NORVIR 100MG CAPSULE
|
Facility
|
OP
|
$10.67
|
|
Service Code
|
NDC 31722059730
|
Hospital Charge Code |
25001107
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.39 |
Max. Negotiated Rate |
$10.24 |
Rate for Payer: Aetna Commercial |
$8.22
|
Rate for Payer: Anthem Medicaid |
$3.67
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8.32
|
Rate for Payer: Cash Price |
$5.34
|
Rate for Payer: Cigna Commercial |
$8.86
|
Rate for Payer: First Health Commercial |
$10.14
|
Rate for Payer: Humana Commercial |
$9.07
|
Rate for Payer: Humana KY Medicaid |
$3.67
|
Rate for Payer: Kentucky WC Medicaid |
$3.71
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
Rate for Payer: Molina Healthcare Medicaid |
$3.74
|
Rate for Payer: Ohio Health Choice Commercial |
$9.39
|
Rate for Payer: Ohio Health Group HMO |
$8.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.13
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
Rate for Payer: PHCS Commercial |
$10.24
|
Rate for Payer: United Healthcare All Payer |
$9.39
|
|
NOVO7 (FCTR VIIA) 1MCG 5000V
|
Facility
|
IP
|
$78.68
|
|
Service Code
|
HCPCS J7189
|
Hospital Charge Code |
25002476
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.23 |
Max. Negotiated Rate |
$75.53 |
Rate for Payer: Aetna Commercial |
$60.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cigna Commercial |
$65.30
|
Rate for Payer: First Health Commercial |
$74.75
|
Rate for Payer: Humana Commercial |
$66.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
Rate for Payer: Ohio Health Group HMO |
$59.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
Rate for Payer: PHCS Commercial |
$75.53
|
Rate for Payer: United Healthcare All Payer |
$69.24
|
|
NOVO7 (FCTR VIIA) 1MCG 5000V
|
Facility
|
OP
|
$78.68
|
|
Service Code
|
HCPCS J7189
|
Hospital Charge Code |
25002476
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.43 |
Max. Negotiated Rate |
$75.53 |
Rate for Payer: Aetna Commercial |
$60.58
|
Rate for Payer: Anthem Medicaid |
$27.06
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.40
|
Rate for Payer: CareSource Just4Me Medicare |
$3.28
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cigna Commercial |
$65.30
|
Rate for Payer: First Health Commercial |
$74.75
|
Rate for Payer: Humana Commercial |
$66.88
|
Rate for Payer: Humana KY Medicaid |
$27.06
|
Rate for Payer: Humana Medicare Advantage |
$2.43
|
Rate for Payer: Kentucky WC Medicaid |
$27.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
Rate for Payer: Molina Healthcare Medicaid |
$27.60
|
Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
Rate for Payer: Ohio Health Group HMO |
$59.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
Rate for Payer: PHCS Commercial |
$75.53
|
Rate for Payer: United Healthcare All Payer |
$69.24
|
|
NOVOLOG 5 UN [100UN/ML 10ML V
|
Facility
|
OP
|
$394.25
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25002191
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$51.25 |
Max. Negotiated Rate |
$378.48 |
Rate for Payer: Anthem POS/PPO/Traditional |
$307.52
|
Rate for Payer: Cash Price |
$197.12
|
Rate for Payer: Cigna Commercial |
$327.23
|
Rate for Payer: First Health Commercial |
$374.54
|
Rate for Payer: Humana Commercial |
$335.11
|
Rate for Payer: Humana KY Medicaid |
$135.58
|
Rate for Payer: Kentucky WC Medicaid |
$136.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$323.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.96
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$118.28
|
Rate for Payer: Molina Healthcare Medicaid |
$138.30
|
Rate for Payer: Ohio Health Choice Commercial |
$346.94
|
Rate for Payer: Ohio Health Group HMO |
$295.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$78.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$51.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.22
|
Rate for Payer: PHCS Commercial |
$378.48
|
Rate for Payer: United Healthcare All Payer |
$346.94
|
Rate for Payer: Aetna Commercial |
$303.57
|
Rate for Payer: Anthem Medicaid |
$135.58
|
|
NOVOLOG 5 UN [100UN/ML 10ML V
|
Facility
|
IP
|
$394.25
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25002191
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$51.25 |
Max. Negotiated Rate |
$378.48 |
Rate for Payer: Aetna Commercial |
$303.57
|
Rate for Payer: Anthem POS/PPO/Traditional |
$307.52
|
Rate for Payer: Cash Price |
$197.12
|
Rate for Payer: Cigna Commercial |
$327.23
|
Rate for Payer: First Health Commercial |
$374.54
|
Rate for Payer: Humana Commercial |
$335.11
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$323.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.96
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$118.28
|
Rate for Payer: Ohio Health Choice Commercial |
$346.94
|
Rate for Payer: Ohio Health Group HMO |
$295.69
|
Rate for Payer: Ohio Health Group PPO Differential |
$78.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$51.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.22
|
Rate for Payer: PHCS Commercial |
$378.48
|
Rate for Payer: United Healthcare All Payer |
$346.94
|
|
NOVOLOG FLX PN 300 U/3ML EA 5U
|
Facility
|
IP
|
$152.27
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25002194
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$19.80 |
Max. Negotiated Rate |
$146.18 |
Rate for Payer: Aetna Commercial |
$117.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$118.77
|
Rate for Payer: Cash Price |
$76.14
|
Rate for Payer: Cigna Commercial |
$126.38
|
Rate for Payer: First Health Commercial |
$144.66
|
Rate for Payer: Humana Commercial |
$129.43
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$124.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.38
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$45.68
|
Rate for Payer: Ohio Health Choice Commercial |
$134.00
|
Rate for Payer: Ohio Health Group HMO |
$114.20
|
Rate for Payer: Ohio Health Group PPO Differential |
$30.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$19.80
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.20
|
Rate for Payer: PHCS Commercial |
$146.18
|
Rate for Payer: United Healthcare All Payer |
$134.00
|
|
NOVOLOG FLX PN 300 U/3ML EA 5U
|
Facility
|
OP
|
$152.27
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25002194
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$19.80 |
Max. Negotiated Rate |
$146.18 |
Rate for Payer: Aetna Commercial |
$117.25
|
Rate for Payer: Anthem Medicaid |
$52.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$118.77
|
Rate for Payer: Cash Price |
$76.14
|
Rate for Payer: Cigna Commercial |
$126.38
|
Rate for Payer: First Health Commercial |
$144.66
|
Rate for Payer: Humana Commercial |
$129.43
|
Rate for Payer: Humana KY Medicaid |
$52.37
|
Rate for Payer: Kentucky WC Medicaid |
$52.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$124.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.38
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$45.68
|
Rate for Payer: Molina Healthcare Medicaid |
$53.42
|
Rate for Payer: Ohio Health Choice Commercial |
$134.00
|
Rate for Payer: Ohio Health Group HMO |
$114.20
|
Rate for Payer: Ohio Health Group PPO Differential |
$30.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$19.80
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.20
|
Rate for Payer: PHCS Commercial |
$146.18
|
Rate for Payer: United Healthcare All Payer |
$134.00
|
|
NovoLOG MIX 70-30 VIAL 10mL
|
Facility
|
OP
|
$307.34
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25004017
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$39.95 |
Max. Negotiated Rate |
$295.05 |
Rate for Payer: Aetna Commercial |
$236.65
|
Rate for Payer: Anthem Medicaid |
$105.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$239.73
|
Rate for Payer: Cash Price |
$153.67
|
Rate for Payer: Cigna Commercial |
$255.09
|
Rate for Payer: First Health Commercial |
$291.97
|
Rate for Payer: Humana Commercial |
$261.24
|
Rate for Payer: Humana KY Medicaid |
$105.69
|
Rate for Payer: Kentucky WC Medicaid |
$106.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$252.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$92.20
|
Rate for Payer: Molina Healthcare Medicaid |
$107.81
|
Rate for Payer: Ohio Health Choice Commercial |
$270.46
|
Rate for Payer: Ohio Health Group HMO |
$230.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$61.47
|
Rate for Payer: Ohio Health Group PPO No Differential |
$39.95
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.28
|
Rate for Payer: PHCS Commercial |
$295.05
|
Rate for Payer: United Healthcare All Payer |
$270.46
|
|
NovoLOG MIX 70-30 VIAL 10mL
|
Facility
|
IP
|
$307.34
|
|
Service Code
|
HCPCS J1815
|
Hospital Charge Code |
25004017
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$39.95 |
Max. Negotiated Rate |
$295.05 |
Rate for Payer: Aetna Commercial |
$236.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$239.73
|
Rate for Payer: Cash Price |
$153.67
|
Rate for Payer: Cigna Commercial |
$255.09
|
Rate for Payer: First Health Commercial |
$291.97
|
Rate for Payer: Humana Commercial |
$261.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$252.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$92.20
|
Rate for Payer: Ohio Health Choice Commercial |
$270.46
|
Rate for Payer: Ohio Health Group HMO |
$230.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$61.47
|
Rate for Payer: Ohio Health Group PPO No Differential |
$39.95
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.28
|
Rate for Payer: PHCS Commercial |
$295.05
|
Rate for Payer: United Healthcare All Payer |
$270.46
|
|
NOVOSEVEN RT 1 MCG (2MG VIAL)
|
Facility
|
OP
|
$78.68
|
|
Service Code
|
HCPCS J7189
|
Hospital Charge Code |
25002475
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$2.43 |
Max. Negotiated Rate |
$75.53 |
Rate for Payer: Aetna Commercial |
$60.58
|
Rate for Payer: Anthem Medicaid |
$27.06
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.40
|
Rate for Payer: CareSource Just4Me Medicare |
$3.28
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cigna Commercial |
$65.30
|
Rate for Payer: First Health Commercial |
$74.75
|
Rate for Payer: Humana Commercial |
$66.88
|
Rate for Payer: Humana KY Medicaid |
$27.06
|
Rate for Payer: Humana Medicare Advantage |
$2.43
|
Rate for Payer: Kentucky WC Medicaid |
$27.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
Rate for Payer: Molina Healthcare Medicaid |
$27.60
|
Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
Rate for Payer: Ohio Health Group HMO |
$59.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
Rate for Payer: PHCS Commercial |
$75.53
|
Rate for Payer: United Healthcare All Payer |
$69.24
|
|
NOVOSEVEN RT 1 MCG (2MG VIAL)
|
Facility
|
IP
|
$78.68
|
|
Service Code
|
HCPCS J7189
|
Hospital Charge Code |
25002475
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.23 |
Max. Negotiated Rate |
$75.53 |
Rate for Payer: Aetna Commercial |
$60.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.37
|
Rate for Payer: Cash Price |
$39.34
|
Rate for Payer: Cigna Commercial |
$65.30
|
Rate for Payer: First Health Commercial |
$74.75
|
Rate for Payer: Humana Commercial |
$66.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.07
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.60
|
Rate for Payer: Ohio Health Choice Commercial |
$69.24
|
Rate for Payer: Ohio Health Group HMO |
$59.01
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.74
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.39
|
Rate for Payer: PHCS Commercial |
$75.53
|
Rate for Payer: United Healthcare All Payer |
$69.24
|
|
NOV PULSE GEN NON RECHARGEABLE
|
Facility
|
IP
|
$88,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,463.40 |
Max. Negotiated Rate |
$84,652.80 |
Rate for Payer: Aetna Commercial |
$67,898.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$68,780.40
|
Rate for Payer: Cash Price |
$44,090.00
|
Rate for Payer: Cigna Commercial |
$73,189.40
|
Rate for Payer: First Health Commercial |
$83,771.00
|
Rate for Payer: Humana Commercial |
$74,953.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$72,307.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,076.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$26,454.00
|
Rate for Payer: Ohio Health Choice Commercial |
$77,598.40
|
Rate for Payer: Ohio Health Group HMO |
$66,135.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$17,636.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,335.80
|
Rate for Payer: PHCS Commercial |
$84,652.80
|
Rate for Payer: United Healthcare All Payer |
$77,598.40
|
|
NOV PULSE GEN NON RECHARGEABLE
|
Facility
|
OP
|
$88,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$11,463.40 |
Max. Negotiated Rate |
$84,652.80 |
Rate for Payer: Aetna Commercial |
$67,898.60
|
Rate for Payer: Anthem Medicaid |
$30,325.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$68,780.40
|
Rate for Payer: Cash Price |
$44,090.00
|
Rate for Payer: Cigna Commercial |
$73,189.40
|
Rate for Payer: First Health Commercial |
$83,771.00
|
Rate for Payer: Humana Commercial |
$74,953.00
|
Rate for Payer: Humana KY Medicaid |
$30,325.10
|
Rate for Payer: Kentucky WC Medicaid |
$30,633.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$72,307.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,076.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$26,454.00
|
Rate for Payer: Molina Healthcare Medicaid |
$30,933.54
|
Rate for Payer: Ohio Health Choice Commercial |
$77,598.40
|
Rate for Payer: Ohio Health Group HMO |
$66,135.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$17,636.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,335.80
|
Rate for Payer: PHCS Commercial |
$84,652.80
|
Rate for Payer: United Healthcare All Payer |
$77,598.40
|
|
NPLATE 10mcg (125mcg SDV)
|
Facility
|
OP
|
$7,144.84
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25004205
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$96.03 |
Max. Negotiated Rate |
$6,859.05 |
Rate for Payer: Aetna Commercial |
$5,501.53
|
Rate for Payer: Anthem Medicaid |
$2,457.11
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$96.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,572.98
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$134.44
|
Rate for Payer: CareSource Just4Me Medicare |
$129.64
|
Rate for Payer: Cash Price |
$3,572.42
|
Rate for Payer: Cash Price |
$3,572.42
|
Rate for Payer: Cigna Commercial |
$5,930.22
|
Rate for Payer: First Health Commercial |
$6,787.60
|
Rate for Payer: Humana Commercial |
$6,073.11
|
Rate for Payer: Humana KY Medicaid |
$2,457.11
|
Rate for Payer: Humana Medicare Advantage |
$96.03
|
Rate for Payer: Kentucky WC Medicaid |
$2,482.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,858.77
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,272.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$115.23
|
Rate for Payer: Molina Healthcare Medicaid |
$2,506.41
|
Rate for Payer: Ohio Health Choice Commercial |
$6,287.46
|
Rate for Payer: Ohio Health Group HMO |
$5,358.63
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,428.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$928.83
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.90
|
Rate for Payer: PHCS Commercial |
$6,859.05
|
Rate for Payer: United Healthcare All Payer |
$6,287.46
|
|
NPLATE 10mcg (125mcg SDV)
|
Facility
|
IP
|
$7,144.84
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25004205
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$928.83 |
Max. Negotiated Rate |
$6,859.05 |
Rate for Payer: Aetna Commercial |
$5,501.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,572.98
|
Rate for Payer: Cash Price |
$3,572.42
|
Rate for Payer: Cigna Commercial |
$5,930.22
|
Rate for Payer: First Health Commercial |
$6,787.60
|
Rate for Payer: Humana Commercial |
$6,073.11
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,858.77
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,272.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.45
|
Rate for Payer: Ohio Health Choice Commercial |
$6,287.46
|
Rate for Payer: Ohio Health Group HMO |
$5,358.63
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,428.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$928.83
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.90
|
Rate for Payer: PHCS Commercial |
$6,859.05
|
Rate for Payer: United Healthcare All Payer |
$6,287.46
|
|
NPLATE 10MCG [250MCG VIAL]
|
Facility
|
OP
|
$14,289.46
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25002353
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$96.03 |
Max. Negotiated Rate |
$13,717.88 |
Rate for Payer: Aetna Commercial |
$11,002.88
|
Rate for Payer: Anthem Medicaid |
$4,914.15
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$96.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,145.78
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$134.44
|
Rate for Payer: CareSource Just4Me Medicare |
$129.64
|
Rate for Payer: Cash Price |
$7,144.73
|
Rate for Payer: Cash Price |
$7,144.73
|
Rate for Payer: Cigna Commercial |
$11,860.25
|
Rate for Payer: First Health Commercial |
$13,574.99
|
Rate for Payer: Humana Commercial |
$12,146.04
|
Rate for Payer: Humana KY Medicaid |
$4,914.15
|
Rate for Payer: Humana Medicare Advantage |
$96.03
|
Rate for Payer: Kentucky WC Medicaid |
$4,964.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.36
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$115.23
|
Rate for Payer: Molina Healthcare Medicaid |
$5,012.74
|
Rate for Payer: Ohio Health Choice Commercial |
$12,574.72
|
Rate for Payer: Ohio Health Group HMO |
$10,717.10
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,857.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,857.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,429.73
|
Rate for Payer: PHCS Commercial |
$13,717.88
|
Rate for Payer: United Healthcare All Payer |
$12,574.72
|
|
NPLATE 10MCG [250MCG VIAL]
|
Facility
|
IP
|
$14,289.46
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25002353
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1,857.63 |
Max. Negotiated Rate |
$13,717.88 |
Rate for Payer: Aetna Commercial |
$11,002.88
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,145.78
|
Rate for Payer: Cash Price |
$7,144.73
|
Rate for Payer: Cigna Commercial |
$11,860.25
|
Rate for Payer: First Health Commercial |
$13,574.99
|
Rate for Payer: Humana Commercial |
$12,146.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,717.36
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,545.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,286.84
|
Rate for Payer: Ohio Health Choice Commercial |
$12,574.72
|
Rate for Payer: Ohio Health Group HMO |
$10,717.10
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,857.89
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,857.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,429.73
|
Rate for Payer: PHCS Commercial |
$13,717.88
|
Rate for Payer: United Healthcare All Payer |
$12,574.72
|
|
NPLATE 10MCG [500MCG VIAL]
|
Facility
|
IP
|
$28,578.87
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25002354
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3,715.25 |
Max. Negotiated Rate |
$27,435.72 |
Rate for Payer: Aetna Commercial |
$22,005.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22,291.52
|
Rate for Payer: Cash Price |
$14,289.43
|
Rate for Payer: Cigna Commercial |
$23,720.46
|
Rate for Payer: First Health Commercial |
$27,149.93
|
Rate for Payer: Humana Commercial |
$24,292.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23,434.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,091.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,573.66
|
Rate for Payer: Ohio Health Choice Commercial |
$25,149.41
|
Rate for Payer: Ohio Health Group HMO |
$21,434.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,715.77
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,715.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,859.45
|
Rate for Payer: PHCS Commercial |
$27,435.72
|
Rate for Payer: United Healthcare All Payer |
$25,149.41
|
|
NPLATE 10MCG [500MCG VIAL]
|
Facility
|
OP
|
$28,578.87
|
|
Service Code
|
HCPCS J2796
|
Hospital Charge Code |
25002354
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$96.03 |
Max. Negotiated Rate |
$27,435.72 |
Rate for Payer: Aetna Commercial |
$22,005.73
|
Rate for Payer: Anthem Medicaid |
$9,828.27
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$96.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22,291.52
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$134.44
|
Rate for Payer: CareSource Just4Me Medicare |
$129.64
|
Rate for Payer: Cash Price |
$14,289.43
|
Rate for Payer: Cash Price |
$14,289.43
|
Rate for Payer: Cigna Commercial |
$23,720.46
|
Rate for Payer: First Health Commercial |
$27,149.93
|
Rate for Payer: Humana Commercial |
$24,292.04
|
Rate for Payer: Humana KY Medicaid |
$9,828.27
|
Rate for Payer: Humana Medicare Advantage |
$96.03
|
Rate for Payer: Kentucky WC Medicaid |
$9,928.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$23,434.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,091.21
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$115.23
|
Rate for Payer: Molina Healthcare Medicaid |
$10,025.47
|
Rate for Payer: Ohio Health Choice Commercial |
$25,149.41
|
Rate for Payer: Ohio Health Group HMO |
$21,434.15
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,715.77
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,715.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,859.45
|
Rate for Payer: PHCS Commercial |
$27,435.72
|
Rate for Payer: United Healthcare All Payer |
$25,149.41
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$690.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
51000050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$89.70 |
Max. Negotiated Rate |
$662.40 |
Rate for Payer: Aetna Commercial |
$531.30
|
Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
Rate for Payer: Cash Price |
$345.00
|
Rate for Payer: Cigna Commercial |
$572.70
|
Rate for Payer: First Health Commercial |
$655.50
|
Rate for Payer: Humana Commercial |
$586.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
Rate for Payer: Ohio Health Group HMO |
$517.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
Rate for Payer: PHCS Commercial |
$662.40
|
Rate for Payer: United Healthcare All Payer |
$607.20
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Professional
|
Both
|
$690.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
51000050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$85.69 |
Max. Negotiated Rate |
$690.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.69
|
Rate for Payer: Anthem Medicaid |
$88.32
|
Rate for Payer: Buckeye Medicare Advantage |
$690.00
|
Rate for Payer: Cash Price |
$345.00
|
Rate for Payer: Cash Price |
$345.00
|
Rate for Payer: Cigna Commercial |
$186.47
|
Rate for Payer: Humana Medicaid |
$88.32
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.36
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.09
|
Rate for Payer: Molina Healthcare Passport |
$88.32
|
Rate for Payer: Multiplan PHCS |
$414.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.00
|
Rate for Payer: UHCCP Medicaid |
$89.97
|
Rate for Payer: Wellcare CHIP/Medicaid |
$89.20
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$690.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
51000050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$89.70 |
Max. Negotiated Rate |
$662.40 |
Rate for Payer: Aetna Commercial |
$531.30
|
Rate for Payer: Anthem Medicaid |
$237.29
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
Rate for Payer: Cash Price |
$345.00
|
Rate for Payer: Cash Price |
$345.00
|
Rate for Payer: Cigna Commercial |
$572.70
|
Rate for Payer: First Health Commercial |
$655.50
|
Rate for Payer: Humana Commercial |
$586.50
|
Rate for Payer: Humana KY Medicaid |
$237.29
|
Rate for Payer: Humana Medicare Advantage |
$463.49
|
Rate for Payer: Kentucky WC Medicaid |
$239.71
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
Rate for Payer: Ohio Health Group HMO |
$517.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
Rate for Payer: PHCS Commercial |
$662.40
|
Rate for Payer: United Healthcare All Payer |
$607.20
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(P
|
Professional
|
Both
|
$310.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
510P0050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$85.69 |
Max. Negotiated Rate |
$310.00 |
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.69
|
Rate for Payer: Anthem Medicaid |
$88.32
|
Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
Rate for Payer: Cash Price |
$155.00
|
Rate for Payer: Cash Price |
$155.00
|
Rate for Payer: Cigna Commercial |
$186.47
|
Rate for Payer: Humana Medicaid |
$88.32
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.36
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.09
|
Rate for Payer: Molina Healthcare Passport |
$88.32
|
Rate for Payer: Multiplan PHCS |
$186.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
Rate for Payer: UHCCP Medicaid |
$89.97
|
Rate for Payer: Wellcare CHIP/Medicaid |
$89.20
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(T
|
Facility
|
OP
|
$380.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
510T0050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$49.40 |
Max. Negotiated Rate |
$648.89 |
Rate for Payer: Aetna Commercial |
$292.60
|
Rate for Payer: Anthem Medicaid |
$130.68
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
Rate for Payer: Cash Price |
$190.00
|
Rate for Payer: Cash Price |
$190.00
|
Rate for Payer: Cigna Commercial |
$315.40
|
Rate for Payer: First Health Commercial |
$361.00
|
Rate for Payer: Humana Commercial |
$323.00
|
Rate for Payer: Humana KY Medicaid |
$130.68
|
Rate for Payer: Humana Medicare Advantage |
$463.49
|
Rate for Payer: Kentucky WC Medicaid |
$132.01
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
Rate for Payer: Ohio Health Group HMO |
$285.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
Rate for Payer: PHCS Commercial |
$364.80
|
Rate for Payer: United Healthcare All Payer |
$334.40
|
|
NRPSYC TST EVAL PHYS/QHP 1ST(T
|
Facility
|
IP
|
$380.00
|
|
Service Code
|
HCPCS 96132
|
Hospital Charge Code |
510T0050
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$49.40 |
Max. Negotiated Rate |
$364.80 |
Rate for Payer: Aetna Commercial |
$292.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
Rate for Payer: Cash Price |
$190.00
|
Rate for Payer: Cigna Commercial |
$315.40
|
Rate for Payer: First Health Commercial |
$361.00
|
Rate for Payer: Humana Commercial |
$323.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
Rate for Payer: Ohio Health Group HMO |
$285.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
Rate for Payer: PHCS Commercial |
$364.80
|
Rate for Payer: United Healthcare All Payer |
$334.40
|
|