|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
OP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem Medicaid |
$9.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Humana KY Medicaid |
$9.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
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
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
IP
|
$8,448.04
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,098.25 |
| Max. Negotiated Rate |
$8,110.12 |
| Rate for Payer: Cash Price |
$4,224.02
|
| Rate for Payer: Aetna Commercial |
$6,504.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,589.47
|
| Rate for Payer: Cigna Commercial |
$7,011.87
|
| Rate for Payer: First Health Commercial |
$8,025.64
|
| Rate for Payer: Humana Commercial |
$7,180.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,927.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,434.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,336.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.89
|
| Rate for Payer: PHCS Commercial |
$8,110.12
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
IP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
IP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
OP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem Medicaid |
$9.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Humana KY Medicaid |
$9.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Professional
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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(400mgPFS)
|
Facility
IP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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(400mgPFS)
|
Facility
IP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0184
|
|
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(400mgPFS)
|
Facility
OP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0184
|
|
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(400mgPFS)
|
Facility
OP
|
$14,804.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$14,211.99 |
| Rate for Payer: Aetna Commercial |
$11,399.20
|
| Rate for Payer: Anthem Medicaid |
$5,091.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,547.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$7,402.08
|
| Rate for Payer: Cash Price |
$7,402.08
|
| Rate for Payer: Cigna Commercial |
$12,287.45
|
| Rate for Payer: First Health Commercial |
$14,063.95
|
| Rate for Payer: Humana Commercial |
$12,583.54
|
| Rate for Payer: Humana KY Medicaid |
$5,091.15
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,142.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,139.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,925.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,193.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,027.66
|
| Rate for Payer: Ohio Health Group HMO |
$11,103.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,960.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,589.29
|
| Rate for Payer: PHCS Commercial |
$14,211.99
|
| Rate for Payer: United Healthcare All Payer |
$13,027.66
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Facility
IP
|
$14,804.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,924.54 |
| Max. Negotiated Rate |
$14,211.99 |
| Rate for Payer: Aetna Commercial |
$11,399.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,547.24
|
| Rate for Payer: Cash Price |
$7,402.08
|
| Rate for Payer: Cigna Commercial |
$12,287.45
|
| Rate for Payer: First Health Commercial |
$14,063.95
|
| Rate for Payer: Humana Commercial |
$12,583.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,139.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,925.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,441.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,027.66
|
| Rate for Payer: Ohio Health Group HMO |
$11,103.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,960.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,589.29
|
| Rate for Payer: PHCS Commercial |
$14,211.99
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Facility
OP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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 [400MG V]
|
Facility
OP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem Medicaid |
$9.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Humana KY Medicaid |
$9.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
IP
|
$11,264.03
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,464.32 |
| Max. Negotiated Rate |
$10,813.47 |
| Rate for Payer: Aetna Commercial |
$8,673.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,785.94
|
| Rate for Payer: Cash Price |
$5,632.02
|
| Rate for Payer: Cigna Commercial |
$9,349.14
|
| Rate for Payer: First Health Commercial |
$10,700.83
|
| Rate for Payer: Humana Commercial |
$9,574.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,236.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,312.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,379.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,912.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,448.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,252.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,491.85
|
| Rate for Payer: PHCS Commercial |
$10,813.47
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
IP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
OP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem Medicaid |
$9.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Humana KY Medicaid |
$9.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
IP
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.96
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$23.37
|
| Rate for Payer: First Health Commercial |
$26.75
|
| Rate for Payer: Humana Commercial |
$23.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$21.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.73
|
| Rate for Payer: PHCS Commercial |
$27.03
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
OP
|
$11,264.03
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$10,813.47 |
| Rate for Payer: Aetna Commercial |
$8,673.30
|
| Rate for Payer: Anthem Medicaid |
$3,873.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,785.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$5,632.02
|
| Rate for Payer: Cash Price |
$5,632.02
|
| Rate for Payer: Cigna Commercial |
$9,349.14
|
| Rate for Payer: First Health Commercial |
$10,700.83
|
| Rate for Payer: Humana Commercial |
$9,574.43
|
| Rate for Payer: Humana KY Medicaid |
$3,873.70
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,913.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,236.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,312.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,912.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,448.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,252.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,491.85
|
| Rate for Payer: PHCS Commercial |
$10,813.47
|
| Rate for Payer: United Healthcare All Payer |
$9,912.35
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Professional
|
$28.16
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
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
|
|
|
ABLATE ATRIA LMTD ENDO
|
Facility
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ABLATE ATRIA LMTD ENDO
|
Professional
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,323.28 |
| Rate for Payer: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,335.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,602.80
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,163.26
|
| Rate for Payer: Healthspan PPO |
$2,284.24
|
| Rate for Payer: Humana Medicaid |
$1,016.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,900.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,335.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,036.49
|
| Rate for Payer: Molina Healthcare Passport |
$1,016.17
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,736.37
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,335.67
|
|
|
ABLATE ATRIA LMTD ENDO
|
Facility
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
|
|
ABLATE ATRIA LMTD ENDO(P
|
Professional
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
761P1276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,323.28 |
| Rate for Payer: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,335.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,602.80
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,163.26
|
| Rate for Payer: Healthspan PPO |
$2,284.24
|
| Rate for Payer: Humana Medicaid |
$1,016.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,900.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,335.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,036.49
|
| Rate for Payer: Molina Healthcare Passport |
$1,016.17
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,736.37
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,335.67
|
|
|
ABLATION
|
Facility
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
