|
ARANESP 1mcg(40mcgSDV)nonESRD
|
Facility
|
OP
|
$1,687.32
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25004397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$1,619.83 |
| Rate for Payer: Aetna Commercial |
$1,299.24
|
| Rate for Payer: Anthem Medicaid |
$580.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cigna Commercial |
$1,400.48
|
| Rate for Payer: First Health Commercial |
$1,602.95
|
| Rate for Payer: Humana Commercial |
$1,434.22
|
| Rate for Payer: Humana KY Medicaid |
$580.27
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$586.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$591.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,484.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,349.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,467.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.25
|
| Rate for Payer: PHCS Commercial |
$1,619.83
|
| Rate for Payer: United Healthcare All Payer |
$1,484.84
|
|
|
ARANESP 1mcg(40mcgSDV)nonESRD
|
Facility
|
IP
|
$1,687.32
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25004397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$506.20 |
| Max. Negotiated Rate |
$1,619.83 |
| Rate for Payer: Aetna Commercial |
$1,299.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.11
|
| Rate for Payer: Cash Price |
$843.66
|
| Rate for Payer: Cigna Commercial |
$1,400.48
|
| Rate for Payer: First Health Commercial |
$1,602.95
|
| Rate for Payer: Humana Commercial |
$1,434.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,383.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,484.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,265.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,349.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,467.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.25
|
| Rate for Payer: PHCS Commercial |
$1,619.83
|
| Rate for Payer: United Healthcare All Payer |
$1,484.84
|
|
|
ARANESP 1mcg (500mcgPFS) ESRD
|
Facility
|
OP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.45
|
| Rate for Payer: Anthem Medicaid |
$7,253.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Humana KY Medicaid |
$7,253.37
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$7,327.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,398.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,349.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,553.14
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg (500mcgPFS) ESRD
|
Facility
|
IP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25001981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,327.45 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,349.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,553.14
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(500mcgPFS)nonESRD
|
Facility
|
IP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,327.45 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,327.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,349.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,553.14
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(500mcgPFS)nonESRD
|
Facility
|
OP
|
$21,091.50
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$20,247.84 |
| Rate for Payer: Aetna Commercial |
$16,240.45
|
| Rate for Payer: Anthem Medicaid |
$7,253.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,451.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cash Price |
$10,545.75
|
| Rate for Payer: Cigna Commercial |
$17,505.94
|
| Rate for Payer: First Health Commercial |
$20,036.92
|
| Rate for Payer: Humana Commercial |
$17,927.78
|
| Rate for Payer: Humana KY Medicaid |
$7,253.37
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$7,327.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,295.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,565.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,398.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,560.52
|
| Rate for Payer: Ohio Health Group HMO |
$15,818.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,873.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,349.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,553.14
|
| Rate for Payer: PHCS Commercial |
$20,247.84
|
| Rate for Payer: United Healthcare All Payer |
$18,560.52
|
|
|
ARANESP 1mcg(60mcgPFS) ESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS) ESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$759.29 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS)nonESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$759.29 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgPFS)nonESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV) ESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$759.29 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV) ESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
25004404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV)nonESRD
|
Facility
|
IP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$759.29 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARANESP 1mcg(60mcgSDV)nonESRD
|
Facility
|
OP
|
$2,530.98
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
25001983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$2,429.74 |
| Rate for Payer: Aetna Commercial |
$1,948.85
|
| Rate for Payer: Anthem Medicaid |
$870.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cash Price |
$1,265.49
|
| Rate for Payer: Cigna Commercial |
$2,100.71
|
| Rate for Payer: First Health Commercial |
$2,404.43
|
| Rate for Payer: Humana Commercial |
$2,151.33
|
| Rate for Payer: Humana KY Medicaid |
$870.40
|
| Rate for Payer: Humana Medicare Advantage |
$3.00
|
| Rate for Payer: Kentucky WC Medicaid |
$879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,024.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,201.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,746.38
|
| Rate for Payer: PHCS Commercial |
$2,429.74
|
| Rate for Payer: United Healthcare All Payer |
$2,227.26
|
|
|
ARAVA 10MG TABLET
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
NDC 88216030
|
| Hospital Charge Code |
25000245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.50
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna Commercial |
$72.89
|
| Rate for Payer: First Health Commercial |
$83.43
|
| Rate for Payer: Humana Commercial |
$74.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.28
|
| Rate for Payer: Ohio Health Group HMO |
$65.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.60
|
| Rate for Payer: PHCS Commercial |
$84.31
|
| Rate for Payer: United Healthcare All Payer |
$77.28
|
|
|
ARAVA 10MG TABLET
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
NDC 88216030
|
| Hospital Charge Code |
25000245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Anthem Medicaid |
$30.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.50
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna Commercial |
$72.89
|
| Rate for Payer: First Health Commercial |
$83.43
|
| Rate for Payer: Humana Commercial |
$74.65
|
| Rate for Payer: Humana KY Medicaid |
$30.20
|
| Rate for Payer: Kentucky WC Medicaid |
$30.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.28
|
| Rate for Payer: Ohio Health Group HMO |
$65.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.60
|
| Rate for Payer: PHCS Commercial |
$84.31
|
| Rate for Payer: United Healthcare All Payer |
$77.28
|
|
|
ARCHER SUPER STIFF GUIDEWIRE
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
ARCHER SUPER STIFF GUIDEWIRE
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
ARCH WIRE BANDS/WIRE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ARCH WIRE BANDS/WIRE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ARCOM ARTIC E1 HIP BRG 22*32
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
ARCOM ARTIC E1 HIP BRG 22*32
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
ARCOM ARTIC E1 HIP BRG 22*36
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
ARCOM ARTIC E1 HIP BRG 22*36
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
ARCOM XL 10^ 36 SZ 24
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
