|
AR 1-MOD CATH 5F
|
Facility
|
OP
|
$440.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem Medicaid |
$151.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Humana KY Medicaid |
$151.41
|
| Rate for Payer: Kentucky WC Medicaid |
$152.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
AR 1-MOD CATH 5F
|
Facility
|
IP
|
$440.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
AR 2-MOD CATH 5F
|
Facility
|
OP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem Medicaid |
$151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Humana KY Medicaid |
$151.35
|
| Rate for Payer: Kentucky WC Medicaid |
$152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
AR 2-MOD CATH 5F
|
Facility
|
IP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
ARALAST 10MG (1000 MG +/- VL)
|
Facility
|
IP
|
$3,542.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,062.75 |
| Max. Negotiated Rate |
$3,400.80 |
| Rate for Payer: Aetna Commercial |
$2,727.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,763.15
|
| Rate for Payer: Cash Price |
$1,771.25
|
| Rate for Payer: Cigna Commercial |
$2,940.28
|
| Rate for Payer: First Health Commercial |
$3,365.38
|
| Rate for Payer: Humana Commercial |
$3,011.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,614.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,117.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,834.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,081.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,444.32
|
| Rate for Payer: PHCS Commercial |
$3,400.80
|
| Rate for Payer: United Healthcare All Payer |
$3,117.40
|
|
|
ARALAST 10MG (1000 MG +/- VL)
|
Facility
|
OP
|
$3,542.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$3,400.80 |
| Rate for Payer: Aetna Commercial |
$2,727.72
|
| Rate for Payer: Anthem Medicaid |
$1,218.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,763.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$1,771.25
|
| Rate for Payer: Cash Price |
$1,771.25
|
| Rate for Payer: Cigna Commercial |
$2,940.28
|
| Rate for Payer: First Health Commercial |
$3,365.38
|
| Rate for Payer: Humana Commercial |
$3,011.12
|
| Rate for Payer: Humana KY Medicaid |
$1,218.27
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,230.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,614.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,242.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,117.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,834.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,081.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,444.32
|
| Rate for Payer: PHCS Commercial |
$3,400.80
|
| Rate for Payer: United Healthcare All Payer |
$3,117.40
|
|
|
ARALAST NP 10MG (+/- 500MG VL)
|
Facility
|
OP
|
$1,771.25
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25002843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$1,700.40 |
| Rate for Payer: Aetna Commercial |
$1,363.86
|
| Rate for Payer: Anthem Medicaid |
$609.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$885.62
|
| Rate for Payer: Cash Price |
$885.62
|
| Rate for Payer: Cigna Commercial |
$1,470.14
|
| Rate for Payer: First Health Commercial |
$1,682.69
|
| Rate for Payer: Humana Commercial |
$1,505.56
|
| Rate for Payer: Humana KY Medicaid |
$609.13
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Kentucky WC Medicaid |
$615.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.16
|
| Rate for Payer: PHCS Commercial |
$1,700.40
|
| Rate for Payer: United Healthcare All Payer |
$1,558.70
|
|
|
ARALAST NP 10MG (+/- 500MG VL)
|
Facility
|
IP
|
$1,771.25
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25002843
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$531.38 |
| Max. Negotiated Rate |
$1,700.40 |
| Rate for Payer: Aetna Commercial |
$1,363.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.58
|
| Rate for Payer: Cash Price |
$885.62
|
| Rate for Payer: Cigna Commercial |
$1,470.14
|
| Rate for Payer: First Health Commercial |
$1,682.69
|
| Rate for Payer: Humana Commercial |
$1,505.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.16
|
| Rate for Payer: PHCS Commercial |
$1,700.40
|
| Rate for Payer: United Healthcare All Payer |
$1,558.70
|
|
|
ARANESP 1mcg(100mcgPFS) ESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.49 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS) ESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS)nonESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.49 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgPFS)nonESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV) ESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV) ESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.49 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV)nonESRD
|
Facility
|
IP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,265.49 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg(100mcgSDV)nonESRD
|
Facility
|
OP
|
$4,218.30
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4,049.57 |
| Rate for Payer: Aetna Commercial |
$3,248.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cash Price |
$2,109.15
|
| Rate for Payer: Cigna Commercial |
$3,501.19
|
| Rate for Payer: First Health Commercial |
$4,007.39
|
| Rate for Payer: Humana Commercial |
$3,585.55
|
| Rate for Payer: Humana KY Medicaid |
$1,450.67
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,459.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,113.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,712.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,669.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.63
|
| Rate for Payer: PHCS Commercial |
$4,049.57
|
| Rate for Payer: United Healthcare All Payer |
$3,712.10
|
|
|
ARANESP 1mcg (10mcgPFS) ESRD
|
Facility
|
IP
|
$421.83
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.55 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.06
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg (10mcgPFS) ESRD
|
Facility
|
OP
|
$421.83
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem Medicaid |
$145.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Humana KY Medicaid |
$145.07
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$146.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.06
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg(10mcgPFS)nonESRD
|
Facility
|
OP
|
$421.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem Medicaid |
$145.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Humana KY Medicaid |
$145.07
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$146.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.06
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg(10mcgPFS)nonESRD
|
Facility
|
IP
|
$421.83
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.55 |
| Max. Negotiated Rate |
$404.96 |
| Rate for Payer: Aetna Commercial |
$324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.03
|
| Rate for Payer: Cash Price |
$210.92
|
| Rate for Payer: Cigna Commercial |
$350.12
|
| Rate for Payer: First Health Commercial |
$400.74
|
| Rate for Payer: Humana Commercial |
$358.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.21
|
| Rate for Payer: Ohio Health Group HMO |
$316.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$337.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.06
|
| Rate for Payer: PHCS Commercial |
$404.96
|
| Rate for Payer: United Healthcare All Payer |
$371.21
|
|
|
ARANESP 1mcg (150mcgPFS) ESRD
|
Facility
|
IP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,898.23 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,898.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,061.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,504.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,365.94
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg (150mcgPFS) ESRD
|
Facility
|
OP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem Medicaid |
$2,176.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Humana KY Medicaid |
$2,176.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,198.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,219.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,061.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,504.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,365.94
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(150mcgPFS)nonESRD
|
Facility
|
IP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,898.23 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,898.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,061.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,504.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,365.94
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(150mcgPFS)nonESRD
|
Facility
|
OP
|
$6,327.45
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6,074.35 |
| Rate for Payer: Aetna Commercial |
$4,872.14
|
| Rate for Payer: Anthem Medicaid |
$2,176.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,935.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cash Price |
$3,163.72
|
| Rate for Payer: Cigna Commercial |
$5,251.78
|
| Rate for Payer: First Health Commercial |
$6,011.08
|
| Rate for Payer: Humana Commercial |
$5,378.33
|
| Rate for Payer: Humana KY Medicaid |
$2,176.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,198.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,188.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,669.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,219.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,568.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,745.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,061.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,504.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,365.94
|
| Rate for Payer: PHCS Commercial |
$6,074.35
|
| Rate for Payer: United Healthcare All Payer |
$5,568.16
|
|
|
ARANESP 1mcg(200mcgPFS) ESRD
|
Facility
|
IP
|
$8,436.60
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,530.98 |
| Max. Negotiated Rate |
$8,099.14 |
| Rate for Payer: Aetna Commercial |
$6,496.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,580.55
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cigna Commercial |
$7,002.38
|
| Rate for Payer: First Health Commercial |
$8,014.77
|
| Rate for Payer: Humana Commercial |
$7,171.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,918.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,226.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,424.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,327.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,749.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,339.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,821.25
|
| Rate for Payer: PHCS Commercial |
$8,099.14
|
| Rate for Payer: United Healthcare All Payer |
$7,424.21
|
|
