187.45
|
| Rate for Payer: Kentucky WC Medicaid |
$189.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.66
|
| Rate for Payer: Ohio Health Group HMO |
$408.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.10
|
| Rate for Payer: PHCS Commercial |
$523.27
|
| Rate for Payer: United Healthcare All Payer |
$479.66
|
|
|
INVANZ 1GM/3.2ML IM
|
Facility
|
IP
|
$545.07
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25003905
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$523.27 |
| Rate for Payer: Aetna Commercial |
$419.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.15
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.41
|
| Rate for Payer: First Health Commercial |
$517.82
|
| Rate for Payer: Humana Commercial |
$463.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.66
|
| Rate for Payer: Ohio Health Group HMO |
$408.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.10
|
| Rate for Payer: PHCS Commercial |
$523.27
|
| Rate for Payer: United Healthcare All Payer |
$479.66
|
|
|
INVANZ 500mg (1gm PreMix) ANE
|
Facility
|
OP
|
$198.97
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25004145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$191.01 |
| Rate for Payer: Aetna Commercial |
$153.21
|
| Rate for Payer: Anthem Medicaid |
$68.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.20
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Cigna Commercial |
$165.15
|
| Rate for Payer: First Health Commercial |
$189.02
|
| Rate for Payer: Humana Commercial |
$169.12
|
| Rate for Payer: Humana KY Medicaid |
$68.43
|
| Rate for Payer: Kentucky WC Medicaid |
$69.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.09
|
| Rate for Payer: Ohio Health Group HMO |
$149.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.29
|
| Rate for Payer: PHCS Commercial |
$191.01
|
| Rate for Payer: United Healthcare All Payer |
$175.09
|
|
|
INVANZ 500mg (1gm PreMix) ANE
|
Facility
|
IP
|
$198.97
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
25004145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$191.01 |
| Rate for Payer: Aetna Commercial |
$153.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.20
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Cigna Commercial |
$165.15
|
| Rate for Payer: First Health Commercial |
$189.02
|
| Rate for Payer: Humana Commercial |
$169.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.09
|
| Rate for Payer: Ohio Health Group HMO |
$149.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.29
|
| Rate for Payer: PHCS Commercial |
$191.01
|
| Rate for Payer: United Healthcare All Payer |
$175.09
|
|
|
INVEGA 3MG TABLET
|
Facility
|
OP
|
$10.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25000788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: Anthem Medicaid |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.93
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.44
|
| Rate for Payer: First Health Commercial |
$9.66
|
| Rate for Payer: Humana Commercial |
$8.64
|
| Rate for Payer: Humana KY Medicaid |
$3.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.95
|
| Rate for Payer: Ohio Health Group HMO |
$7.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.02
|
| Rate for Payer: PHCS Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Payer |
$8.95
|
|
|
INVEGA 3MG TABLET
|
Facility
|
IP
|
$10.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25000788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna Commercial |
$7.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.93
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cigna Commercial |
$8.44
|
| Rate for Payer: First Health Commercial |
$9.66
|
| Rate for Payer: Humana Commercial |
$8.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.95
|
| Rate for Payer: Ohio Health Group HMO |
$7.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.02
|
| Rate for Payer: PHCS Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Payer |
$8.95
|
|
|
INVEGA HAFYERA 1mg(1092mg Syr)
|
Facility
|
OP
|
$77,809.32
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25004181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$74,696.95 |
| Rate for Payer: Aetna Commercial |
$59,913.18
|
| Rate for Payer: Anthem Medicaid |
$26,758.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,691.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$38,904.66
|
| Rate for Payer: Cash Price |
$38,904.66
|
| Rate for Payer: Cigna Commercial |
$64,581.74
|
| Rate for Payer: First Health Commercial |
$73,918.85
|
| Rate for Payer: Humana Commercial |
$66,137.92
|
| Rate for Payer: Humana KY Medicaid |
$26,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$27,030.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,803.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,423.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,295.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,472.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,356.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,247.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,694.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,688.43
|
| Rate for Payer: PHCS Commercial |
$74,696.95
|
| Rate for Payer: United Healthcare All Payer |
$68,472.20
|
|
|
INVEGA HAFYERA 1mg(1092mg Syr)
|
Facility
|
IP
|
$77,809.32
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25004181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,342.80 |
| Max. Negotiated Rate |
$74,696.95 |
| Rate for Payer: Aetna Commercial |
$59,913.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,691.27
|
| Rate for Payer: Cash Price |
$38,904.66
|
| Rate for Payer: Cigna Commercial |
$64,581.74
|
| Rate for Payer: First Health Commercial |
$73,918.85
|
| Rate for Payer: Humana Commercial |
$66,137.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,803.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,423.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,342.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,472.20
|
| Rate for Payer: Ohio Health Group HMO |
$58,356.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,247.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,694.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,688.43
|
| Rate for Payer: PHCS Commercial |
$74,696.95
|
| Rate for Payer: United Healthcare All Payer |
$68,472.20
|
|
|
INVEGA HAFYERA 1mg(1560mg Syr)
|
Facility
|
OP
|
$116,711.21
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25004182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$112,042.76 |
| Rate for Payer: Aetna Commercial |
$89,867.63
|
| Rate for Payer: Anthem Medicaid |
$40,136.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91,034.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$58,355.61
|
| Rate for Payer: Cash Price |
$58,355.61
|
| Rate for Payer: Cigna Commercial |
$96,870.30
|
| Rate for Payer: First Health Commercial |
$110,875.65
|
| Rate for Payer: Humana Commercial |
$99,204.53
|
| Rate for Payer: Humana KY Medicaid |
$40,136.99
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$40,545.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95,703.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,942.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$102,705.86
|
| Rate for Payer: Ohio Health Group HMO |
$87,533.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93,368.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101,538.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80,530.73
|
| Rate for Payer: PHCS Commercial |
$112,042.76
|
| Rate for Payer: United Healthcare All Payer |
$102,705.86
|
|
|
INVEGA HAFYERA 1mg(1560mg Syr)
|
Facility
|
IP
|
$116,711.21
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25004182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35,013.36 |
| Max. Negotiated Rate |
$112,042.76 |
| Rate for Payer: Aetna Commercial |
$89,867.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91,034.74
|
| Rate for Payer: Cash Price |
$58,355.61
|
| Rate for Payer: Cigna Commercial |
$96,870.30
|
| Rate for Payer: First Health Commercial |
$110,875.65
|
| Rate for Payer: Humana Commercial |
$99,204.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95,703.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,013.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$102,705.86
|
| Rate for Payer: Ohio Health Group HMO |
$87,533.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93,368.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101,538.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80,530.73
|
| Rate for Payer: PHCS Commercial |
$112,042.76
|
| Rate for Payer: United Healthcare All Payer |
$102,705.86
|
|
