|
STAPLE SYSTEM 12*12*12
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
STAR CLOSE SE
|
Facility
|
OP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem Medicaid |
$670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Humana KY Medicaid |
$670.54
|
| Rate for Payer: Kentucky WC Medicaid |
$677.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
STAR CLOSE SE
|
Facility
|
IP
|
$1,949.80
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,871.81 |
| Rate for Payer: Aetna Commercial |
$1,501.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.84
|
| Rate for Payer: Cash Price |
$974.90
|
| Rate for Payer: Cigna Commercial |
$1,618.33
|
| Rate for Payer: First Health Commercial |
$1,852.31
|
| Rate for Payer: Humana Commercial |
$1,657.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.36
|
| Rate for Payer: PHCS Commercial |
$1,871.81
|
| Rate for Payer: United Healthcare All Payer |
$1,715.82
|
|
|
STARLIX (NATEGLINIDE)120 MG T
|
Facility
|
OP
|
$10.89
|
|
|
Service Code
|
NDC 60687068421
|
| Hospital Charge Code |
25001430
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem Medicaid |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Commercial |
$9.04
|
| Rate for Payer: First Health Commercial |
$10.35
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Humana KY Medicaid |
$3.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.58
|
| Rate for Payer: Ohio Health Group HMO |
$8.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.51
|
| Rate for Payer: PHCS Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Payer |
$9.58
|
|
|
STARLIX (NATEGLINIDE)120 MG T
|
Facility
|
IP
|
$10.89
|
|
|
Service Code
|
NDC 60687068421
|
| Hospital Charge Code |
25001430
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cigna Commercial |
$9.04
|
| Rate for Payer: First Health Commercial |
$10.35
|
| Rate for Payer: Humana Commercial |
$9.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.93
|
| 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 |
$9.58
|
| Rate for Payer: Ohio Health Group HMO |
$8.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.51
|
| Rate for Payer: PHCS Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Payer |
$9.58
|
|
|
STARLIX NATEGLINIDE 60MG TAB
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 60687067321
|
| Hospital Charge Code |
25001431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Anthem Medicaid |
$3.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.96
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$8.47
|
| Rate for Payer: First Health Commercial |
$9.69
|
| Rate for Payer: Humana Commercial |
$8.67
|
| Rate for Payer: Humana KY Medicaid |
$3.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.98
|
| Rate for Payer: Ohio Health Group HMO |
$7.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.04
|
| Rate for Payer: PHCS Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Payer |
$8.98
|
|
|
STARLIX NATEGLINIDE 60MG TAB
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 60687067321
|
| Hospital Charge Code |
25001431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.96
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$8.47
|
| Rate for Payer: First Health Commercial |
$9.69
|
| Rate for Payer: Humana Commercial |
$8.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.98
|
| Rate for Payer: Ohio Health Group HMO |
$7.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.04
|
| Rate for Payer: PHCS Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Payer |
$8.98
|
|
|
STEALTH 360 1.25*145
|
Facility
|
OP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem Medicaid |
$6,316.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Humana KY Medicaid |
$6,316.58
|
| Rate for Payer: Kentucky WC Medicaid |
$6,380.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,443.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STEALTH 360 1.25*145
|
Facility
|
IP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STEALTH 360 1.50*145
|
Facility
|
OP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem Medicaid |
$6,316.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Humana KY Medicaid |
$6,316.58
|
| Rate for Payer: Kentucky WC Medicaid |
$6,380.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,443.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STEALTH 360 1.50*145
|
Facility
|
IP
|
$18,367.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,510.25 |
| Max. Negotiated Rate |
$17,632.80 |
| Rate for Payer: Aetna Commercial |
$14,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,326.65
|
| Rate for Payer: Cash Price |
$9,183.75
|
| Rate for Payer: Cigna Commercial |
$15,245.02
|
| Rate for Payer: First Health Commercial |
$17,449.12
|
| Rate for Payer: Humana Commercial |
$15,612.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,061.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,555.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,510.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,163.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,775.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,694.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,979.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,673.58
|
| Rate for Payer: PHCS Commercial |
$17,632.80
|
| Rate for Payer: United Healthcare All Payer |
$16,163.40
|
|
|
STEALTH 360 2.0*145
|
Facility
|
OP
|
$17,701.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,310.45 |
| Max. Negotiated Rate |
$16,993.44 |
| Rate for Payer: Aetna Commercial |
$13,630.16
|
| Rate for Payer: Anthem Medicaid |
$6,087.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,807.17
|
| Rate for Payer: Cash Price |
$8,850.75
|
| Rate for Payer: Cigna Commercial |
$14,692.25
|
| Rate for Payer: First Health Commercial |
$16,816.42
|
| Rate for Payer: Humana Commercial |
$15,046.27
|
| Rate for Payer: Humana KY Medicaid |
$6,087.55
|
| Rate for Payer: Kentucky WC Medicaid |
$6,149.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,515.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,063.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,310.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,209.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,276.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,161.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,400.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,214.03
|
| Rate for Payer: PHCS Commercial |
$16,993.44
|
| Rate for Payer: United Healthcare All Payer |
$15,577.32
|
|
|
STEALTH 360 2.0*145
|
Facility
|
IP
|
$17,701.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,310.45 |
| Max. Negotiated Rate |
$16,993.44 |
| Rate for Payer: Aetna Commercial |
$13,630.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,807.17
|
| Rate for Payer: Cash Price |
$8,850.75
|
| Rate for Payer: Cigna Commercial |
$14,692.25
|
| Rate for Payer: First Health Commercial |
$16,816.42
|
| Rate for Payer: Humana Commercial |
$15,046.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,515.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,063.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,310.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$13,276.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,161.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,400.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,214.03
|
| Rate for Payer: PHCS Commercial |
$16,993.44
|
| Rate for Payer: United Healthcare All Payer |
$15,577.32
|
|
|
STEGLATRO 15MG TABLET
|
Facility
|
IP
|
$28.90
|
|
|
Service Code
|
NDC 6536403
|
| Hospital Charge Code |
25003484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.54
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna Commercial |
$23.99
|
| Rate for Payer: First Health Commercial |
$27.45
|
| Rate for Payer: Humana Commercial |
$24.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.43
|
| Rate for Payer: Ohio Health Group HMO |
$21.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.94
|
| Rate for Payer: PHCS Commercial |
$27.74
|
| Rate for Payer: United Healthcare All Payer |
$25.43
|
|
|
STEGLATRO 15MG TABLET
|
Facility
|
OP
|
$28.90
|
|
|
Service Code
|
NDC 6536403
|
| Hospital Charge Code |
25003484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: Anthem Medicaid |
$9.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.54
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna Commercial |
$23.99
|
| Rate for Payer: First Health Commercial |
$27.45
|
| Rate for Payer: Humana Commercial |
$24.57
|
| Rate for Payer: Humana KY Medicaid |
$9.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.43
|
| Rate for Payer: Ohio Health Group HMO |
$21.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.94
|
| Rate for Payer: PHCS Commercial |
$27.74
|
| Rate for Payer: United Healthcare All Payer |
$25.43
|
|
|
STEINMAN 2MM PIN 9 IN
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
STEINMAN 2MM PIN 9 IN
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
STELARA 1MG [45MG/0.5ML]
|
Facility
|
OP
|
$16,325.74
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25003877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.68 |
| Max. Negotiated Rate |
$15,672.71 |
| Rate for Payer: Aetna Commercial |
$12,570.82
|
| Rate for Payer: Anthem Medicaid |
$5,614.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$157.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,734.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$220.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.87
|
| Rate for Payer: Cash Price |
$8,162.87
|
| Rate for Payer: Cash Price |
$8,162.87
|
| Rate for Payer: Cigna Commercial |
$13,550.36
|
| Rate for Payer: First Health Commercial |
$15,509.45
|
| Rate for Payer: Humana Commercial |
$13,876.88
|
| Rate for Payer: Humana KY Medicaid |
$5,614.42
|
| Rate for Payer: Humana Medicare Advantage |
$157.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,671.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,387.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,048.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,727.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,366.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,244.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,060.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,203.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,264.76
|
| Rate for Payer: PHCS Commercial |
$15,672.71
|
| Rate for Payer: United Healthcare All Payer |
$14,366.65
|
|
|
STELARA 1MG [45MG/0.5ML]
|
Facility
|
IP
|
$16,325.74
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25003877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,897.72 |
| Max. Negotiated Rate |
$15,672.71 |
| Rate for Payer: Aetna Commercial |
$12,570.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,734.08
|
| Rate for Payer: Cash Price |
$8,162.87
|
| Rate for Payer: Cigna Commercial |
$13,550.36
|
| Rate for Payer: First Health Commercial |
$15,509.45
|
| Rate for Payer: Humana Commercial |
$13,876.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,387.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,048.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,897.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,366.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,244.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,060.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,203.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,264.76
|
| Rate for Payer: PHCS Commercial |
$15,672.71
|
| Rate for Payer: United Healthcare All Payer |
$14,366.65
|
|
|
STELARA 1MG[90 MG SYRINGE]
|
Facility
|
OP
|
$30,901.46
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25002402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.68 |
| Max. Negotiated Rate |
$29,665.40 |
| Rate for Payer: Aetna Commercial |
$23,794.12
|
| Rate for Payer: Anthem Medicaid |
$10,627.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$157.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,103.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$220.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$212.87
|
| Rate for Payer: Cash Price |
$15,450.73
|
| Rate for Payer: Cash Price |
$15,450.73
|
| Rate for Payer: Cigna Commercial |
$25,648.21
|
| Rate for Payer: First Health Commercial |
$29,356.39
|
| Rate for Payer: Humana Commercial |
$26,266.24
|
| Rate for Payer: Humana KY Medicaid |
$10,627.01
|
| Rate for Payer: Humana Medicare Advantage |
$157.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,735.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,339.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,805.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,840.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,193.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,176.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,721.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,884.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,322.01
|
| Rate for Payer: PHCS Commercial |
$29,665.40
|
| Rate for Payer: United Healthcare All Payer |
$27,193.28
|
|
|
STELARA 1MG[90 MG SYRINGE]
|
Facility
|
IP
|
$30,901.46
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25002402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,270.44 |
| Max. Negotiated Rate |
$29,665.40 |
| Rate for Payer: Aetna Commercial |
$23,794.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,103.14
|
| Rate for Payer: Cash Price |
$15,450.73
|
| Rate for Payer: Cigna Commercial |
$25,648.21
|
| Rate for Payer: First Health Commercial |
$29,356.39
|
| Rate for Payer: Humana Commercial |
$26,266.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,339.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,805.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,270.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,193.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,176.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,721.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,884.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,322.01
|
| Rate for Payer: PHCS Commercial |
$29,665.40
|
| Rate for Payer: United Healthcare All Payer |
$27,193.28
|
|
|
STELAZINE 2MG TAB
|
Facility
|
OP
|
$9.67
|
|
|
Service Code
|
NDC 51079057320
|
| Hospital Charge Code |
25001432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
STELAZINE 2MG TAB
|
Facility
|
IP
|
$9.67
|
|
|
Service Code
|
NDC 51079057320
|
| Hospital Charge Code |
25001432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
STELAZINE 5MG TABLET
|
Facility
|
IP
|
$9.14
|
|
|
Service Code
|
NDC 378240501
|
| Hospital Charge Code |
25001433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.13
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.68
|
| Rate for Payer: Humana Commercial |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| Rate for Payer: PHCS Commercial |
$8.77
|
| Rate for Payer: United Healthcare All Payer |
$8.04
|
|
|
STELAZINE 5MG TABLET
|
Facility
|
OP
|
$9.14
|
|
|
Service Code
|
NDC 378240501
|
| Hospital Charge Code |
25001433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Anthem Medicaid |
$3.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.13
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.68
|
| Rate for Payer: Humana Commercial |
$7.77
|
| Rate for Payer: Humana KY Medicaid |
$3.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| Rate for Payer: PHCS Commercial |
$8.77
|
| Rate for Payer: United Healthcare All Payer |
$8.04
|
|
