|
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
|
|
|
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]
|
Professional
|
Both
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$17.54 |
| 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 |
$14.62
|
| Rate for Payer: Cash Price |
$14.62
|
| 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 |
$17.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.41
|
| Rate for Payer: UHCCP Medicaid |
$10.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.24
|
|
|
ABILIFY MAINTENA 1MG[300MG VL]
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$14.62
|
| 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: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| 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 |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| 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(400mgPFS)
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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(400mgPFS)
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0184
|
|
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(400mgPFS)
|
Professional
|
Both
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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(400mgPFS)
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0184
|
|
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(400mgPFS)
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600184
|
|
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(400mgPFS)
|
Facility
|
IP
|
$15,829.20
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,748.76 |
| Max. Negotiated Rate |
$15,196.03 |
| Rate for Payer: Aetna Commercial |
$12,188.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.78
|
| Rate for Payer: Cash Price |
$7,914.60
|
| Rate for Payer: Cigna Commercial |
$13,138.24
|
| Rate for Payer: First Health Commercial |
$15,037.74
|
| Rate for Payer: Humana Commercial |
$13,454.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.70
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,663.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,771.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,922.15
|
| Rate for Payer: PHCS Commercial |
$15,196.03
|
| Rate for Payer: United Healthcare All Payer |
$13,929.70
|
|
|
ABILIFY MAINTENA 1mg(400mgPFS)
|
Facility
|
OP
|
$15,829.20
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25004354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$15,196.03 |
| Rate for Payer: Aetna Commercial |
$12,188.48
|
| Rate for Payer: Anthem Medicaid |
$5,443.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$7,914.60
|
| Rate for Payer: Cash Price |
$7,914.60
|
| Rate for Payer: Cigna Commercial |
$13,138.24
|
| Rate for Payer: First Health Commercial |
$15,037.74
|
| Rate for Payer: Humana Commercial |
$13,454.82
|
| Rate for Payer: Humana KY Medicaid |
$5,443.66
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5,499.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.70
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,663.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,771.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,922.15
|
| Rate for Payer: PHCS Commercial |
$15,196.03
|
| Rate for Payer: United Healthcare All Payer |
$13,929.70
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
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 [400MG V]
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$14.62
|
| 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: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| 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 |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| 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 [400MG V]
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$14.62
|
| 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: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Humana Medicare Advantage |
$7.24
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| 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 |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| 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 [400MG V]
|
Facility
|
OP
|
$11,693.14
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
25001875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| 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 |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,120.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| 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 |
$7.24
|
| 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 |
$8.69
|
| 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 |
$8,769.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,354.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,173.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,068.27
|
| Rate for Payer: PHCS Commercial |
$11,225.41
|
| Rate for Payer: United Healthcare All Payer |
$10,289.96
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Professional
|
Both
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$17.54 |
| 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 |
$14.62
|
| Rate for Payer: Cash Price |
$14.62
|
| 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 |
$17.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.41
|
| Rate for Payer: UHCCP Medicaid |
$10.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.24
|
|
|
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 |
$3,507.94 |
| 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 |
$8,769.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,354.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,173.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,068.27
|
| Rate for Payer: PHCS Commercial |
$11,225.41
|
| Rate for Payer: United Healthcare All Payer |
$10,289.96
|
|
|
ABILIFY MAINTENA 1MG [400MG V]
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
636T0011
|
|
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
|
|
|
ABLATE ATRIA LMTD ENDO
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| 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: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| 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: Molina Healthcare Medicaid |
$701.60
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
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: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Ambetter Exchange |
$1,280.12
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,280.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,536.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,280.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.12
|
| 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 |
$1,664.16
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,280.12
|
|
|
ABLATE ATRIA LMTD ENDO
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ABLATE ATRIA LMTD ENDO(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
761P1276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,323.28 |
| Rate for Payer: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Ambetter Exchange |
$1,280.12
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,280.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,536.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,280.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.12
|
| 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 |
$1,664.16
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,280.12
|
|
|
ABLATION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ABLATION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ABLATION
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.13 |
| Max. Negotiated Rate |
$1,563.61 |
| Rate for Payer: Aetna Commercial |
$335.18
|
| Rate for Payer: Ambetter Exchange |
$217.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.13
|
| Rate for Payer: Anthem Medicaid |
$162.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$217.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.04
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$330.94
|
| Rate for Payer: Healthspan PPO |
$1,563.61
|
| Rate for Payer: Humana Medicaid |
$162.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$217.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.22
|
| Rate for Payer: Molina Healthcare Passport |
$162.96
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.79
|
| Rate for Payer: UHCCP Medicaid |
$145.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.53
|
|
