|
AUTONOMIC NRV PARASYM INERV(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
510P0038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$112.43
|
| Rate for Payer: Ambetter Exchange |
$79.07
|
| Rate for Payer: Anthem Medicaid |
$64.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.88
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$98.95
|
| Rate for Payer: Healthspan PPO |
$99.02
|
| Rate for Payer: Humana Medicaid |
$64.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.59
|
| Rate for Payer: Molina Healthcare Passport |
$64.30
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.79
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.07
|
|
|
AUTONOMIC NRV PARASYM INERV(T
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
510T0038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
AUTONOMIC NRV PARASYM INERV(T
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
510T0038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
76102280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| 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 |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
AUTOTRANSPLANT PARATHYROID
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 60512
|
| Hospital Charge Code |
76102280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| 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 |
$338.71
|
| 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 |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
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 |
$585.00 |
| Rate for Payer: Aetna Commercial |
$367.90
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| 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 |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
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 |
$585.00 |
| Rate for Payer: Aetna Commercial |
$367.90
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem Medicaid |
$205.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| 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 |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
AVAMAX BALLOON 13G 10MM
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
AVAMAX BALLOON 13G 10MM
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
Avapro 300mg
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004383
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| 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 |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| 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 |
$1.32 |
| 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 |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| 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 |
$1.32 |
| 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 |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
AVAPRO (IRBESARTAN) 150MG TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 33342004810
|
| Hospital Charge Code |
25000290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| 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
|
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
AVAPRO (IRBESARTAN) 150MG TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 33342004810
|
| Hospital Charge Code |
25000290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
AVASTIN 10MG (400MG/16ML)
|
Facility
|
OP
|
$17,373.29
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25003767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.05 |
| 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 |
$73.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,551.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$102.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.62
|
| 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 |
$73.05
|
| 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 |
$87.66
|
| 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 |
$13,898.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,114.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,987.57
|
| Rate for Payer: PHCS Commercial |
$16,678.36
|
| Rate for Payer: United Healthcare All Payer |
$15,288.50
|
|
|
AVASTIN 10MG (400MG/16ML)
|
Facility
|
IP
|
$17,373.29
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
25003767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,211.99 |
| 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 |
$13,898.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,114.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,987.57
|
| 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 |
$1,303.00 |
| 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 |
$3,474.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.89
|
| 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 |
$73.05 |
| 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 |
$73.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$102.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.62
|
| 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 |
$73.05
|
| 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 |
$87.66
|
| 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 |
$3,474.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.89
|
| Rate for Payer: PHCS Commercial |
$4,169.59
|
| Rate for Payer: United Healthcare All Payer |
$3,822.12
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
636T0170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Aetna Commercial |
$11.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.75
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna Commercial |
$12.50
|
| Rate for Payer: First Health Commercial |
$14.31
|
| Rate for Payer: Humana Commercial |
$12.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.25
|
| Rate for Payer: Ohio Health Group HMO |
$11.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.39
|
| Rate for Payer: PHCS Commercial |
$14.46
|
| Rate for Payer: United Healthcare All Payer |
$13.25
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
636T0170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Aetna Commercial |
$11.60
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna Commercial |
$12.50
|
| Rate for Payer: First Health Commercial |
$14.31
|
| Rate for Payer: Humana Commercial |
$12.80
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$1.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.25
|
| Rate for Payer: Ohio Health Group HMO |
$11.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.39
|
| Rate for Payer: PHCS Commercial |
$14.46
|
| Rate for Payer: United Healthcare All Payer |
$13.25
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$11,295.02
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
25004256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$10,843.22 |
| Rate for Payer: Aetna Commercial |
$8,697.17
|
| Rate for Payer: Anthem Medicaid |
$3,884.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,810.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$5,647.51
|
| Rate for Payer: Cash Price |
$5,647.51
|
| Rate for Payer: Cigna Commercial |
$9,374.87
|
| Rate for Payer: First Health Commercial |
$10,730.27
|
| Rate for Payer: Humana Commercial |
$9,600.77
|
| Rate for Payer: Humana KY Medicaid |
$3,884.36
|
| Rate for Payer: Humana Medicare Advantage |
$1.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,261.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,335.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,962.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,939.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,471.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,036.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,826.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,793.56
|
| Rate for Payer: PHCS Commercial |
$10,843.22
|
| Rate for Payer: United Healthcare All Payer |
$9,939.62
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Aetna Commercial |
$11.60
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna Commercial |
$12.50
|
| Rate for Payer: First Health Commercial |
$14.31
|
| Rate for Payer: Humana Commercial |
$12.80
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$1.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.25
|
| Rate for Payer: Ohio Health Group HMO |
$11.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.39
|
| Rate for Payer: PHCS Commercial |
$14.46
|
| Rate for Payer: United Healthcare All Payer |
$13.25
|
|
|
AVEED 1MG (750MG SDV)
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Aetna Commercial |
$11.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.75
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cigna Commercial |
$12.50
|
| Rate for Payer: First Health Commercial |
$14.31
|
| Rate for Payer: Humana Commercial |
$12.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.25
|
| Rate for Payer: Ohio Health Group HMO |
$11.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.39
|
| Rate for Payer: PHCS Commercial |
$14.46
|
| Rate for Payer: United Healthcare All Payer |
$13.25
|
|
|
AVEED 1MG (750MG SDV)
|
Professional
|
Both
|
$15.06
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Ambetter Exchange |
$1.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.39
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.99
|
| Rate for Payer: Multiplan PHCS |
$9.04
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.59
|
| Rate for Payer: UHCCP Medicaid |
$5.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.99
|
|
