|
ARANESP 1mcg(40mcgSDV)nonESRD
|
Facility
|
IP
|
$1,687.32
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25004397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.35 |
| Max. Negotiated Rate |
$1,619.83 |
| Rate for Payer: Aetna Commercial |
$1,299.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.11
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cigna Commercial |
$1,400.48
|
| Rate for Payer: First Health Commercial |
$1,602.95
|
| Rate for Payer: Humana Commercial |
$1,434.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,484.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.07
|
| Rate for Payer: PHCS Commercial |
$1,619.83
|
| Rate for Payer: United Healthcare All Payer |
$1,484.84
|
|
|
ARANESP 1mcg(40mcgSDV)nonESRD
|
Facility
|
OP
|
$1,687.32
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25004397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$1,619.83 |
| Rate for Payer: Aetna Commercial |
$1,299.24
|
| Rate for Payer: Anthem Medicaid |
$580.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cigna Commercial |
$1,400.48
|
| Rate for Payer: First Health Commercial |
$1,602.95
|
| Rate for Payer: Humana Commercial |
$1,434.22
|
| Rate for Payer: Humana KY Medicaid |
$580.27
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$586.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$591.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,484.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.07
|
| Rate for Payer: PHCS Commercial |
$1,619.83
|
| Rate for Payer: United Healthcare All Payer |
$1,484.84
|
|
|
ARANESP 1mcg (500mcgPFS) ESRD
|
Facility
|
OP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.46
|
| Rate for Payer: Anthem Medicaid |
$7,253.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Humana KY Medicaid |
$7,253.37
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,327.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,398.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,218.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,741.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,538.36
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg (500mcgPFS) ESRD
|
Facility
|
IP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,741.90 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,218.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,741.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,538.36
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(500mcgPFS)nonESRD
|
Facility
|
IP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,741.90 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,218.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,741.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,538.36
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(500mcgPFS)nonESRD
|
Facility
|
OP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.46
|
| Rate for Payer: Anthem Medicaid |
$7,253.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Humana KY Medicaid |
$7,253.37
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,327.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,398.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,218.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,741.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,538.36
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(60mcgPFS) ESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS) ESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS)nonESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS)nonESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV) ESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV) ESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV)nonESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV)nonESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.96
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$2.93
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.60
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARAVA 10MG TABLET
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
NDC 88216030
|
| Hospital Charge Code |
25000245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Anthem Medicaid |
$30.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.50
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna Commercial |
$72.89
|
| Rate for Payer: First Health Commercial |
$83.43
|
| Rate for Payer: Humana Commercial |
$74.65
|
| Rate for Payer: Humana KY Medicaid |
$30.20
|
| Rate for Payer: Kentucky WC Medicaid |
$30.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.28
|
| Rate for Payer: Ohio Health Group HMO |
$65.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.22
|
| Rate for Payer: PHCS Commercial |
$84.31
|
| Rate for Payer: United Healthcare All Payer |
$77.28
|
|
|
ARAVA 10MG TABLET
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
NDC 88216030
|
| Hospital Charge Code |
25000245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.50
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna Commercial |
$72.89
|
| Rate for Payer: First Health Commercial |
$83.43
|
| Rate for Payer: Humana Commercial |
$74.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.28
|
| Rate for Payer: Ohio Health Group HMO |
$65.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.22
|
| Rate for Payer: PHCS Commercial |
$84.31
|
| Rate for Payer: United Healthcare All Payer |
$77.28
|
|
|
ARCHER SUPER STIFF GUIDEWIRE
|
Facility
|
IP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
ARCHER SUPER STIFF GUIDEWIRE
|
Facility
|
OP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem Medicaid |
$638.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Humana KY Medicaid |
$638.79
|
| Rate for Payer: Kentucky WC Medicaid |
$645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
ARCH WIRE BANDS/WIRE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ARCH WIRE BANDS/WIRE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ARCOM ARTIC E1 HIP BRG 22*32
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
ARCOM ARTIC E1 HIP BRG 22*32
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
ARCOM ARTIC E1 HIP BRG 22*36
|
Facility
|
OP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem Medicaid |
$4,524.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Humana KY Medicaid |
$4,524.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,570.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
ARCOM ARTIC E1 HIP BRG 22*36
|
Facility
|
IP
|
$13,155.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.15 |
| Max. Negotiated Rate |
$12,628.80 |
| Rate for Payer: Aetna Commercial |
$10,129.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,260.90
|
| Rate for Payer: Cash Price |
$6,577.50
|
| Rate for Payer: Cigna Commercial |
$10,918.65
|
| Rate for Payer: First Health Commercial |
$12,497.25
|
| Rate for Payer: Humana Commercial |
$11,181.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,787.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,708.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,946.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,576.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,078.05
|
| Rate for Payer: PHCS Commercial |
$12,628.80
|
| Rate for Payer: United Healthcare All Payer |
$11,576.40
|
|
|
ARCOM XL 10^ 36 SZ 24
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
