|
AUTOTRANSPLANT PARATHYROID
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
76102280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.93 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$367.90
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$348.86
|
| Rate for Payer: Healthspan PPO |
$310.26
|
| Rate for Payer: Humana Medicaid |
$205.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.05
|
| Rate for Payer: Molina Healthcare Passport |
$205.93
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
76102280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
76102280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
AUTOTRANSPLANT PARATHYROID(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
761P2280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.93 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$367.90
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$348.86
|
| Rate for Payer: Healthspan PPO |
$310.26
|
| Rate for Payer: Humana Medicaid |
$205.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.05
|
| Rate for Payer: Molina Healthcare Passport |
$205.93
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
|
|
AVAMAX BALLOON 13G 10MM
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
AVAMAX BALLOON 13G 10MM
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
Avapro 300mg
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004383
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
Avapro 300mg
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004383
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
AVAPRO 75MG TABLET
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 33342004710
|
| Hospital Charge Code |
25000291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
AVAPRO 75MG TABLET
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 33342004710
|
| Hospital Charge Code |
25000291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
AVAPRO (IRBESARTAN) 150MG TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 33342004810
|
| Hospital Charge Code |
25000290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
AVAPRO (IRBESARTAN) 150MG TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 33342004810
|
| Hospital Charge Code |
25000290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
|
|
AVASTIN 10MG (400MG/16ML)
|
Facility
|
IP
|
$17,373.29
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25003767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,258.53 |
| Max. Negotiated Rate |
$16,678.36 |
| Rate for Payer: Aetna Commercial |
$13,377.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,551.17
|
| Rate for Payer: Cash Price |
$8,686.65
|
| Rate for Payer: Cigna Commercial |
$14,419.83
|
| Rate for Payer: First Health Commercial |
$16,504.63
|
| Rate for Payer: Humana Commercial |
$14,767.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,821.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,211.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,288.50
|
| Rate for Payer: Ohio Health Group HMO |
$13,029.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,385.72
|
| Rate for Payer: PHCS Commercial |
$16,678.36
|
| Rate for Payer: United Healthcare All Payer |
$15,288.50
|
|
|
AVASTIN 10MG (400MG/16ML)
|
Facility
|
OP
|
$17,373.29
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25003767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$16,678.36 |
| Rate for Payer: Aetna Commercial |
$13,377.43
|
| Rate for Payer: Anthem Medicaid |
$5,974.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$74.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,551.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$103.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$8,686.65
|
| Rate for Payer: Cash Price |
$8,686.65
|
| Rate for Payer: Cigna Commercial |
$14,419.83
|
| Rate for Payer: First Health Commercial |
$16,504.63
|
| Rate for Payer: Humana Commercial |
$14,767.30
|
| Rate for Payer: Humana KY Medicaid |
$5,974.67
|
| Rate for Payer: Humana Medicare Advantage |
$74.07
|
| Rate for Payer: Kentucky WC Medicaid |
$6,035.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,246.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,821.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,094.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,288.50
|
| Rate for Payer: Ohio Health Group HMO |
$13,029.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,385.72
|
| Rate for Payer: PHCS Commercial |
$16,678.36
|
| Rate for Payer: United Healthcare All Payer |
$15,288.50
|
|
|
AVASTIN EA 10MG (100MG)
|
Facility
|
IP
|
$4,343.32
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25002567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$564.63 |
| Max. Negotiated Rate |
$4,169.59 |
| Rate for Payer: Aetna Commercial |
$3,344.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.79
|
| Rate for Payer: Cash Price |
$2,171.66
|
| Rate for Payer: Cigna Commercial |
$3,604.96
|
| Rate for Payer: First Health Commercial |
$4,126.15
|
| Rate for Payer: Humana Commercial |
$3,691.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.43
|
| Rate for Payer: PHCS Commercial |
$4,169.59
|
| Rate for Payer: United Healthcare All Payer |
$3,822.12
|
|
|
AVASTIN EA 10MG (100MG)
|
Facility
|
OP
|
$4,343.32
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25002567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$4,169.59 |
| Rate for Payer: Aetna Commercial |
$3,344.36
|
| Rate for Payer: Anthem Medicaid |
$1,493.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$74.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$103.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$2,171.66
|
| Rate for Payer: Cash Price |
$2,171.66
|
| Rate for Payer: Cigna Commercial |
$3,604.96
|
| Rate for Payer: First Health Commercial |
$4,126.15
|
| Rate for Payer: Humana Commercial |
$3,691.82
|
| Rate for Payer: Humana KY Medicaid |
$1,493.67
|
| Rate for Payer: Humana Medicare Advantage |
$74.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.43
|
| Rate for Payer: PHCS Commercial |
$4,169.59
|
| Rate for Payer: United Healthcare All Payer |
$3,822.12
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
636T0170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.50
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna Commercial |
$9.05
|
| Rate for Payer: First Health Commercial |
$10.36
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.59
|
| Rate for Payer: Ohio Health Group HMO |
$8.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Payer |
$9.59
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$10.90
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
636T0170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem Medicaid |
$3.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna Commercial |
$9.05
|
| Rate for Payer: First Health Commercial |
$10.36
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Humana KY Medicaid |
$3.75
|
| Rate for Payer: Humana Medicare Advantage |
$1.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.59
|
| Rate for Payer: Ohio Health Group HMO |
$8.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Payer |
$9.59
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$10.90
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem Medicaid |
$3.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna Commercial |
$9.05
|
| Rate for Payer: First Health Commercial |
$10.36
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Humana KY Medicaid |
$3.75
|
| Rate for Payer: Humana Medicare Advantage |
$1.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.59
|
| Rate for Payer: Ohio Health Group HMO |
$8.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Payer |
$9.59
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
IP
|
$10,274.23
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
25004256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,335.65 |
| Max. Negotiated Rate |
$9,863.26 |
| Rate for Payer: Aetna Commercial |
$7,911.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,013.90
|
| Rate for Payer: Cash Price |
$5,137.12
|
| Rate for Payer: Cigna Commercial |
$8,527.61
|
| Rate for Payer: First Health Commercial |
$9,760.52
|
| Rate for Payer: Humana Commercial |
$8,733.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,424.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,582.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,082.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,041.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,705.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,054.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,185.01
|
| Rate for Payer: PHCS Commercial |
$9,863.26
|
| Rate for Payer: United Healthcare All Payer |
$9,041.32
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$10,274.23
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
25004256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$9,863.26 |
| Rate for Payer: Aetna Commercial |
$7,911.16
|
| Rate for Payer: Anthem Medicaid |
$3,533.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,013.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$5,137.12
|
| Rate for Payer: Cash Price |
$5,137.12
|
| Rate for Payer: Cigna Commercial |
$8,527.61
|
| Rate for Payer: First Health Commercial |
$9,760.52
|
| Rate for Payer: Humana Commercial |
$8,733.10
|
| Rate for Payer: Humana KY Medicaid |
$3,533.31
|
| Rate for Payer: Humana Medicare Advantage |
$1.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,569.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,424.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,582.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,604.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,041.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,705.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,054.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,185.01
|
| Rate for Payer: PHCS Commercial |
$9,863.26
|
| Rate for Payer: United Healthcare All Payer |
$9,041.32
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.50
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cigna Commercial |
$9.05
|
| Rate for Payer: First Health Commercial |
$10.36
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.59
|
| Rate for Payer: Ohio Health Group HMO |
$8.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Payer |
$9.59
|
|
|
AVEED 1MG (750MG SDV)
|
Professional
|
Both
|
$10.90
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.90
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.25
|
| Rate for Payer: Multiplan PHCS |
$6.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.63
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
|
|
AVELUMAB 10mg (200mg SDV)
|
Facility
|
IP
|
$10,551.42
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
25004410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,371.68 |
| Max. Negotiated Rate |
$10,129.36 |
| Rate for Payer: Aetna Commercial |
$8,124.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,230.11
|
| Rate for Payer: Cash Price |
$5,275.71
|
| Rate for Payer: Cigna Commercial |
$8,757.68
|
| Rate for Payer: First Health Commercial |
$10,023.85
|
| Rate for Payer: Humana Commercial |
$8,968.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,652.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,786.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,165.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,285.25
|
| Rate for Payer: Ohio Health Group HMO |
$7,913.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,110.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,270.94
|
| Rate for Payer: PHCS Commercial |
$10,129.36
|
| Rate for Payer: United Healthcare All Payer |
$9,285.25
|
|
|
AVELUMAB 10mg (200mg SDV)
|
Facility
|
OP
|
$10,551.42
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
25004410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$10,129.36 |
| Rate for Payer: Aetna Commercial |
$8,124.59
|
| Rate for Payer: Anthem Medicaid |
$3,628.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$92.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,230.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$129.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.70
|
| Rate for Payer: Cash Price |
$5,275.71
|
| Rate for Payer: Cash Price |
$5,275.71
|
| Rate for Payer: Cigna Commercial |
$8,757.68
|
| Rate for Payer: First Health Commercial |
$10,023.85
|
| Rate for Payer: Humana Commercial |
$8,968.71
|
| Rate for Payer: Humana KY Medicaid |
$3,628.63
|
| Rate for Payer: Humana Medicare Advantage |
$92.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,665.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,652.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,786.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,701.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,285.25
|
| Rate for Payer: Ohio Health Group HMO |
$7,913.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,110.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,270.94
|
| Rate for Payer: PHCS Commercial |
$10,129.36
|
| Rate for Payer: United Healthcare All Payer |
$9,285.25
|
|
