|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
OP
|
$35.69
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
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(300mgPFS)
|
Facility
|
OP
|
$11,526.10
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$11,065.06 |
| Rate for Payer: Aetna Commercial |
$8,875.10
|
| Rate for Payer: Anthem Medicaid |
$3,963.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,990.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$5,763.05
|
| Rate for Payer: Cash Price |
$5,763.05
|
| Rate for Payer: Cigna Commercial |
$9,566.66
|
| Rate for Payer: First Health Commercial |
$10,949.80
|
| Rate for Payer: Humana Commercial |
$9,797.18
|
| Rate for Payer: Humana KY Medicaid |
$3,963.83
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,004.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,043.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,142.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,644.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,305.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,573.09
|
| Rate for Payer: PHCS Commercial |
$11,065.06
|
| Rate for Payer: United Healthcare All Payer |
$10,142.97
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
|
OP
|
$8,769.87
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$8,419.08 |
| Rate for Payer: Aetna Commercial |
$6,752.80
|
| Rate for Payer: Anthem Medicaid |
$3,015.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,840.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$4,384.94
|
| Rate for Payer: Cash Price |
$4,384.94
|
| Rate for Payer: Cigna Commercial |
$7,278.99
|
| Rate for Payer: First Health Commercial |
$8,331.38
|
| Rate for Payer: Humana Commercial |
$7,454.39
|
| Rate for Payer: Humana KY Medicaid |
$3,015.96
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,046.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,191.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,472.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,076.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,717.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,577.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,753.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,718.66
|
| Rate for Payer: PHCS Commercial |
$8,419.08
|
| Rate for Payer: United Healthcare All Payer |
$7,717.49
|
|
|
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[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
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Professional
|
Both
|
$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 Medicare Advantage |
$28.16
|
| 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: Multiplan PHCS |
$16.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.71
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
|
IP
|
$8,769.87
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,140.08 |
| Max. Negotiated Rate |
$8,419.08 |
| Rate for Payer: Aetna Commercial |
$6,752.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,840.50
|
| Rate for Payer: Cash Price |
$4,384.94
|
| Rate for Payer: Cigna Commercial |
$7,278.99
|
| Rate for Payer: First Health Commercial |
$8,331.38
|
| Rate for Payer: Humana Commercial |
$7,454.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,191.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,472.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,717.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,577.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,753.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,718.66
|
| Rate for Payer: PHCS Commercial |
$8,419.08
|
| Rate for Payer: United Healthcare All Payer |
$7,717.49
|
|
|
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
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
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(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
|
| Rate for Payer: United Healthcare All Payer |
$31.41
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Facility
|
IP
|
$15,368.13
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,997.86 |
| Max. Negotiated Rate |
$14,753.40 |
| Rate for Payer: Aetna Commercial |
$11,833.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,987.14
|
| Rate for Payer: Cash Price |
$7,684.06
|
| Rate for Payer: Cigna Commercial |
$12,755.55
|
| Rate for Payer: First Health Commercial |
$14,599.72
|
| Rate for Payer: Humana Commercial |
$13,062.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,601.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,341.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,610.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,523.95
|
| Rate for Payer: Ohio Health Group HMO |
$11,526.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,073.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,997.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.12
|
| Rate for Payer: PHCS Commercial |
$14,753.40
|
| Rate for Payer: United Healthcare All Payer |
$13,523.95
|
|
|
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
|
| Rate for Payer: United Healthcare All Payer |
$31.41
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Facility
|
OP
|
$15,368.13
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$14,753.40 |
| Rate for Payer: Aetna Commercial |
$11,833.46
|
| Rate for Payer: Anthem Medicaid |
$5,285.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,987.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$7,684.06
|
| Rate for Payer: Cash Price |
$7,684.06
|
| Rate for Payer: Cigna Commercial |
$12,755.55
|
| Rate for Payer: First Health Commercial |
$14,599.72
|
| Rate for Payer: Humana Commercial |
$13,062.91
|
| Rate for Payer: Humana KY Medicaid |
$5,285.10
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,338.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,601.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,341.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,523.95
|
| Rate for Payer: Ohio Health Group HMO |
$11,526.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,073.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,997.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.12
|
| Rate for Payer: PHCS Commercial |
$14,753.40
|
| Rate for Payer: United Healthcare All Payer |
$13,523.95
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Professional
|
Both
|
$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 Medicare Advantage |
$35.69
|
| 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: Multiplan PHCS |
$21.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.98
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
|
|
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(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 [400MG V]
|
Professional
|
Both
|
$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 Medicare Advantage |
$28.16
|
| 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: Multiplan PHCS |
$16.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.71
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
|
|
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
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
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 |
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
|
| Rate for Payer: United Healthcare All Payer |
$24.78
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
|
IP
|
$11,693.14
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,520.11 |
| Max. Negotiated Rate |
$11,225.41 |
| Rate for Payer: Aetna Commercial |
$9,003.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,120.65
|
| Rate for Payer: Cash Price |
$5,846.57
|
| Rate for Payer: Cigna Commercial |
$9,705.31
|
| Rate for Payer: First Health Commercial |
$11,108.48
|
| Rate for Payer: Humana Commercial |
$9,939.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,588.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,629.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,507.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,289.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,769.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,338.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,624.87
|
| Rate for Payer: PHCS Commercial |
$11,225.41
|
| Rate for Payer: United Healthcare All Payer |
$10,289.96
|
|
|
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
|
OP
|
$11,693.14
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$11,225.41 |
| Rate for Payer: Aetna Commercial |
$9,003.72
|
| Rate for Payer: Anthem Medicaid |
$4,021.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,120.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.19
|
| Rate for Payer: Cash Price |
$5,846.57
|
| Rate for Payer: Cash Price |
$5,846.57
|
| Rate for Payer: Cigna Commercial |
$9,705.31
|
| Rate for Payer: First Health Commercial |
$11,108.48
|
| Rate for Payer: Humana Commercial |
$9,939.17
|
| Rate for Payer: Humana KY Medicaid |
$4,021.27
|
| Rate for Payer: Humana Medicare Advantage |
$6.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,588.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,629.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,101.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,289.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,769.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,338.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,624.87
|
| Rate for Payer: PHCS Commercial |
$11,225.41
|
| Rate for Payer: United Healthcare All Payer |
$10,289.96
|
|
|
ABLATE ATRIA LMTD ENDO
|
Professional
|
Both
|
$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: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| 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: 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 |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
|
|
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
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
