|
VEIN X-RAY NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360P1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$683.88 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$683.88
|
| Rate for Payer: Healthspan PPO |
$394.02
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
VEIN X-RAY NECK
|
Professional
|
Both
|
$4,722.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,722.00
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cigna Commercial |
$683.88
|
| Rate for Payer: Healthspan PPO |
$394.02
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,833.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,305.40
|
| Rate for Payer: UHCCP Medicaid |
$1,652.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
VEIN X-RAY NECK
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360T1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VEIN X-RAY NECK
|
Facility
|
OP
|
$4,722.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$613.86 |
| Max. Negotiated Rate |
$4,533.12 |
| Rate for Payer: Aetna Commercial |
$3,635.94
|
| Rate for Payer: Anthem Medicaid |
$1,623.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,683.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cash Price |
$2,361.00
|
| Rate for Payer: Cigna Commercial |
$3,919.26
|
| Rate for Payer: First Health Commercial |
$4,485.90
|
| Rate for Payer: Humana Commercial |
$4,013.70
|
| Rate for Payer: Humana KY Medicaid |
$1,623.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,872.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,484.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,656.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,155.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,541.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.82
|
| Rate for Payer: PHCS Commercial |
$4,533.12
|
| Rate for Payer: United Healthcare All Payer |
$4,155.36
|
|
|
VELCADE 0.1MG (3.5 MG/1.4MLSDV
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem Medicaid |
$468.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.64
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Humana KY Medicaid |
$468.56
|
| Rate for Payer: Humana Medicare Advantage |
$1.96
|
| Rate for Payer: Kentucky WC Medicaid |
$473.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.38
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG (3.5 MG/1.4MLSDV
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.12 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.38
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG(3.5 MG/3.5ML SDV
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem Medicaid |
$468.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.64
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Humana KY Medicaid |
$468.56
|
| Rate for Payer: Humana Medicare Advantage |
$1.96
|
| Rate for Payer: Kentucky WC Medicaid |
$473.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.38
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG(3.5 MG/3.5ML SDV
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.12 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.38
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELETRI 0.5MG (0.5MGVIAL)
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25004469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$174.79 |
| Rate for Payer: Aetna Commercial |
$140.19
|
| Rate for Payer: Anthem Medicaid |
$62.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.01
|
| Rate for Payer: Cash Price |
$91.03
|
| Rate for Payer: Cigna Commercial |
$151.12
|
| Rate for Payer: First Health Commercial |
$172.97
|
| Rate for Payer: Humana Commercial |
$154.76
|
| Rate for Payer: Humana KY Medicaid |
$62.61
|
| Rate for Payer: Kentucky WC Medicaid |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.22
|
| Rate for Payer: Ohio Health Group HMO |
$136.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.44
|
| Rate for Payer: PHCS Commercial |
$174.79
|
| Rate for Payer: United Healthcare All Payer |
$160.22
|
|
|
VELETRI 0.5MG (0.5MGVIAL)
|
Facility
|
IP
|
$182.07
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25004469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$174.79 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.22
|
| Rate for Payer: Ohio Health Group HMO |
$136.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.44
|
| Rate for Payer: PHCS Commercial |
$174.79
|
| Rate for Payer: United Healthcare All Payer |
$160.22
|
| Rate for Payer: Aetna Commercial |
$140.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.01
|
| Rate for Payer: Cash Price |
$91.03
|
| Rate for Payer: Cigna Commercial |
$151.12
|
| Rate for Payer: First Health Commercial |
$172.97
|
| Rate for Payer: Humana Commercial |
$154.76
|
|
|
VELETRI 0.5MG(1.5MG VIAL)
|
Facility
|
OP
|
$321.13
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25004470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$308.28 |
| Rate for Payer: Aetna Commercial |
$247.27
|
| Rate for Payer: Anthem Medicaid |
$110.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.48
|
| Rate for Payer: Cash Price |
$160.56
|
| Rate for Payer: Cigna Commercial |
$266.54
|
| Rate for Payer: First Health Commercial |
$305.07
|
| Rate for Payer: Humana Commercial |
$272.96
|
| Rate for Payer: Humana KY Medicaid |
$110.44
|
| Rate for Payer: Kentucky WC Medicaid |
$111.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.59
|
| Rate for Payer: Ohio Health Group HMO |
$240.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.55
|
| Rate for Payer: PHCS Commercial |
$308.28
|
| Rate for Payer: United Healthcare All Payer |
$282.59
|
|
|
VELETRI 0.5MG(1.5MG VIAL)
|
Facility
|
IP
|
$321.13
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25004470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$308.28 |
| Rate for Payer: Aetna Commercial |
$247.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.48
|
| Rate for Payer: Cash Price |
$160.56
|
| Rate for Payer: Cigna Commercial |
$266.54
|
| Rate for Payer: First Health Commercial |
$305.07
|
| Rate for Payer: Humana Commercial |
$272.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.59
|
| Rate for Payer: Ohio Health Group HMO |
$240.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.55
|
| Rate for Payer: PHCS Commercial |
$308.28
|
| Rate for Payer: United Healthcare All Payer |
$282.59
|
|
|
VELTASSA 8.4 GM PACKET
|
Facility
|
OP
|
$82.10
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
25003567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$78.82 |
| Rate for Payer: Aetna Commercial |
$63.22
|
| Rate for Payer: Anthem Medicaid |
$28.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.04
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cigna Commercial |
$68.14
|
| Rate for Payer: First Health Commercial |
$78.00
|
| Rate for Payer: Humana Commercial |
$69.78
|
| Rate for Payer: Humana KY Medicaid |
$28.23
|
| Rate for Payer: Kentucky WC Medicaid |
$28.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.25
|
| Rate for Payer: Ohio Health Group HMO |
$61.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.45
|
| Rate for Payer: PHCS Commercial |
$78.82
|
| Rate for Payer: United Healthcare All Payer |
$72.25
|
|
|
VELTASSA 8.4 GM PACKET
|
Facility
|
IP
|
$82.10
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
25003567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$78.82 |
| Rate for Payer: Aetna Commercial |
$63.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.04
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cigna Commercial |
$68.14
|
| Rate for Payer: First Health Commercial |
$78.00
|
| Rate for Payer: Humana Commercial |
$69.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.25
|
| Rate for Payer: Ohio Health Group HMO |
$61.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.45
|
| Rate for Payer: PHCS Commercial |
$78.82
|
| Rate for Payer: United Healthcare All Payer |
$72.25
|
|
|
VENIPUNCTURE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Anthem Medicaid |
$8.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.00
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Healthspan PPO |
$3.84
|
| Rate for Payer: Humana Medicaid |
$8.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.62
|
| Rate for Payer: Molina Healthcare Passport |
$8.45
|
| Rate for Payer: Multiplan PHCS |
$13.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.10
|
| Rate for Payer: UHCCP Medicaid |
$8.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.30
|
|
|
VENIPUNCTURE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$8.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.83
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$8.83
|
| Rate for Payer: Humana Medicare Advantage |
$8.57
|
| Rate for Payer: Kentucky WC Medicaid |
$8.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VENIPUNCTURE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.19
|
| Rate for Payer: Anthem Medicaid |
$239.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Healthspan PPO |
$2,275.48
|
| Rate for Payer: Humana Medicaid |
$239.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.26
|
| Rate for Payer: Molina Healthcare Passport |
$239.47
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$225.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.86
|
|
|
VEN MECHNL THRMBC REPEAT TX(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
761P1529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.19
|
| Rate for Payer: Anthem Medicaid |
$239.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Healthspan PPO |
$2,275.48
|
| Rate for Payer: Humana Medicaid |
$239.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.26
|
| Rate for Payer: Molina Healthcare Passport |
$239.47
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$225.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.86
|
|
|
VENOFER 1mg (200mg SDV)
|
Facility
|
IP
|
$667.24
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25004357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$640.55 |
| Rate for Payer: Aetna Commercial |
$513.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.45
|
| Rate for Payer: Cash Price |
$333.62
|
| Rate for Payer: Cigna Commercial |
$553.81
|
| Rate for Payer: First Health Commercial |
$633.88
|
| Rate for Payer: Humana Commercial |
$567.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.17
|
| Rate for Payer: Ohio Health Group HMO |
$500.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.84
|
| Rate for Payer: PHCS Commercial |
$640.55
|
| Rate for Payer: United Healthcare All Payer |
$587.17
|
|
|
VENOFER 1mg (200mg SDV)
|
Facility
|
OP
|
$667.24
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25004357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$640.55 |
| Rate for Payer: Aetna Commercial |
$513.77
|
| Rate for Payer: Anthem Medicaid |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.45
|
| Rate for Payer: Cash Price |
$333.62
|
| Rate for Payer: Cigna Commercial |
$553.81
|
| Rate for Payer: First Health Commercial |
$633.88
|
| Rate for Payer: Humana Commercial |
$567.15
|
| Rate for Payer: Humana KY Medicaid |
$229.46
|
| Rate for Payer: Kentucky WC Medicaid |
$231.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.17
|
| Rate for Payer: Ohio Health Group HMO |
$500.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.84
|
| Rate for Payer: PHCS Commercial |
$640.55
|
| Rate for Payer: United Healthcare All Payer |
$587.17
|
|
|
VENOFERIRON SUC(1 MG)100MG/5ML
|
Facility
|
OP
|
$333.65
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25002163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$320.30 |
| Rate for Payer: Aetna Commercial |
$256.91
|
| Rate for Payer: Anthem Medicaid |
$114.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.25
|
| Rate for Payer: Cash Price |
$166.82
|
| Rate for Payer: Cigna Commercial |
$276.93
|
| Rate for Payer: First Health Commercial |
$316.97
|
| Rate for Payer: Humana Commercial |
$283.60
|
| Rate for Payer: Humana KY Medicaid |
$114.74
|
| Rate for Payer: Kentucky WC Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.61
|
| Rate for Payer: Ohio Health Group HMO |
$250.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.43
|
| Rate for Payer: PHCS Commercial |
$320.30
|
| Rate for Payer: United Healthcare All Payer |
$293.61
|
|
|
VENOFERIRON SUC(1 MG)100MG/5ML
|
Facility
|
IP
|
$333.65
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25002163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$320.30 |
| Rate for Payer: Aetna Commercial |
$256.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.25
|
| Rate for Payer: Cash Price |
$166.82
|
| Rate for Payer: Cigna Commercial |
$276.93
|
| Rate for Payer: First Health Commercial |
$316.97
|
| Rate for Payer: Humana Commercial |
$283.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.61
|
| Rate for Payer: Ohio Health Group HMO |
$250.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.43
|
| Rate for Payer: PHCS Commercial |
$320.30
|
| Rate for Payer: United Healthcare All Payer |
$293.61
|
|
