|
TAP BLOCK UNIL BY INJECTION(T
|
Facility
|
IP
|
$2,395.98
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
761T2325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.48 |
| Max. Negotiated Rate |
$2,300.14 |
| Rate for Payer: Aetna Commercial |
$1,844.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.86
|
| Rate for Payer: Cash Price |
$1,197.99
|
| Rate for Payer: Cigna Commercial |
$1,988.66
|
| Rate for Payer: First Health Commercial |
$2,276.18
|
| Rate for Payer: Humana Commercial |
$2,036.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,768.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,108.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.75
|
| Rate for Payer: PHCS Commercial |
$2,300.14
|
| Rate for Payer: United Healthcare All Payer |
$2,108.46
|
|
|
TAPERLOC FEM STEM 10MMX140
|
Facility
|
IP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
TAPERLOC FEM STEM 10MMX140
|
Facility
|
OP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem Medicaid |
$7,680.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Humana KY Medicaid |
$7,680.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7,759.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,834.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
TAPERLOC POR FMRLSTEM 13.5X147
|
Facility
|
OP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem Medicaid |
$7,680.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Humana KY Medicaid |
$7,680.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7,759.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,834.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
TAPERLOC POR FMRLSTEM 13.5X147
|
Facility
|
IP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
TAPER POST 8.0MM
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
TAPER POST 8.0MM
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
TAPER POST 9.5MM
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
TAPER POST 9.5MM
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
TARCEVA (ERLOTINIB) 100MG
|
Facility
|
OP
|
$1,357.43
|
|
|
Service Code
|
NDC 50242006301
|
| Hospital Charge Code |
25003513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$1,303.13 |
| Rate for Payer: Aetna Commercial |
$1,045.22
|
| Rate for Payer: Anthem Medicaid |
$466.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,058.80
|
| Rate for Payer: Cash Price |
$678.72
|
| Rate for Payer: Cigna Commercial |
$1,126.67
|
| Rate for Payer: First Health Commercial |
$1,289.56
|
| Rate for Payer: Humana Commercial |
$1,153.82
|
| Rate for Payer: Humana KY Medicaid |
$466.82
|
| Rate for Payer: Kentucky WC Medicaid |
$471.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,001.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$476.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,194.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.80
|
| Rate for Payer: PHCS Commercial |
$1,303.13
|
| Rate for Payer: United Healthcare All Payer |
$1,194.54
|
|
|
TARCEVA (ERLOTINIB) 100MG
|
Facility
|
IP
|
$1,357.43
|
|
|
Service Code
|
NDC 50242006301
|
| Hospital Charge Code |
25003513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$1,303.13 |
| Rate for Payer: Aetna Commercial |
$1,045.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,058.80
|
| Rate for Payer: Cash Price |
$678.72
|
| Rate for Payer: Cigna Commercial |
$1,126.67
|
| Rate for Payer: First Health Commercial |
$1,289.56
|
| Rate for Payer: Humana Commercial |
$1,153.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,001.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,194.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.80
|
| Rate for Payer: PHCS Commercial |
$1,303.13
|
| Rate for Payer: United Healthcare All Payer |
$1,194.54
|
|
|
TARCEVA(ERLOTINIB) 150 MG
|
Facility
|
IP
|
$1,535.32
|
|
|
Service Code
|
NDC 50242006401
|
| Hospital Charge Code |
25003514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$199.59 |
| Max. Negotiated Rate |
$1,473.91 |
| Rate for Payer: Aetna Commercial |
$1,182.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.55
|
| Rate for Payer: Cash Price |
$767.66
|
| Rate for Payer: Cigna Commercial |
$1,274.32
|
| Rate for Payer: First Health Commercial |
$1,458.55
|
| Rate for Payer: Humana Commercial |
$1,305.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.95
|
| Rate for Payer: PHCS Commercial |
$1,473.91
|
| Rate for Payer: United Healthcare All Payer |
$1,351.08
|
|
|
TARCEVA(ERLOTINIB) 150 MG
|
Facility
|
OP
|
$1,535.32
|
|
|
Service Code
|
NDC 50242006401
|
| Hospital Charge Code |
25003514
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$199.59 |
| Max. Negotiated Rate |
$1,473.91 |
| Rate for Payer: Aetna Commercial |
$1,182.20
|
| Rate for Payer: Anthem Medicaid |
$528.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.55
|
| Rate for Payer: Cash Price |
$767.66
|
| Rate for Payer: Cigna Commercial |
$1,274.32
|
| Rate for Payer: First Health Commercial |
$1,458.55
|
| Rate for Payer: Humana Commercial |
$1,305.02
|
| Rate for Payer: Humana KY Medicaid |
$528.00
|
| Rate for Payer: Kentucky WC Medicaid |
$533.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.95
|
| Rate for Payer: PHCS Commercial |
$1,473.91
|
| Rate for Payer: United Healthcare All Payer |
$1,351.08
|
|
|
TARCEVA (ERLOTINIB) 25MG TAB
|
Facility
|
IP
|
$494.21
|
|
|
Service Code
|
NDC 50242006201
|
| Hospital Charge Code |
25001490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$474.44 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.48
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cigna Commercial |
$410.19
|
| Rate for Payer: First Health Commercial |
$469.50
|
| Rate for Payer: Humana Commercial |
$420.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.90
|
| Rate for Payer: Ohio Health Group HMO |
$370.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.21
|
| Rate for Payer: PHCS Commercial |
$474.44
|
| Rate for Payer: United Healthcare All Payer |
$434.90
|
|
|
TARCEVA (ERLOTINIB) 25MG TAB
|
Facility
|
OP
|
$494.21
|
|
|
Service Code
|
NDC 50242006201
|
| Hospital Charge Code |
25001490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$474.44 |
| Rate for Payer: Aetna Commercial |
$380.54
|
| Rate for Payer: Anthem Medicaid |
$169.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.48
|
| Rate for Payer: Cash Price |
$247.10
|
| Rate for Payer: Cigna Commercial |
$410.19
|
| Rate for Payer: First Health Commercial |
$469.50
|
| Rate for Payer: Humana Commercial |
$420.08
|
| Rate for Payer: Humana KY Medicaid |
$169.96
|
| Rate for Payer: Kentucky WC Medicaid |
$171.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.90
|
| Rate for Payer: Ohio Health Group HMO |
$370.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.21
|
| Rate for Payer: PHCS Commercial |
$474.44
|
| Rate for Payer: United Healthcare All Payer |
$434.90
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMAN
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
76101017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem Medicaid |
$199.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Humana KY Medicaid |
$199.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$201.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMAN
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
45000177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMAN
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
45000177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMAN
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
76101017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$556.80 |
| Rate for Payer: Aetna Commercial |
$446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$452.40
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$481.40
|
| Rate for Payer: First Health Commercial |
$551.00
|
| Rate for Payer: Humana Commercial |
$493.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$510.40
|
| Rate for Payer: Ohio Health Group HMO |
$435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.80
|
| Rate for Payer: PHCS Commercial |
$556.80
|
| Rate for Payer: United Healthcare All Payer |
$510.40
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMAN
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
76101017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.50
|
| Rate for Payer: Anthem Medicaid |
$128.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$424.64
|
| Rate for Payer: Healthspan PPO |
$366.63
|
| Rate for Payer: Humana Medicaid |
$128.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.17
|
| Rate for Payer: Molina Healthcare Passport |
$128.60
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$155.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.89
|
|
|
TARSAL FX(NOTTALUSCALCAN)WMA(P
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 28455
|
| Hospital Charge Code |
761P1017
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.50
|
| Rate for Payer: Anthem Medicaid |
$128.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$424.64
|
| Rate for Payer: Healthspan PPO |
$366.63
|
| Rate for Payer: Humana Medicaid |
$128.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$322.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.17
|
| Rate for Payer: Molina Healthcare Passport |
$128.60
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$155.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.89
|
|
|
TASMAR (TOLCAPONE) 100MG TAB
|
Facility
|
IP
|
$288.54
|
|
|
Service Code
|
NDC 187093801
|
| Hospital Charge Code |
25001493
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna Commercial |
$222.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.06
|
| Rate for Payer: Cash Price |
$144.27
|
| Rate for Payer: Cigna Commercial |
$239.49
|
| Rate for Payer: First Health Commercial |
$274.11
|
| Rate for Payer: Humana Commercial |
$245.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.92
|
| Rate for Payer: Ohio Health Group HMO |
$216.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.45
|
| Rate for Payer: PHCS Commercial |
$277.00
|
| Rate for Payer: United Healthcare All Payer |
$253.92
|
|
|
TASMAR (TOLCAPONE) 100MG TAB
|
Facility
|
OP
|
$288.54
|
|
|
Service Code
|
NDC 187093801
|
| Hospital Charge Code |
25001493
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna Commercial |
$222.18
|
| Rate for Payer: Anthem Medicaid |
$99.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$225.06
|
| Rate for Payer: Cash Price |
$144.27
|
| Rate for Payer: Cigna Commercial |
$239.49
|
| Rate for Payer: First Health Commercial |
$274.11
|
| Rate for Payer: Humana Commercial |
$245.26
|
| Rate for Payer: Humana KY Medicaid |
$99.23
|
| Rate for Payer: Kentucky WC Medicaid |
$100.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.92
|
| Rate for Payer: Ohio Health Group HMO |
$216.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.45
|
| Rate for Payer: PHCS Commercial |
$277.00
|
| Rate for Payer: United Healthcare All Payer |
$253.92
|
|
|
TAXOTERE 1MG (20MG VL)
|
Facility
|
OP
|
$594.05
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.23 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$457.42
|
| Rate for Payer: Anthem Medicaid |
$204.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.36
|
| Rate for Payer: Cash Price |
$297.02
|
| Rate for Payer: Cigna Commercial |
$493.06
|
| Rate for Payer: First Health Commercial |
$564.35
|
| Rate for Payer: Humana Commercial |
$504.94
|
| Rate for Payer: Humana KY Medicaid |
$204.29
|
| Rate for Payer: Kentucky WC Medicaid |
$206.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.76
|
| Rate for Payer: Ohio Health Group HMO |
$445.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.16
|
| Rate for Payer: PHCS Commercial |
$570.29
|
| Rate for Payer: United Healthcare All Payer |
$522.76
|
|
|
TAXOTERE 1MG (20MG VL)
|
Facility
|
IP
|
$594.05
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.23 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$457.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.36
|
| Rate for Payer: Cash Price |
$297.02
|
| Rate for Payer: Cigna Commercial |
$493.06
|
| Rate for Payer: First Health Commercial |
$564.35
|
| Rate for Payer: Humana Commercial |
$504.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.76
|
| Rate for Payer: Ohio Health Group HMO |
$445.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.16
|
| Rate for Payer: PHCS Commercial |
$570.29
|
| Rate for Payer: United Healthcare All Payer |
$522.76
|
|
