|
AR 1-MOD CATH 5F
|
Facility
|
IP
|
$31.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.88
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cigna Commercial |
$26.48
|
| Rate for Payer: First Health Commercial |
$30.30
|
| Rate for Payer: Humana Commercial |
$27.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.07
|
| Rate for Payer: Ohio Health Group HMO |
$23.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.89
|
| Rate for Payer: PHCS Commercial |
$30.62
|
| Rate for Payer: United Healthcare All Payer |
$28.07
|
|
|
AR 1-MOD CATH 5F
|
Facility
|
OP
|
$31.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$24.56
|
| Rate for Payer: Anthem Medicaid |
$10.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.88
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cigna Commercial |
$26.48
|
| Rate for Payer: First Health Commercial |
$30.30
|
| Rate for Payer: Humana Commercial |
$27.12
|
| Rate for Payer: Humana KY Medicaid |
$10.97
|
| Rate for Payer: Kentucky WC Medicaid |
$11.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.07
|
| Rate for Payer: Ohio Health Group HMO |
$23.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.89
|
| Rate for Payer: PHCS Commercial |
$30.62
|
| Rate for Payer: United Healthcare All Payer |
$28.07
|
|
|
AR 2-MOD CATH 5F
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
AR 2-MOD CATH 5F
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
ARALAST 10MG (1000 MG +/- VL)
|
Facility
|
IP
|
$3,433.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$446.36 |
| Max. Negotiated Rate |
$3,296.16 |
| Rate for Payer: Aetna Commercial |
$2,643.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.13
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cigna Commercial |
$2,849.80
|
| Rate for Payer: First Health Commercial |
$3,261.82
|
| Rate for Payer: Humana Commercial |
$2,918.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,021.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.38
|
| Rate for Payer: PHCS Commercial |
$3,296.16
|
| Rate for Payer: United Healthcare All Payer |
$3,021.48
|
|
|
ARALAST 10MG (1000 MG +/- VL)
|
Facility
|
OP
|
$3,433.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$3,296.16 |
| Rate for Payer: Aetna Commercial |
$2,643.80
|
| Rate for Payer: Anthem Medicaid |
$1,180.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cigna Commercial |
$2,849.80
|
| Rate for Payer: First Health Commercial |
$3,261.82
|
| Rate for Payer: Humana Commercial |
$2,918.48
|
| Rate for Payer: Humana KY Medicaid |
$1,180.78
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,021.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.38
|
| Rate for Payer: PHCS Commercial |
$3,296.16
|
| Rate for Payer: United Healthcare All Payer |
$3,021.48
|
|
|
ARALAST NP 10MG (+/- 500MG VL)
|
Facility
|
OP
|
$1,716.75
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25002843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$1,648.08 |
| Rate for Payer: Aetna Commercial |
$1,321.90
|
| Rate for Payer: Anthem Medicaid |
$590.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$858.38
|
| Rate for Payer: Cash Price |
$858.38
|
| Rate for Payer: Cigna Commercial |
$1,424.90
|
| Rate for Payer: First Health Commercial |
$1,630.91
|
| Rate for Payer: Humana Commercial |
$1,459.24
|
| Rate for Payer: Humana KY Medicaid |
$590.39
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$596.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,266.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.19
|
| Rate for Payer: PHCS Commercial |
$1,648.08
|
| Rate for Payer: United Healthcare All Payer |
$1,510.74
|
|
|
ARALAST NP 10MG (+/- 500MG VL)
|
Facility
|
IP
|
$1,716.75
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25002843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$223.18 |
| Max. Negotiated Rate |
$1,648.08 |
| Rate for Payer: Aetna Commercial |
$1,321.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.06
|
| Rate for Payer: Cash Price |
$858.38
|
| Rate for Payer: Cigna Commercial |
$1,424.90
|
| Rate for Payer: First Health Commercial |
$1,630.91
|
| Rate for Payer: Humana Commercial |
$1,459.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,266.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.19
|
| Rate for Payer: PHCS Commercial |
$1,648.08
|
| Rate for Payer: United Healthcare All Payer |
$1,510.74
|
|
|
ARANESP 1mcg(100mcgPFS) ESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS) ESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$548.38 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS)nonESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS)nonESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$548.38 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV) ESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV) ESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$548.38 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV)nonESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV)nonESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$548.38 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.38
|
| Rate for Payer: Humana Commercial |
$3,585.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.67
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg (10mcgPFS) ESRD
|
Facility
|
OP
|
$421.83
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem Medicaid |
$145.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Humana KY Medicaid |
$145.07
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$146.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.77
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg (10mcgPFS) ESRD
|
Facility
|
IP
|
$421.83
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.77
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg(10mcgPFS)nonESRD
|
Facility
|
IP
|
$421.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.77
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg(10mcgPFS)nonESRD
|
Facility
|
OP
|
$421.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem Medicaid |
$145.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Humana KY Medicaid |
$145.07
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$146.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.77
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg (150mcgPFS) ESRD
|
Facility
|
OP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem Medicaid |
$2,176.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Humana KY Medicaid |
$2,176.01
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,198.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,219.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,961.51
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg (150mcgPFS) ESRD
|
Facility
|
IP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$822.57 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,898.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,961.51
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(150mcgPFS)nonESRD
|
Facility
|
OP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem Medicaid |
$2,176.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Humana KY Medicaid |
$2,176.01
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,198.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,219.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,961.51
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(150mcgPFS)nonESRD
|
Facility
|
IP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$822.57 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,898.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,961.51
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(200mcgPFS) ESRD
|
Facility
|
OP
|
$8,436.60
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$8,099.14 |
| Rate for Payer: Aetna Commercial |
$6,496.18
|
| Rate for Payer: Anthem Medicaid |
$2,901.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,580.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cigna Commercial |
$7,002.38
|
| Rate for Payer: First Health Commercial |
$8,014.77
|
| Rate for Payer: Humana Commercial |
$7,171.11
|
| Rate for Payer: Humana KY Medicaid |
$2,901.35
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,918.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,424.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,327.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.35
|
| Rate for Payer: PHCS Commercial |
$8,099.14
|
| Rate for Payer: United Healthcare All Payer |
$7,424.21
|
|
