|
NEUFLEX PIP IMPLANT SZ 1
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 2
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 2
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 3
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 3
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 4
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 4
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 5
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 5
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEULASTA 0.5mg (6mg) PFS
|
Facility
|
IP
|
$34,978.05
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
25004173
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,547.15 |
| Max. Negotiated Rate |
$33,578.93 |
| Rate for Payer: Aetna Commercial |
$26,933.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,282.88
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cigna Commercial |
$29,031.78
|
| Rate for Payer: First Health Commercial |
$33,229.15
|
| Rate for Payer: Humana Commercial |
$29,731.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,682.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,813.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,493.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,780.68
|
| Rate for Payer: Ohio Health Group HMO |
$26,233.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,995.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,843.20
|
| Rate for Payer: PHCS Commercial |
$33,578.93
|
| Rate for Payer: United Healthcare All Payer |
$30,780.68
|
|
|
NEULASTA 0.5mg (6mg) PFS
|
Facility
|
OP
|
$34,978.05
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
25004173
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$33,578.93 |
| Rate for Payer: Aetna Commercial |
$26,933.10
|
| Rate for Payer: Anthem Medicaid |
$12,028.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,282.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$70.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.42
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cigna Commercial |
$29,031.78
|
| Rate for Payer: First Health Commercial |
$33,229.15
|
| Rate for Payer: Humana Commercial |
$29,731.34
|
| Rate for Payer: Humana KY Medicaid |
$12,028.95
|
| Rate for Payer: Humana Medicare Advantage |
$50.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12,151.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,682.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,813.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,270.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,780.68
|
| Rate for Payer: Ohio Health Group HMO |
$26,233.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,995.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,843.20
|
| Rate for Payer: PHCS Commercial |
$33,578.93
|
| Rate for Payer: United Healthcare All Payer |
$30,780.68
|
|
|
NEULASTA OBI 0.5mg(6mg) PFS
|
Facility
|
OP
|
$34,978.05
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
25004174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$33,578.93 |
| Rate for Payer: Aetna Commercial |
$26,933.10
|
| Rate for Payer: Anthem Medicaid |
$12,028.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,282.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$70.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.42
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cigna Commercial |
$29,031.78
|
| Rate for Payer: First Health Commercial |
$33,229.15
|
| Rate for Payer: Humana Commercial |
$29,731.34
|
| Rate for Payer: Humana KY Medicaid |
$12,028.95
|
| Rate for Payer: Humana Medicare Advantage |
$50.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12,151.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,682.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,813.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,270.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,780.68
|
| Rate for Payer: Ohio Health Group HMO |
$26,233.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,995.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,843.20
|
| Rate for Payer: PHCS Commercial |
$33,578.93
|
| Rate for Payer: United Healthcare All Payer |
$30,780.68
|
|
|
NEULASTA OBI 0.5mg(6mg) PFS
|
Facility
|
IP
|
$34,978.05
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
25004174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,547.15 |
| Max. Negotiated Rate |
$33,578.93 |
| Rate for Payer: Aetna Commercial |
$26,933.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,282.88
|
| Rate for Payer: Cash Price |
$17,489.03
|
| Rate for Payer: Cigna Commercial |
$29,031.78
|
| Rate for Payer: First Health Commercial |
$33,229.15
|
| Rate for Payer: Humana Commercial |
$29,731.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,682.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,813.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,493.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,780.68
|
| Rate for Payer: Ohio Health Group HMO |
$26,233.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,995.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,547.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,843.20
|
| Rate for Payer: PHCS Commercial |
$33,578.93
|
| Rate for Payer: United Healthcare All Payer |
$30,780.68
|
|
|
NEUOMUSCULAR RE ED 15 MIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 97112
|
| Hospital Charge Code |
43000013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$45.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$45.39
|
| Rate for Payer: Kentucky WC Medicaid |
$45.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
NEUOMUSCULAR RE ED 15 MIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 97112
|
| Hospital Charge Code |
43000013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
NEUPOGEN 480MCG SYRINGE
|
Facility
|
OP
|
$2,896.29
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25002062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2,780.44 |
| Rate for Payer: Aetna Commercial |
$2,230.14
|
| Rate for Payer: Anthem Medicaid |
$996.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,259.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$1,448.14
|
| Rate for Payer: Cash Price |
$1,448.14
|
| Rate for Payer: Cigna Commercial |
$2,403.92
|
| Rate for Payer: First Health Commercial |
$2,751.48
|
| Rate for Payer: Humana Commercial |
$2,461.85
|
| Rate for Payer: Humana KY Medicaid |
$996.03
|
| Rate for Payer: Humana Medicare Advantage |
$0.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,006.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,374.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,137.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,016.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,548.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,172.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.85
|
| Rate for Payer: PHCS Commercial |
$2,780.44
|
| Rate for Payer: United Healthcare All Payer |
$2,548.74
|
|
|
NEUPOGEN 480MCG SYRINGE
|
Facility
|
IP
|
$2,896.29
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25002062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$376.52 |
| Max. Negotiated Rate |
$2,780.44 |
| Rate for Payer: Aetna Commercial |
$2,230.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,259.11
|
| Rate for Payer: Cash Price |
$1,448.14
|
| Rate for Payer: Cigna Commercial |
$2,403.92
|
| Rate for Payer: First Health Commercial |
$2,751.48
|
| Rate for Payer: Humana Commercial |
$2,461.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,374.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,137.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$868.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,548.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,172.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.85
|
| Rate for Payer: PHCS Commercial |
$2,780.44
|
| Rate for Payer: United Healthcare All Payer |
$2,548.74
|
|
|
NEUPOGEN EA MCG (300 MCG SYR)
|
Facility
|
IP
|
$1,818.67
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25003749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.43 |
| Max. Negotiated Rate |
$1,745.92 |
| Rate for Payer: Aetna Commercial |
$1,400.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.56
|
| Rate for Payer: Cash Price |
$909.34
|
| Rate for Payer: Cigna Commercial |
$1,509.50
|
| Rate for Payer: First Health Commercial |
$1,727.74
|
| Rate for Payer: Humana Commercial |
$1,545.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,491.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,600.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,364.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.79
|
| Rate for Payer: PHCS Commercial |
$1,745.92
|
| Rate for Payer: United Healthcare All Payer |
$1,600.43
|
|
|
NEUPOGEN EA MCG (300 MCG SYR)
|
Facility
|
OP
|
$1,818.67
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25003749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1,745.92 |
| Rate for Payer: Aetna Commercial |
$1,400.38
|
| Rate for Payer: Anthem Medicaid |
$625.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,418.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$909.34
|
| Rate for Payer: Cash Price |
$909.34
|
| Rate for Payer: Cigna Commercial |
$1,509.50
|
| Rate for Payer: First Health Commercial |
$1,727.74
|
| Rate for Payer: Humana Commercial |
$1,545.87
|
| Rate for Payer: Humana KY Medicaid |
$625.44
|
| Rate for Payer: Humana Medicare Advantage |
$0.99
|
| Rate for Payer: Kentucky WC Medicaid |
$631.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,491.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,600.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,364.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.79
|
| Rate for Payer: PHCS Commercial |
$1,745.92
|
| Rate for Payer: United Healthcare All Payer |
$1,600.43
|
|
|
NEUPOGENFILGRAST1MCG300MCG/1ML
|
Facility
|
OP
|
$1,715.82
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25002061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1,647.19 |
| Rate for Payer: Aetna Commercial |
$1,321.18
|
| Rate for Payer: Anthem Medicaid |
$590.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,338.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$857.91
|
| Rate for Payer: Cash Price |
$857.91
|
| Rate for Payer: Cigna Commercial |
$1,424.13
|
| Rate for Payer: First Health Commercial |
$1,630.03
|
| Rate for Payer: Humana Commercial |
$1,458.45
|
| Rate for Payer: Humana KY Medicaid |
$590.07
|
| Rate for Payer: Humana Medicare Advantage |
$0.99
|
| Rate for Payer: Kentucky WC Medicaid |
$596.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,406.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,266.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,509.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,286.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.90
|
| Rate for Payer: PHCS Commercial |
$1,647.19
|
| Rate for Payer: United Healthcare All Payer |
$1,509.92
|
|
|
NEUPOGENFILGRAST1MCG300MCG/1ML
|
Facility
|
IP
|
$1,715.82
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25002061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$1,647.19 |
| Rate for Payer: Aetna Commercial |
$1,321.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,338.34
|
| Rate for Payer: Cash Price |
$857.91
|
| Rate for Payer: Cigna Commercial |
$1,424.13
|
| Rate for Payer: First Health Commercial |
$1,630.03
|
| Rate for Payer: Humana Commercial |
$1,458.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,406.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,266.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,509.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,286.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.90
|
| Rate for Payer: PHCS Commercial |
$1,647.19
|
| Rate for Payer: United Healthcare All Payer |
$1,509.92
|
|
|
NEUPRO 1MG PATCH (24HR)
|
Facility
|
OP
|
$66.10
|
|
|
Service Code
|
NDC 50474080103
|
| Hospital Charge Code |
25003262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem Medicaid |
$22.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.56
|
| Rate for Payer: Cash Price |
$33.05
|
| Rate for Payer: Cigna Commercial |
$54.86
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.18
|
| Rate for Payer: Humana KY Medicaid |
$22.73
|
| Rate for Payer: Kentucky WC Medicaid |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.17
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.46
|
| Rate for Payer: United Healthcare All Payer |
$58.17
|
|
|
NEUPRO 1MG PATCH (24HR)
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
NDC 50474080103
|
| Hospital Charge Code |
25003262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.56
|
| Rate for Payer: Cash Price |
$33.05
|
| Rate for Payer: Cigna Commercial |
$54.86
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.17
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.46
|
| Rate for Payer: United Healthcare All Payer |
$58.17
|
|
|
NEUPRO 2MG PATCH (24HR)
|
Facility
|
OP
|
$66.10
|
|
|
Service Code
|
NDC 50474080203
|
| Hospital Charge Code |
25003263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem Medicaid |
$22.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.56
|
| Rate for Payer: Cash Price |
$33.05
|
| Rate for Payer: Cigna Commercial |
$54.86
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.18
|
| Rate for Payer: Humana KY Medicaid |
$22.73
|
| Rate for Payer: Kentucky WC Medicaid |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.17
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.46
|
| Rate for Payer: United Healthcare All Payer |
$58.17
|
|
|
NEUPRO 2MG PATCH (24HR)
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
NDC 50474080203
|
| Hospital Charge Code |
25003263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.56
|
| Rate for Payer: Cash Price |
$33.05
|
| Rate for Payer: Cigna Commercial |
$54.86
|
| Rate for Payer: First Health Commercial |
$62.80
|
| Rate for Payer: Humana Commercial |
$56.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.17
|
| Rate for Payer: Ohio Health Group HMO |
$49.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.49
|
| Rate for Payer: PHCS Commercial |
$63.46
|
| Rate for Payer: United Healthcare All Payer |
$58.17
|
|
