|
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
|
|
|
AVELUMAB 10mg (200mg SDV)
|
Facility
|
IP
|
$10,973.47
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
25004410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,292.04 |
| Max. Negotiated Rate |
$10,534.53 |
| Rate for Payer: Aetna Commercial |
$8,449.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,559.31
|
| Rate for Payer: Cash Price |
$5,486.74
|
| Rate for Payer: Cigna Commercial |
$9,107.98
|
| Rate for Payer: First Health Commercial |
$10,424.80
|
| Rate for Payer: Humana Commercial |
$9,327.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,998.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,098.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,656.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,230.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,778.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,546.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,571.69
|
| Rate for Payer: PHCS Commercial |
$10,534.53
|
| Rate for Payer: United Healthcare All Payer |
$9,656.65
|
|
|
AVELUMAB 10mg (200mg SDV)
|
Facility
|
OP
|
$10,973.47
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
25004410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$10,534.53 |
| Rate for Payer: Aetna Commercial |
$8,449.57
|
| Rate for Payer: Anthem Medicaid |
$3,773.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$100.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,559.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$140.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.41
|
| Rate for Payer: Cash Price |
$5,486.74
|
| Rate for Payer: Cash Price |
$5,486.74
|
| Rate for Payer: Cigna Commercial |
$9,107.98
|
| Rate for Payer: First Health Commercial |
$10,424.80
|
| Rate for Payer: Humana Commercial |
$9,327.45
|
| Rate for Payer: Humana KY Medicaid |
$3,773.78
|
| Rate for Payer: Humana Medicare Advantage |
$100.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,998.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,098.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,849.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,656.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,230.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,778.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,546.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,571.69
|
| Rate for Payer: PHCS Commercial |
$10,534.53
|
| Rate for Payer: United Healthcare All Payer |
$9,656.65
|
|
|
AVENIR FEM STEM STD SZ 7
|
Facility
|
OP
|
$21,031.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,309.38 |
| Max. Negotiated Rate |
$20,190.00 |
| Rate for Payer: Aetna Commercial |
$16,194.06
|
| Rate for Payer: Anthem Medicaid |
$7,232.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,404.38
|
| Rate for Payer: Cash Price |
$10,515.62
|
| Rate for Payer: Cigna Commercial |
$17,455.94
|
| Rate for Payer: First Health Commercial |
$19,979.69
|
| Rate for Payer: Humana Commercial |
$17,876.56
|
| Rate for Payer: Humana KY Medicaid |
$7,232.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,306.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,245.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,521.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,309.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,377.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,507.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,297.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,511.56
|
| Rate for Payer: PHCS Commercial |
$20,190.00
|
| Rate for Payer: United Healthcare All Payer |
$18,507.50
|
|
|
AVENIR FEM STEM STD SZ 7
|
Facility
|
IP
|
$21,031.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,309.38 |
| Max. Negotiated Rate |
$20,190.00 |
| Rate for Payer: Aetna Commercial |
$16,194.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,404.38
|
| Rate for Payer: Cash Price |
$10,515.62
|
| Rate for Payer: Cigna Commercial |
$17,455.94
|
| Rate for Payer: First Health Commercial |
$19,979.69
|
| Rate for Payer: Humana Commercial |
$17,876.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,245.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,521.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,309.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,507.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,297.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,511.56
|
| Rate for Payer: PHCS Commercial |
$20,190.00
|
| Rate for Payer: United Healthcare All Payer |
$18,507.50
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem Medicaid |
$371.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Humana KY Medicaid |
$371.41
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$375.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$745.20
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$939.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$745.20
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,086.76 |
| Rate for Payer: Aetna Commercial |
$1,086.76
|
| Rate for Payer: Ambetter Exchange |
$644.86
|
| Rate for Payer: Anthem Medicaid |
$544.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.83
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,050.66
|
| Rate for Payer: Healthspan PPO |
$868.97
|
| Rate for Payer: Humana Medicaid |
$544.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$555.25
|
| Rate for Payer: Molina Healthcare Passport |
$544.36
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.32
|
| Rate for Payer: UHCCP Medicaid |
$378.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.86
|
|
|
AV FIST CEPHAL BRACH FISTUA(P
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
761P1504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,086.76 |
| Rate for Payer: Aetna Commercial |
$1,086.76
|
| Rate for Payer: Ambetter Exchange |
$644.86
|
| Rate for Payer: Anthem Medicaid |
$544.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.83
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,050.66
|
| Rate for Payer: Healthspan PPO |
$868.97
|
| Rate for Payer: Humana Medicaid |
$544.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$555.25
|
| Rate for Payer: Molina Healthcare Passport |
$544.36
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.32
|
| Rate for Payer: UHCCP Medicaid |
$378.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.86
|
|
|
AVISTA MRI PERC LEAD 56CM
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
AVISTA MRI PERC LEAD 56CM
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
AVISTA MRI PERC LEAD 74CM
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
AVISTA MRI PERC LEAD 74CM
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
IP
|
$337.09
|
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.13 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.59
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 53276101009
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 53276101009
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
OP
|
$337.09
|
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.13 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem Medicaid |
$115.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Humana KY Medicaid |
$115.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.59
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE POWDER
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE POWDER
|
Facility
|
IP
|
$337.09
|
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.13 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.59
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE POWDER
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE POWDER
|
Facility
|
OP
|
$337.09
|
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.13 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem Medicaid |
$115.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Humana KY Medicaid |
$115.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.59
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVODART (DUTASTERIDE) 0.5MG
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 60505387703
|
| Hospital Charge Code |
25000297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
AVODART (DUTASTERIDE) 0.5MG
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 60505387703
|
| Hospital Charge Code |
25000297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
AV OPEN UPPER ARM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.90 |
| Max. Negotiated Rate |
$1,174.08 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$843.87
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
AV OPEN UPPER ARM
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,271.56 |
| Rate for Payer: Aetna Commercial |
$1,271.56
|
| Rate for Payer: Ambetter Exchange |
$682.58
|
| Rate for Payer: Anthem Medicaid |
$612.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.10
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,210.34
|
| Rate for Payer: Healthspan PPO |
$1,016.73
|
| Rate for Payer: Humana Medicaid |
$612.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,070.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$682.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$624.73
|
| Rate for Payer: Molina Healthcare Passport |
$612.48
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.35
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$618.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.58
|
|
