|
JAGWIRE DISCOVER
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
JAGWIRE GUIDEWIRE .035*260 ST
|
Facility
|
IP
|
$1,910.47
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.14 |
| Max. Negotiated Rate |
$1,834.05 |
| Rate for Payer: Aetna Commercial |
$1,471.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Cash Price |
$955.24
|
| Rate for Payer: Cigna Commercial |
$1,585.69
|
| Rate for Payer: First Health Commercial |
$1,814.95
|
| Rate for Payer: Humana Commercial |
$1,623.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,681.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.22
|
| Rate for Payer: PHCS Commercial |
$1,834.05
|
| Rate for Payer: United Healthcare All Payer |
$1,681.21
|
|
|
JAGWIRE GUIDEWIRE .035*260 ST
|
Facility
|
OP
|
$1,910.47
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.14 |
| Max. Negotiated Rate |
$1,834.05 |
| Rate for Payer: Aetna Commercial |
$1,471.06
|
| Rate for Payer: Anthem Medicaid |
$657.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.17
|
| Rate for Payer: Cash Price |
$955.24
|
| Rate for Payer: Cigna Commercial |
$1,585.69
|
| Rate for Payer: First Health Commercial |
$1,814.95
|
| Rate for Payer: Humana Commercial |
$1,623.90
|
| Rate for Payer: Humana KY Medicaid |
$657.01
|
| Rate for Payer: Kentucky WC Medicaid |
$663.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,681.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.22
|
| Rate for Payer: PHCS Commercial |
$1,834.05
|
| Rate for Payer: United Healthcare All Payer |
$1,681.21
|
|
|
JAGWIR GUIDWIR .035*260 ANGLE
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
JAGWIR GUIDWIR .035*260 ANGLE
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
JANUVIA SITAGLIPTIN 100MG TAB
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 6027782
|
| Hospital Charge Code |
25000804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
JANUVIA SITAGLIPTIN 100MG TAB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 6027782
|
| Hospital Charge Code |
25000804
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem Medicaid |
$9.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Humana KY Medicaid |
$9.63
|
| Rate for Payer: Kentucky WC Medicaid |
$9.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
JANUVIA SITAGLIPTIN 50MG TAB
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 6011231
|
| Hospital Charge Code |
25000806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
JANUVIA SITAGLIPTIN 50MG TAB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 6011231
|
| Hospital Charge Code |
25000806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem Medicaid |
$9.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.84
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Humana KY Medicaid |
$9.63
|
| Rate for Payer: Kentucky WC Medicaid |
$9.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
JARDIANCE 10MG TABLET
|
Facility
|
IP
|
$37.98
|
|
|
Service Code
|
NDC 597015230
|
| Hospital Charge Code |
25000807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.08
|
| Rate for Payer: Humana Commercial |
$32.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.42
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.21
|
| Rate for Payer: PHCS Commercial |
$36.46
|
| Rate for Payer: United Healthcare All Payer |
$33.42
|
|
|
JARDIANCE 10MG TABLET
|
Facility
|
OP
|
$37.98
|
|
|
Service Code
|
NDC 597015230
|
| Hospital Charge Code |
25000807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem Medicaid |
$13.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.08
|
| Rate for Payer: Humana Commercial |
$32.28
|
| Rate for Payer: Humana KY Medicaid |
$13.06
|
| Rate for Payer: Kentucky WC Medicaid |
$13.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.42
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.21
|
| Rate for Payer: PHCS Commercial |
$36.46
|
| Rate for Payer: United Healthcare All Payer |
$33.42
|
|
|
JARDIANCE 25MG TABLET
|
Facility
|
OP
|
$37.98
|
|
|
Service Code
|
NDC 597015330
|
| Hospital Charge Code |
25000808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem Medicaid |
$13.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.08
|
| Rate for Payer: Humana Commercial |
$32.28
|
| Rate for Payer: Humana KY Medicaid |
$13.06
|
| Rate for Payer: Kentucky WC Medicaid |
$13.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.42
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.21
|
| Rate for Payer: PHCS Commercial |
$36.46
|
| Rate for Payer: United Healthcare All Payer |
$33.42
|
|
|
JARDIANCE 25MG TABLET
|
Facility
|
IP
|
$37.98
|
|
|
Service Code
|
NDC 597015330
|
| Hospital Charge Code |
25000808
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.08
|
| Rate for Payer: Humana Commercial |
$32.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.42
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.21
|
| Rate for Payer: PHCS Commercial |
$36.46
|
| Rate for Payer: United Healthcare All Payer |
$33.42
|
|
|
JAW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 29800
|
| Hospital Charge Code |
76101073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.33 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$251.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.25
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
JAW ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 29800
|
| Hospital Charge Code |
76101073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.25
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
JAW ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 29800
|
| Hospital Charge Code |
76101073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$752.82
|
| Rate for Payer: Ambetter Exchange |
$506.97
|
| Rate for Payer: Anthem Medicaid |
$273.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$506.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$506.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$608.36
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$870.51
|
| Rate for Payer: Healthspan PPO |
$681.89
|
| Rate for Payer: Humana Medicaid |
$273.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$648.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$506.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.14
|
| Rate for Payer: Molina Healthcare Passport |
$273.67
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.06
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$506.97
|
|
|
JAW ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 29800
|
| Hospital Charge Code |
761P1073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$752.82
|
| Rate for Payer: Ambetter Exchange |
$506.97
|
| Rate for Payer: Anthem Medicaid |
$273.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$506.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$506.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$608.36
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$870.51
|
| Rate for Payer: Healthspan PPO |
$681.89
|
| Rate for Payer: Humana Medicaid |
$273.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$648.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$506.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.14
|
| Rate for Payer: Molina Healthcare Passport |
$273.67
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.06
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$506.97
|
|
|
JB2 CATH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JB2 CATH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JEJUNOSTOMY TUBE
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
76101804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.79 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$217.90
|
| Rate for Payer: Ambetter Exchange |
$133.79
|
| Rate for Payer: Anthem Medicaid |
$174.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.55
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$204.93
|
| Rate for Payer: Healthspan PPO |
$183.76
|
| Rate for Payer: Humana Medicaid |
$174.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$186.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.66
|
| Rate for Payer: Molina Healthcare Passport |
$174.18
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.93
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.79
|
|
|
JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
76101804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
JEJUNOSTOMY TUBE
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
76101804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
JEJUNOSTOMY TUBE(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
761P1804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.79 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$217.90
|
| Rate for Payer: Ambetter Exchange |
$133.79
|
| Rate for Payer: Anthem Medicaid |
$174.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.55
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$204.93
|
| Rate for Payer: Healthspan PPO |
$183.76
|
| Rate for Payer: Humana Medicaid |
$174.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$186.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.66
|
| Rate for Payer: Molina Healthcare Passport |
$174.18
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.93
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.79
|
|
|
JEMPERLI 10mg (500mg SDV)
|
Facility
|
OP
|
$64,279.37
|
|
|
Service Code
|
HCPCS J9272
|
| Hospital Charge Code |
25004100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.82 |
| Max. Negotiated Rate |
$61,708.20 |
| Rate for Payer: Aetna Commercial |
$49,495.11
|
| Rate for Payer: Anthem Medicaid |
$22,105.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$243.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50,137.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$341.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.16
|
| Rate for Payer: Cash Price |
$32,139.69
|
| Rate for Payer: Cash Price |
$32,139.69
|
| Rate for Payer: Cigna Commercial |
$53,351.88
|
| Rate for Payer: First Health Commercial |
$61,065.40
|
| Rate for Payer: Humana Commercial |
$54,637.46
|
| Rate for Payer: Humana KY Medicaid |
$22,105.68
|
| Rate for Payer: Humana Medicare Advantage |
$243.82
|
| Rate for Payer: Kentucky WC Medicaid |
$22,330.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,709.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,438.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,549.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,565.85
|
| Rate for Payer: Ohio Health Group HMO |
$48,209.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51,423.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,923.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44,352.77
|
| Rate for Payer: PHCS Commercial |
$61,708.20
|
| Rate for Payer: United Healthcare All Payer |
$56,565.85
|
|
|
JEMPERLI 10mg (500mg SDV)
|
Facility
|
IP
|
$64,279.37
|
|
|
Service Code
|
HCPCS J9272
|
| Hospital Charge Code |
25004100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,283.81 |
| Max. Negotiated Rate |
$61,708.20 |
| Rate for Payer: Aetna Commercial |
$49,495.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50,137.91
|
| Rate for Payer: Cash Price |
$32,139.69
|
| Rate for Payer: Cigna Commercial |
$53,351.88
|
| Rate for Payer: First Health Commercial |
$61,065.40
|
| Rate for Payer: Humana Commercial |
$54,637.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,709.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,438.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,283.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,565.85
|
| Rate for Payer: Ohio Health Group HMO |
$48,209.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51,423.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,923.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44,352.77
|
| Rate for Payer: PHCS Commercial |
$61,708.20
|
| Rate for Payer: United Healthcare All Payer |
$56,565.85
|
|
