|
ARISTADA PER MG (1064MG SYR)
|
Facility
|
IP
|
$20,311.11
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,640.44 |
| Max. Negotiated Rate |
$19,498.67 |
| Rate for Payer: Aetna Commercial |
$15,639.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,842.67
|
| Rate for Payer: Cash Price |
$10,155.56
|
| Rate for Payer: Cigna Commercial |
$16,858.22
|
| Rate for Payer: First Health Commercial |
$19,295.55
|
| Rate for Payer: Humana Commercial |
$17,264.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,655.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,989.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,093.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,873.78
|
| Rate for Payer: Ohio Health Group HMO |
$15,233.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,062.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,296.44
|
| Rate for Payer: PHCS Commercial |
$19,498.67
|
| Rate for Payer: United Healthcare All Payer |
$17,873.78
|
|
|
ARISTADA PER MG (1064MG SYR)
|
Facility
|
OP
|
$20,311.11
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$19,498.67 |
| Rate for Payer: Aetna Commercial |
$15,639.55
|
| Rate for Payer: Anthem Medicaid |
$6,984.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,842.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$10,155.56
|
| Rate for Payer: Cash Price |
$10,155.56
|
| Rate for Payer: Cigna Commercial |
$16,858.22
|
| Rate for Payer: First Health Commercial |
$19,295.55
|
| Rate for Payer: Humana Commercial |
$17,264.44
|
| Rate for Payer: Humana KY Medicaid |
$6,984.99
|
| Rate for Payer: Humana Medicare Advantage |
$2.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,056.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,655.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,989.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,125.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,873.78
|
| Rate for Payer: Ohio Health Group HMO |
$15,233.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,062.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,296.44
|
| Rate for Payer: PHCS Commercial |
$19,498.67
|
| Rate for Payer: United Healthcare All Payer |
$17,873.78
|
|
|
ARISTADA PER MG (441MG SYR)
|
Facility
|
OP
|
$8,418.40
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$8,081.66 |
| Rate for Payer: Aetna Commercial |
$6,482.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,566.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$4,209.20
|
| Rate for Payer: Cash Price |
$4,209.20
|
| Rate for Payer: Cigna Commercial |
$6,987.27
|
| Rate for Payer: First Health Commercial |
$7,997.48
|
| Rate for Payer: Humana Commercial |
$7,155.64
|
| Rate for Payer: Humana KY Medicaid |
$2,895.09
|
| Rate for Payer: Humana Medicare Advantage |
$2.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,924.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,903.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,212.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,953.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,408.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,313.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.70
|
| Rate for Payer: PHCS Commercial |
$8,081.66
|
| Rate for Payer: United Healthcare All Payer |
$7,408.19
|
|
|
ARISTADA PER MG (441MG SYR)
|
Facility
|
IP
|
$8,418.40
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,094.39 |
| Max. Negotiated Rate |
$8,081.66 |
| Rate for Payer: Aetna Commercial |
$6,482.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,566.35
|
| Rate for Payer: Cash Price |
$4,209.20
|
| Rate for Payer: Cigna Commercial |
$6,987.27
|
| Rate for Payer: First Health Commercial |
$7,997.48
|
| Rate for Payer: Humana Commercial |
$7,155.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,903.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,212.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,525.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,408.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,313.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.70
|
| Rate for Payer: PHCS Commercial |
$8,081.66
|
| Rate for Payer: United Healthcare All Payer |
$7,408.19
|
|
|
ARISTADA PER MG (662MG SYR)
|
Facility
|
IP
|
$12,637.19
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,642.83 |
| Max. Negotiated Rate |
$12,131.70 |
| Rate for Payer: Aetna Commercial |
$9,730.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.01
|
| Rate for Payer: Cash Price |
$6,318.60
|
| Rate for Payer: Cigna Commercial |
$10,488.87
|
| Rate for Payer: First Health Commercial |
$12,005.33
|
| Rate for Payer: Humana Commercial |
$10,741.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,362.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,326.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,120.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,477.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,527.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,642.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.53
|
| Rate for Payer: PHCS Commercial |
$12,131.70
|
| Rate for Payer: United Healthcare All Payer |
$11,120.73
|
|
|
ARISTADA PER MG (662MG SYR)
|
Facility
|
OP
|
$12,637.19
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$12,131.70 |
| Rate for Payer: Aetna Commercial |
$9,730.64
|
| Rate for Payer: Anthem Medicaid |
$4,345.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$6,318.60
|
| Rate for Payer: Cash Price |
$6,318.60
|
| Rate for Payer: Cigna Commercial |
$10,488.87
|
| Rate for Payer: First Health Commercial |
$12,005.33
|
| Rate for Payer: Humana Commercial |
$10,741.61
|
| Rate for Payer: Humana KY Medicaid |
$4,345.93
|
| Rate for Payer: Humana Medicare Advantage |
$2.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,362.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,326.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,120.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,477.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,527.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,642.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,917.53
|
| Rate for Payer: PHCS Commercial |
$12,131.70
|
| Rate for Payer: United Healthcare All Payer |
$11,120.73
|
|
|
ARISTADA PER MG (882MG SYR)
|
Facility
|
OP
|
$16,836.74
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$16,163.27 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,806.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,425.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,906.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,816.33
|
| Rate for Payer: Ohio Health Group HMO |
$12,627.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,367.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,219.39
|
| Rate for Payer: PHCS Commercial |
$16,163.27
|
| Rate for Payer: United Healthcare All Payer |
$14,816.33
|
| Rate for Payer: Aetna Commercial |
$12,964.29
|
| Rate for Payer: Anthem Medicaid |
$5,790.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,132.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$8,418.37
|
| Rate for Payer: Cash Price |
$8,418.37
|
| Rate for Payer: Cigna Commercial |
$13,974.49
|
| Rate for Payer: First Health Commercial |
$15,994.90
|
| Rate for Payer: Humana Commercial |
$14,311.23
|
| Rate for Payer: Humana KY Medicaid |
$5,790.15
|
| Rate for Payer: Humana Medicare Advantage |
$2.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5,849.08
|
|
|
ARISTADA PER MG (882MG SYR)
|
Facility
|
IP
|
$16,836.74
|
|
|
Service Code
|
HCPCS J1944
|
| Hospital Charge Code |
25002205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,188.78 |
| Max. Negotiated Rate |
$16,163.27 |
| Rate for Payer: Aetna Commercial |
$12,964.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,132.66
|
| Rate for Payer: Cash Price |
$8,418.37
|
| Rate for Payer: Cigna Commercial |
$13,974.49
|
| Rate for Payer: First Health Commercial |
$15,994.90
|
| Rate for Payer: Humana Commercial |
$14,311.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,806.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,425.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,051.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,816.33
|
| Rate for Payer: Ohio Health Group HMO |
$12,627.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,367.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,219.39
|
| Rate for Payer: PHCS Commercial |
$16,163.27
|
| Rate for Payer: United Healthcare All Payer |
$14,816.33
|
|
|
ARIXTRA 0.5 MG (10 MG/0.8 ML)
|
Facility
|
IP
|
$323.32
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25003822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$310.39 |
| Rate for Payer: Aetna Commercial |
$248.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.19
|
| Rate for Payer: Cash Price |
$161.66
|
| Rate for Payer: Cigna Commercial |
$268.36
|
| Rate for Payer: First Health Commercial |
$307.15
|
| Rate for Payer: Humana Commercial |
$274.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.52
|
| Rate for Payer: Ohio Health Group HMO |
$242.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.23
|
| Rate for Payer: PHCS Commercial |
$310.39
|
| Rate for Payer: United Healthcare All Payer |
$284.52
|
|
|
ARIXTRA 0.5 MG (10 MG/0.8 ML)
|
Facility
|
OP
|
$323.32
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25003822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$310.39 |
| Rate for Payer: Humana Commercial |
$274.82
|
| Rate for Payer: Humana KY Medicaid |
$111.19
|
| Rate for Payer: Kentucky WC Medicaid |
$112.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.52
|
| Rate for Payer: Ohio Health Group HMO |
$242.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.23
|
| Rate for Payer: PHCS Commercial |
$310.39
|
| Rate for Payer: United Healthcare All Payer |
$284.52
|
| Rate for Payer: Aetna Commercial |
$248.96
|
| Rate for Payer: Anthem Medicaid |
$111.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.19
|
| Rate for Payer: Cash Price |
$161.66
|
| Rate for Payer: Cigna Commercial |
$268.36
|
| Rate for Payer: First Health Commercial |
$307.15
|
|
|
ARIXTRA 0.5 MG (7 MG/0.6 ML)
|
Facility
|
OP
|
$558.87
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25003823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$536.52 |
| Rate for Payer: Aetna Commercial |
$430.33
|
| Rate for Payer: Anthem Medicaid |
$192.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.92
|
| Rate for Payer: Cash Price |
$279.44
|
| Rate for Payer: Cigna Commercial |
$463.86
|
| Rate for Payer: First Health Commercial |
$530.93
|
| Rate for Payer: Humana Commercial |
$475.04
|
| Rate for Payer: Humana KY Medicaid |
$192.20
|
| Rate for Payer: Kentucky WC Medicaid |
$194.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.81
|
| Rate for Payer: Ohio Health Group HMO |
$419.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.25
|
| Rate for Payer: PHCS Commercial |
$536.52
|
| Rate for Payer: United Healthcare All Payer |
$491.81
|
|
|
ARIXTRA 0.5 MG (7 MG/0.6 ML)
|
Facility
|
IP
|
$558.87
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25003823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$536.52 |
| Rate for Payer: Aetna Commercial |
$430.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.92
|
| Rate for Payer: Cash Price |
$279.44
|
| Rate for Payer: Cigna Commercial |
$463.86
|
| Rate for Payer: First Health Commercial |
$530.93
|
| Rate for Payer: Humana Commercial |
$475.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.81
|
| Rate for Payer: Ohio Health Group HMO |
$419.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.25
|
| Rate for Payer: PHCS Commercial |
$536.52
|
| Rate for Payer: United Healthcare All Payer |
$491.81
|
|
|
ARIXTRA 5 MG SYRINGE
|
Facility
|
IP
|
$558.87
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25002152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$536.52 |
| Rate for Payer: Humana Commercial |
$475.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.81
|
| Rate for Payer: Ohio Health Group HMO |
$419.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.25
|
| Rate for Payer: PHCS Commercial |
$536.52
|
| Rate for Payer: United Healthcare All Payer |
$491.81
|
| Rate for Payer: Aetna Commercial |
$430.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.92
|
| Rate for Payer: Cash Price |
$279.44
|
| Rate for Payer: Cigna Commercial |
$463.86
|
| Rate for Payer: First Health Commercial |
$530.93
|
|
|
ARIXTRA 5 MG SYRINGE
|
Facility
|
OP
|
$558.87
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25002152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$536.52 |
| Rate for Payer: Aetna Commercial |
$430.33
|
| Rate for Payer: Anthem Medicaid |
$192.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.92
|
| Rate for Payer: Cash Price |
$279.44
|
| Rate for Payer: Cigna Commercial |
$463.86
|
| Rate for Payer: First Health Commercial |
$530.93
|
| Rate for Payer: Humana Commercial |
$475.04
|
| Rate for Payer: Humana KY Medicaid |
$192.20
|
| Rate for Payer: Kentucky WC Medicaid |
$194.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.81
|
| Rate for Payer: Ohio Health Group HMO |
$419.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.25
|
| Rate for Payer: PHCS Commercial |
$536.52
|
| Rate for Payer: United Healthcare All Payer |
$491.81
|
|
|
ARIXTRA(FONDAPARI SOD)2.5MGSYR
|
Facility
|
IP
|
$324.61
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25002151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$311.63 |
| Rate for Payer: Aetna Commercial |
$249.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$269.43
|
| Rate for Payer: First Health Commercial |
$308.38
|
| Rate for Payer: Humana Commercial |
$275.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.66
|
| Rate for Payer: Ohio Health Group HMO |
$243.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.63
|
| Rate for Payer: PHCS Commercial |
$311.63
|
| Rate for Payer: United Healthcare All Payer |
$285.66
|
|
|
ARIXTRA(FONDAPARI SOD)2.5MGSYR
|
Facility
|
OP
|
$324.61
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
25002151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$311.63 |
| Rate for Payer: Aetna Commercial |
$249.95
|
| Rate for Payer: Anthem Medicaid |
$111.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$269.43
|
| Rate for Payer: First Health Commercial |
$308.38
|
| Rate for Payer: Humana Commercial |
$275.92
|
| Rate for Payer: Humana KY Medicaid |
$111.63
|
| Rate for Payer: Kentucky WC Medicaid |
$112.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.66
|
| Rate for Payer: Ohio Health Group HMO |
$243.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.63
|
| Rate for Payer: PHCS Commercial |
$311.63
|
| Rate for Payer: United Healthcare All Payer |
$285.66
|
|
|
ARMADA BALLOON 10*20*135
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
ARMADA BALLOON 10*20*135
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
ARMADA BALLOON 10*20*80
|
Facility
|
OP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem Medicaid |
$381.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Humana KY Medicaid |
$381.04
|
| Rate for Payer: Kentucky WC Medicaid |
$384.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ARMADA BALLOON 10*20*80
|
Facility
|
IP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ARMADA BALLOON 10*40*135
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
ARMADA BALLOON 10*40*135
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
ARMADA BALLOON 10*40*80
|
Facility
|
IP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ARMADA BALLOON 10*40*80
|
Facility
|
OP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem Medicaid |
$381.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Humana KY Medicaid |
$381.04
|
| Rate for Payer: Kentucky WC Medicaid |
$384.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ARMADA BALLOON 10*60*135
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
