|
ABD ULTRASOUND COMPLETE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
402P0013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$207.83 |
| Rate for Payer: Aetna Commercial |
$207.83
|
| Rate for Payer: Ambetter Exchange |
$104.53
|
| Rate for Payer: Anthem Medicaid |
$88.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.44
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$183.40
|
| Rate for Payer: Healthspan PPO |
$194.75
|
| Rate for Payer: Humana Medicaid |
$88.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.02
|
| Rate for Payer: Molina Healthcare Passport |
$88.25
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.89
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.53
|
|
|
ABD ULTRASOUND COMPLETE(T
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
402T0013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,207.68 |
| Rate for Payer: Aetna Commercial |
$968.66
|
| Rate for Payer: Anthem Medicaid |
$432.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$981.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cigna Commercial |
$1,044.14
|
| Rate for Payer: First Health Commercial |
$1,195.10
|
| Rate for Payer: Humana Commercial |
$1,069.30
|
| Rate for Payer: Humana KY Medicaid |
$432.63
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$437.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,031.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$928.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$441.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,107.04
|
| Rate for Payer: Ohio Health Group HMO |
$943.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,006.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.02
|
| Rate for Payer: PHCS Commercial |
$1,207.68
|
| Rate for Payer: United Healthcare All Payer |
$1,107.04
|
|
|
ABD ULTRASOUND COMPLETE(T
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
HCPCS 76700
|
| Hospital Charge Code |
402T0013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,207.68 |
| Rate for Payer: Aetna Commercial |
$968.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$981.24
|
| Rate for Payer: Cash Price |
$629.00
|
| Rate for Payer: Cigna Commercial |
$1,044.14
|
| Rate for Payer: First Health Commercial |
$1,195.10
|
| Rate for Payer: Humana Commercial |
$1,069.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,031.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$928.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,107.04
|
| Rate for Payer: Ohio Health Group HMO |
$943.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,006.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.02
|
| Rate for Payer: PHCS Commercial |
$1,207.68
|
| Rate for Payer: United Healthcare All Payer |
$1,107.04
|
|
|
ABELCET 10MG
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS J0287
|
| Hospital Charge Code |
25001859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$511.68 |
| Rate for Payer: Aetna Commercial |
$410.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.74
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cigna Commercial |
$442.39
|
| Rate for Payer: First Health Commercial |
$506.35
|
| Rate for Payer: Humana Commercial |
$453.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.04
|
| Rate for Payer: Ohio Health Group HMO |
$399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.77
|
| Rate for Payer: PHCS Commercial |
$511.68
|
| Rate for Payer: United Healthcare All Payer |
$469.04
|
|
|
ABELCET 10MG
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS J0287
|
| Hospital Charge Code |
25001859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$511.68 |
| Rate for Payer: Aetna Commercial |
$410.41
|
| Rate for Payer: Anthem Medicaid |
$183.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$415.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.90
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cigna Commercial |
$442.39
|
| Rate for Payer: First Health Commercial |
$506.35
|
| Rate for Payer: Humana Commercial |
$453.05
|
| Rate for Payer: Humana KY Medicaid |
$183.30
|
| Rate for Payer: Humana Medicare Advantage |
$10.30
|
| Rate for Payer: Kentucky WC Medicaid |
$185.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.04
|
| Rate for Payer: Ohio Health Group HMO |
$399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.77
|
| Rate for Payer: PHCS Commercial |
$511.68
|
| Rate for Payer: United Healthcare All Payer |
$469.04
|
|
|
ABILIFY 15 MG TABLET
|
Facility
|
IP
|
$36.46
|
|
|
Service Code
|
NDC 59148000913
|
| Hospital Charge Code |
25000130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.44
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cigna Commercial |
$30.26
|
| Rate for Payer: First Health Commercial |
$34.64
|
| Rate for Payer: Humana Commercial |
$30.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.08
|
| Rate for Payer: Ohio Health Group HMO |
$27.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.16
|
| Rate for Payer: PHCS Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Payer |
$32.08
|
|
|
ABILIFY 15 MG TABLET
|
Facility
|
OP
|
$36.46
|
|
|
Service Code
|
NDC 59148000913
|
| Hospital Charge Code |
25000130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Anthem Medicaid |
$12.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.44
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cigna Commercial |
$30.26
|
| Rate for Payer: First Health Commercial |
$34.64
|
| Rate for Payer: Humana Commercial |
$30.99
|
| Rate for Payer: Humana KY Medicaid |
$12.54
|
| Rate for Payer: Kentucky WC Medicaid |
$12.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.08
|
| Rate for Payer: Ohio Health Group HMO |
$27.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.16
|
| Rate for Payer: PHCS Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Payer |
$32.08
|
|
|
ABILIFY 20 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 65162090109
|
| Hospital Charge Code |
25000131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
ABILIFY 20 MG TABLET
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 65162090109
|
| Hospital Charge Code |
25000131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
ABILIFY 2MG TABLET
|
Facility
|
OP
|
$9.04
|
|
|
Service Code
|
NDC 50268008712
|
| Hospital Charge Code |
25000132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: First Health Commercial |
$8.59
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.24
|
| Rate for Payer: PHCS Commercial |
$8.68
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
ABILIFY 2MG TABLET
|
Facility
|
IP
|
$9.04
|
|
|
Service Code
|
NDC 50268008712
|
| Hospital Charge Code |
25000132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: First Health Commercial |
$8.59
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.24
|
| Rate for Payer: PHCS Commercial |
$8.68
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
ABILIFY (ARIPIPRAZOLE) 10MGTAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 62332009930
|
| Hospital Charge Code |
25000128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ABILIFY (ARIPIPRAZOLE) 10MGTAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 62332009930
|
| Hospital Charge Code |
25000128
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ABILIFY (ARIPIPRAZOLE) 5MG TAB
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 50268008815
|
| Hospital Charge Code |
25000129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.45
|
| Rate for Payer: Humana Commercial |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.12
|
| Rate for Payer: Ohio Health Group HMO |
$3.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Payer |
$4.12
|
|
|
ABILIFY (ARIPIPRAZOLE) 5MG TAB
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 50268008815
|
| Hospital Charge Code |
25000129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.45
|
| Rate for Payer: Humana Commercial |
$3.98
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.12
|
| Rate for Payer: Ohio Health Group HMO |
$3.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Payer |
$4.12
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.86
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cigna Commercial |
$32.84
|
| Rate for Payer: First Health Commercial |
$37.59
|
| Rate for Payer: Humana Commercial |
$33.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.82
|
| Rate for Payer: Ohio Health Group HMO |
$29.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.30
|
| Rate for Payer: PHCS Commercial |
$37.99
|
| Rate for Payer: United Healthcare All Payer |
$34.82
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Professional
|
Both
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Ambetter Exchange |
$7.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.69
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.24
|
| Rate for Payer: Multiplan PHCS |
$23.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.41
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.24
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Anthem Medicaid |
$13.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cigna Commercial |
$32.84
|
| Rate for Payer: First Health Commercial |
$37.59
|
| Rate for Payer: Humana Commercial |
$33.63
|
| Rate for Payer: Humana KY Medicaid |
$13.61
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.82
|
| Rate for Payer: Ohio Health Group HMO |
$29.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.30
|
| Rate for Payer: PHCS Commercial |
$37.99
|
| Rate for Payer: United Healthcare All Payer |
$34.82
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
OP
|
$11,871.90
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$11,397.02 |
| Rate for Payer: Aetna Commercial |
$9,141.36
|
| Rate for Payer: Anthem Medicaid |
$4,082.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,260.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$5,935.95
|
| Rate for Payer: Cash Price |
$5,935.95
|
| Rate for Payer: Cigna Commercial |
$9,853.68
|
| Rate for Payer: First Health Commercial |
$11,278.31
|
| Rate for Payer: Humana Commercial |
$10,091.11
|
| Rate for Payer: Humana KY Medicaid |
$4,082.75
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,124.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,734.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,761.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,447.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,903.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,497.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,328.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,191.61
|
| Rate for Payer: PHCS Commercial |
$11,397.02
|
| Rate for Payer: United Healthcare All Payer |
$10,447.27
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Anthem Medicaid |
$13.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cigna Commercial |
$32.84
|
| Rate for Payer: First Health Commercial |
$37.59
|
| Rate for Payer: Humana Commercial |
$33.63
|
| Rate for Payer: Humana KY Medicaid |
$13.61
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$13.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.82
|
| Rate for Payer: Ohio Health Group HMO |
$29.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.30
|
| Rate for Payer: PHCS Commercial |
$37.99
|
| Rate for Payer: United Healthcare All Payer |
$34.82
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
IP
|
$11,871.90
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,561.57 |
| Max. Negotiated Rate |
$11,397.02 |
| Rate for Payer: Aetna Commercial |
$9,141.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,260.08
|
| Rate for Payer: Cash Price |
$5,935.95
|
| Rate for Payer: Cigna Commercial |
$9,853.68
|
| Rate for Payer: First Health Commercial |
$11,278.31
|
| Rate for Payer: Humana Commercial |
$10,091.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,734.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,761.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,561.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,447.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,903.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,497.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,328.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,191.61
|
| Rate for Payer: PHCS Commercial |
$11,397.02
|
| Rate for Payer: United Healthcare All Payer |
$10,447.27
|
|
|
ABILIFY MAINTENA 1mg(300mgPFS)
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.86
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cigna Commercial |
$32.84
|
| Rate for Payer: First Health Commercial |
$37.59
|
| Rate for Payer: Humana Commercial |
$33.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.82
|
| Rate for Payer: Ohio Health Group HMO |
$29.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.30
|
| Rate for Payer: PHCS Commercial |
$37.99
|
| Rate for Payer: United Healthcare All Payer |
$34.82
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
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 |
$2,630.96 |
| 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 |
$7,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,629.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,051.21
|
| 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
|
$8,769.87
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| 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 |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,840.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| 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 |
$7.24
|
| 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 |
$8.69
|
| 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 |
$7,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,629.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,051.21
|
| Rate for Payer: PHCS Commercial |
$8,419.08
|
| Rate for Payer: United Healthcare All Payer |
$7,717.49
|
|
