|
ABDOMINAL PARACENTESIS W/O IMG
|
Facility
IP
|
$1,584.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
76101979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$1,520.64 |
| Rate for Payer: Aetna Commercial |
$1,219.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,235.52
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,314.72
|
| Rate for Payer: First Health Commercial |
$1,504.80
|
| Rate for Payer: Humana Commercial |
$1,346.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,298.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,168.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,393.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.04
|
| Rate for Payer: PHCS Commercial |
$1,520.64
|
|
|
ABDOMINOPLASTY
|
Professional
|
$2,675.00
|
|
| Hospital Charge Code |
22200036
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$2,675.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,675.00
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Multiplan PHCS |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,872.50
|
| Rate for Payer: UHCCP Medicaid |
$936.25
|
|
|
ABDOMINOPLASTY -80
|
Professional
|
$1,337.50
|
|
| Hospital Charge Code |
22200371
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$468.12 |
| Max. Negotiated Rate |
$1,337.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,337.50
|
| Rate for Payer: Cash Price |
$668.75
|
| Rate for Payer: Multiplan PHCS |
$802.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$936.25
|
| Rate for Payer: UHCCP Medicaid |
$468.12
|
|
|
ABDOMINOPLASTY - MINI
|
Professional
|
$780.00
|
|
| Hospital Charge Code |
22200085
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
|
|
ABDOMINOPLASTY-MINI -80
|
Professional
|
$390.00
|
|
| Hospital Charge Code |
22200384
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$390.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
|
|
ABELCET 10MG
|
Facility
OP
|
$517.00
|
|
|
Service Code
|
HCPCS J0287
|
| Hospital Charge Code |
25001859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$496.32 |
| Rate for Payer: Aetna Commercial |
$398.09
|
| Rate for Payer: Anthem Medicaid |
$177.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$429.11
|
| Rate for Payer: First Health Commercial |
$491.15
|
| Rate for Payer: Humana Commercial |
$439.45
|
| Rate for Payer: Humana KY Medicaid |
$177.80
|
| Rate for Payer: Humana Medicare Advantage |
$11.13
|
| Rate for Payer: Kentucky WC Medicaid |
$179.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
| Rate for Payer: Ohio Health Group HMO |
$387.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.27
|
| Rate for Payer: PHCS Commercial |
$496.32
|
| Rate for Payer: United Healthcare All Payer |
$454.96
|
|
|
ABELCET 10MG
|
Facility
IP
|
$517.00
|
|
|
Service Code
|
HCPCS J0287
|
| Hospital Charge Code |
25001859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$496.32 |
| Rate for Payer: Aetna Commercial |
$398.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$429.11
|
| Rate for Payer: First Health Commercial |
$491.15
|
| Rate for Payer: Humana Commercial |
$439.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
| Rate for Payer: Ohio Health Group HMO |
$387.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.27
|
| Rate for Payer: PHCS Commercial |
$496.32
|
|
|
ABILIFY 15 MG TABLET
|
Facility
OP
|
$34.46
|
|
| Hospital Charge Code |
25000130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Anthem Medicaid |
$11.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.88
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cigna Commercial |
$28.60
|
| Rate for Payer: First Health Commercial |
$32.74
|
| Rate for Payer: Humana Commercial |
$29.29
|
| Rate for Payer: Humana KY Medicaid |
$11.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.32
|
| Rate for Payer: Ohio Health Group HMO |
$25.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.68
|
| Rate for Payer: PHCS Commercial |
$33.08
|
| Rate for Payer: United Healthcare All Payer |
$30.32
|
|
|
ABILIFY 15 MG TABLET
|
Facility
IP
|
$34.46
|
|
| Hospital Charge Code |
25000130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.88
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cigna Commercial |
$28.60
|
| Rate for Payer: First Health Commercial |
$32.74
|
| Rate for Payer: Humana Commercial |
$29.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.32
|
| Rate for Payer: Ohio Health Group HMO |
$25.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.68
|
| Rate for Payer: PHCS Commercial |
$33.08
|
|
|
ABILIFY 20 MG TABLET
|
Facility
OP
|
$4.50
|
|
| Hospital Charge Code |
25000131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ABILIFY 20 MG TABLET
|
Facility
IP
|
$4.50
|
|
| Hospital Charge Code |
25000131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
|
|
ABILIFY 2MG TABLET
|
Facility
IP
|
$8.74
|
|
| Hospital Charge Code |
25000132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.82
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna Commercial |
$7.25
|
| Rate for Payer: First Health Commercial |
$8.30
|
| Rate for Payer: Humana Commercial |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.69
|
| Rate for Payer: Ohio Health Group HMO |
$6.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.71
|
| Rate for Payer: PHCS Commercial |
$8.39
|
|
|
ABILIFY 2MG TABLET
|
Facility
OP
|
$8.74
|
|
| Hospital Charge Code |
25000132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Anthem Medicaid |
$3.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.82
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna Commercial |
$7.25
|
| Rate for Payer: First Health Commercial |
$8.30
|
| Rate for Payer: Humana Commercial |
$7.43
|
| Rate for Payer: Humana KY Medicaid |
$3.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.69
|
| Rate for Payer: Ohio Health Group HMO |
$6.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.71
|
| Rate for Payer: PHCS Commercial |
$8.39
|
| Rate for Payer: United Healthcare All Payer |
$7.69
|
|
|
ABILIFY (ARIPIPRAZOLE) 10MGTAB
|
Facility
IP
|
$4.45
|
|
| Hospital Charge Code |
25000128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
|
|
ABILIFY (ARIPIPRAZOLE) 10MGTAB
|
Facility
OP
|
$4.45
|
|
| Hospital Charge Code |
25000128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
ABILIFY (ARIPIPRAZOLE) 5MG TAB
|
Facility
OP
|
$4.58
|
|
| Hospital Charge Code |
25000129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
ABILIFY (ARIPIPRAZOLE) 5MG TAB
|
Facility
IP
|
$4.58
|
|
| Hospital Charge Code |
25000129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
OP
|
$11,103.12
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$10,659.00 |
| Rate for Payer: Aetna Commercial |
$8,549.40
|
| Rate for Payer: Anthem Medicaid |
$3,818.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,660.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$5,551.56
|
| Rate for Payer: Cash Price |
$5,551.56
|
| Rate for Payer: Cigna Commercial |
$9,215.59
|
| Rate for Payer: First Health Commercial |
$10,547.96
|
| Rate for Payer: Humana Commercial |
$9,437.65
|
| Rate for Payer: Humana KY Medicaid |
$3,818.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,857.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,104.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,194.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,770.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,327.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,220.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,441.97
|
| Rate for Payer: PHCS Commercial |
$10,659.00
|
| Rate for Payer: United Healthcare All Payer |
$9,770.75
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
IP
|
$11,103.12
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,443.41 |
| Max. Negotiated Rate |
$10,659.00 |
| Rate for Payer: Aetna Commercial |
$8,549.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,660.43
|
| Rate for Payer: Cash Price |
$5,551.56
|
| Rate for Payer: Cigna Commercial |
$9,215.59
|
| Rate for Payer: First Health Commercial |
$10,547.96
|
| Rate for Payer: Humana Commercial |
$9,437.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,104.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,194.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,770.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,327.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,220.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,441.97
|
| Rate for Payer: PHCS Commercial |
$10,659.00
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
OP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$27.48
|
| Rate for Payer: Anthem Medicaid |
$12.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna Commercial |
$29.62
|
| Rate for Payer: First Health Commercial |
$33.91
|
| Rate for Payer: Humana Commercial |
$30.34
|
| Rate for Payer: Humana KY Medicaid |
$12.27
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$12.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.41
|
| Rate for Payer: Ohio Health Group HMO |
$26.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.06
|
| Rate for Payer: PHCS Commercial |
$34.26
|
| Rate for Payer: United Healthcare All Payer |
$31.41
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
IP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$27.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna Commercial |
$29.62
|
| Rate for Payer: First Health Commercial |
$33.91
|
| Rate for Payer: Humana Commercial |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.41
|
| Rate for Payer: Ohio Health Group HMO |
$26.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.06
|
| Rate for Payer: PHCS Commercial |
$34.26
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
IP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$27.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna Commercial |
$29.62
|
| Rate for Payer: First Health Commercial |
$33.91
|
| Rate for Payer: Humana Commercial |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.41
|
| Rate for Payer: Ohio Health Group HMO |
$26.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.06
|
| Rate for Payer: PHCS Commercial |
$34.26
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
OP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$27.48
|
| Rate for Payer: Anthem Medicaid |
$12.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cigna Commercial |
$29.62
|
| Rate for Payer: First Health Commercial |
$33.91
|
| Rate for Payer: Humana Commercial |
$30.34
|
| Rate for Payer: Humana KY Medicaid |
$12.27
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$12.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.41
|
| Rate for Payer: Ohio Health Group HMO |
$26.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.06
|
| Rate for Payer: PHCS Commercial |
$34.26
|
| Rate for Payer: United Healthcare All Payer |
$31.41
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Professional
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$35.69 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Multiplan PHCS |
$21.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.74
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.72
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Professional
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Multiplan PHCS |
$16.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.74
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.72
|
|
