|
DARZALEX 400MG/20ML VIAL
|
Facility
|
IP
|
$16,030.09
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
25002598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,083.91 |
| Max. Negotiated Rate |
$15,388.89 |
| Rate for Payer: Aetna Commercial |
$12,343.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,503.47
|
| Rate for Payer: Cash Price |
$8,015.04
|
| Rate for Payer: Cigna Commercial |
$13,304.97
|
| Rate for Payer: First Health Commercial |
$15,228.59
|
| Rate for Payer: Humana Commercial |
$13,625.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,144.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,830.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,809.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,106.48
|
| Rate for Payer: Ohio Health Group HMO |
$12,022.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,206.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,083.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,969.33
|
| Rate for Payer: PHCS Commercial |
$15,388.89
|
| Rate for Payer: United Healthcare All Payer |
$14,106.48
|
|
|
DARZALEX 400MG/20ML VIAL
|
Facility
|
OP
|
$16,030.09
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
25002598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$15,388.89 |
| Rate for Payer: Aetna Commercial |
$12,343.17
|
| Rate for Payer: Anthem Medicaid |
$5,512.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$61.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,503.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.30
|
| Rate for Payer: Cash Price |
$8,015.04
|
| Rate for Payer: Cash Price |
$8,015.04
|
| Rate for Payer: Cigna Commercial |
$13,304.97
|
| Rate for Payer: First Health Commercial |
$15,228.59
|
| Rate for Payer: Humana Commercial |
$13,625.58
|
| Rate for Payer: Humana KY Medicaid |
$5,512.75
|
| Rate for Payer: Humana Medicare Advantage |
$61.70
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,144.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,830.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,623.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,106.48
|
| Rate for Payer: Ohio Health Group HMO |
$12,022.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,206.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,083.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,969.33
|
| Rate for Payer: PHCS Commercial |
$15,388.89
|
| Rate for Payer: United Healthcare All Payer |
$14,106.48
|
|
|
DARZALEX FASPRO 10mg (1800mg)
|
Facility
|
OP
|
$54,623.33
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
25004160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$52,438.40 |
| Rate for Payer: Aetna Commercial |
$42,059.96
|
| Rate for Payer: Anthem Medicaid |
$18,784.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42,606.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$68.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.22
|
| Rate for Payer: Cash Price |
$27,311.67
|
| Rate for Payer: Cash Price |
$27,311.67
|
| Rate for Payer: Cigna Commercial |
$45,337.36
|
| Rate for Payer: First Health Commercial |
$51,892.16
|
| Rate for Payer: Humana Commercial |
$46,429.83
|
| Rate for Payer: Humana KY Medicaid |
$18,784.96
|
| Rate for Payer: Humana Medicare Advantage |
$49.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18,976.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44,791.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40,312.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,161.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$48,068.53
|
| Rate for Payer: Ohio Health Group HMO |
$40,967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,101.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.23
|
| Rate for Payer: PHCS Commercial |
$52,438.40
|
| Rate for Payer: United Healthcare All Payer |
$48,068.53
|
|
|
DARZALEX FASPRO 10mg (1800mg)
|
Facility
|
IP
|
$54,623.33
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
25004160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,101.03 |
| Max. Negotiated Rate |
$52,438.40 |
| Rate for Payer: Aetna Commercial |
$42,059.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42,606.20
|
| Rate for Payer: Cash Price |
$27,311.67
|
| Rate for Payer: Cigna Commercial |
$45,337.36
|
| Rate for Payer: First Health Commercial |
$51,892.16
|
| Rate for Payer: Humana Commercial |
$46,429.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44,791.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40,312.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$48,068.53
|
| Rate for Payer: Ohio Health Group HMO |
$40,967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,101.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.23
|
| Rate for Payer: PHCS Commercial |
$52,438.40
|
| Rate for Payer: United Healthcare All Payer |
$48,068.53
|
|
|
DAUNORUBICIN 10MG (20MG VIAL)
|
Facility
|
OP
|
$714.71
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
25002599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$686.12 |
| Rate for Payer: Aetna Commercial |
$550.33
|
| Rate for Payer: Anthem Medicaid |
$245.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.16
|
| Rate for Payer: Cash Price |
$357.36
|
| Rate for Payer: Cash Price |
$357.36
|
| Rate for Payer: Cigna Commercial |
$593.21
|
| Rate for Payer: First Health Commercial |
$678.97
|
| Rate for Payer: Humana Commercial |
$607.50
|
| Rate for Payer: Humana KY Medicaid |
$245.79
|
| Rate for Payer: Humana Medicare Advantage |
$35.67
|
| Rate for Payer: Kentucky WC Medicaid |
$248.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.94
|
| Rate for Payer: Ohio Health Group HMO |
$536.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.56
|
| Rate for Payer: PHCS Commercial |
$686.12
|
| Rate for Payer: United Healthcare All Payer |
$628.94
|
|
|
DAUNORUBICIN 10MG (20MG VIAL)
|
Facility
|
IP
|
$714.71
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
25002599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.91 |
| Max. Negotiated Rate |
$686.12 |
| Rate for Payer: Aetna Commercial |
$550.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.47
|
| Rate for Payer: Cash Price |
$357.36
|
| Rate for Payer: Cigna Commercial |
$593.21
|
| Rate for Payer: First Health Commercial |
$678.97
|
| Rate for Payer: Humana Commercial |
$607.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$628.94
|
| Rate for Payer: Ohio Health Group HMO |
$536.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.56
|
| Rate for Payer: PHCS Commercial |
$686.12
|
| Rate for Payer: United Healthcare All Payer |
$628.94
|
|
|
DAYPRO (OXAPROZIN) 600MG/1TAB
|
Facility
|
IP
|
$9.47
|
|
|
Service Code
|
NDC 185014101
|
| Hospital Charge Code |
25000517
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.39
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.86
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: Humana Commercial |
$8.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.09
|
| Rate for Payer: United Healthcare All Payer |
$8.33
|
|
|
DAYPRO (OXAPROZIN) 600MG/1TAB
|
Facility
|
OP
|
$9.47
|
|
|
Service Code
|
NDC 185014101
|
| Hospital Charge Code |
25000517
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Anthem Medicaid |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.39
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.86
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: Humana Commercial |
$8.05
|
| Rate for Payer: Humana KY Medicaid |
$3.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.09
|
| Rate for Payer: United Healthcare All Payer |
$8.33
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
76100030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.21
|
| Rate for Payer: Anthem Medicaid |
$33.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,287.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna Commercial |
$90.04
|
| Rate for Payer: Healthspan PPO |
$51.78
|
| Rate for Payer: Humana Medicaid |
$33.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.89
|
| Rate for Payer: Molina Healthcare Passport |
$33.23
|
| Rate for Payer: Multiplan PHCS |
$772.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.90
|
| Rate for Payer: UHCCP Medicaid |
$29.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.56
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
761P0030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.21
|
| Rate for Payer: Anthem Medicaid |
$33.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$90.04
|
| Rate for Payer: Healthspan PPO |
$51.78
|
| Rate for Payer: Humana Medicaid |
$33.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.89
|
| Rate for Payer: Molina Healthcare Passport |
$33.23
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$29.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.56
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
761T0030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$1,139.52 |
| Rate for Payer: Aetna Commercial |
$913.99
|
| Rate for Payer: Anthem Medicaid |
$408.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$925.86
|
| Rate for Payer: Cash Price |
$593.50
|
| Rate for Payer: Cigna Commercial |
$985.21
|
| Rate for Payer: First Health Commercial |
$1,127.65
|
| Rate for Payer: Humana Commercial |
$1,008.95
|
| Rate for Payer: Humana KY Medicaid |
$408.21
|
| Rate for Payer: Kentucky WC Medicaid |
$412.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$973.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$416.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,044.56
|
| Rate for Payer: Ohio Health Group HMO |
$890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.97
|
| Rate for Payer: PHCS Commercial |
$1,139.52
|
| Rate for Payer: United Healthcare All Payer |
$1,044.56
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
761T0030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$1,139.52 |
| Rate for Payer: Aetna Commercial |
$913.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$925.86
|
| Rate for Payer: Cash Price |
$593.50
|
| Rate for Payer: Cigna Commercial |
$985.21
|
| Rate for Payer: First Health Commercial |
$1,127.65
|
| Rate for Payer: Humana Commercial |
$1,008.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$973.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,044.56
|
| Rate for Payer: Ohio Health Group HMO |
$890.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$367.97
|
| Rate for Payer: PHCS Commercial |
$1,139.52
|
| Rate for Payer: United Healthcare All Payer |
$1,044.56
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Facility
|
OP
|
$1,287.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
76100030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$1,235.52 |
| Rate for Payer: Aetna Commercial |
$990.99
|
| Rate for Payer: Anthem Medicaid |
$442.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.86
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna Commercial |
$1,068.21
|
| Rate for Payer: First Health Commercial |
$1,222.65
|
| Rate for Payer: Humana Commercial |
$1,093.95
|
| Rate for Payer: Humana KY Medicaid |
$442.60
|
| Rate for Payer: Kentucky WC Medicaid |
$447.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,055.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,132.56
|
| Rate for Payer: Ohio Health Group HMO |
$965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.97
|
| Rate for Payer: PHCS Commercial |
$1,235.52
|
| Rate for Payer: United Healthcare All Payer |
$1,132.56
|
|
|
DBR MUC/FAS UP TO EA AD 20SQCM
|
Facility
|
IP
|
$1,287.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
76100030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$1,235.52 |
| Rate for Payer: Aetna Commercial |
$990.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.86
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna Commercial |
$1,068.21
|
| Rate for Payer: First Health Commercial |
$1,222.65
|
| Rate for Payer: Humana Commercial |
$1,093.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,055.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,132.56
|
| Rate for Payer: Ohio Health Group HMO |
$965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.97
|
| Rate for Payer: PHCS Commercial |
$1,235.52
|
| Rate for Payer: United Healthcare All Payer |
$1,132.56
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$22,020.70
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$14,942.62 |
| Max. Negotiated Rate |
$22,020.70 |
| Rate for Payer: Anthem Medicaid |
$14,942.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,729.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,020.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,234.24
|
| Rate for Payer: Humana KY Medicaid |
$14,942.62
|
| Rate for Payer: Humana Medicare Advantage |
$15,729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$15,092.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,874.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,241.47
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$12,118.18
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$8,223.05 |
| Max. Negotiated Rate |
$12,118.18 |
| Rate for Payer: Anthem Medicaid |
$8,223.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,655.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,118.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,685.38
|
| Rate for Payer: Humana KY Medicaid |
$8,223.05
|
| Rate for Payer: Humana Medicare Advantage |
$8,655.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,305.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,387.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,387.51
|
|
|
DCMPRSSN THIGH/KNEE W/DBRDMT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27497
|
| Hospital Charge Code |
76102946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
DCMPRSSN THIGH/KNEE W/DBRDMT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27497
|
| Hospital Charge Code |
76102946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.46 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$797.19
|
| Rate for Payer: Anthem Medicaid |
$341.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$862.84
|
| Rate for Payer: Healthspan PPO |
$722.09
|
| Rate for Payer: Humana Medicaid |
$341.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.29
|
| Rate for Payer: Molina Healthcare Passport |
$341.46
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$344.87
|
|
|
DCMPRSSN THIGH/KNEE W/DBRDMT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27497
|
| Hospital Charge Code |
76102946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
DDAVP(DESMOPRES ACET)0.2 MGTAB
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 60505025801
|
| Hospital Charge Code |
25000522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
DDAVP(DESMOPRES ACET)0.2 MGTAB
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 60505025801
|
| Hospital Charge Code |
25000522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
DDAVP(DESMOPRESSIN .25MG/2.5ML
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
NDC 24208034205
|
| Hospital Charge Code |
25002983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna Commercial |
$9.47
|
| Rate for Payer: Anthem Medicaid |
$4.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Cash Price |
$6.15
|
| Rate for Payer: Cigna Commercial |
$10.21
|
| Rate for Payer: First Health Commercial |
$11.68
|
| Rate for Payer: Humana Commercial |
$10.46
|
| Rate for Payer: Humana KY Medicaid |
$4.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.82
|
| Rate for Payer: Ohio Health Group HMO |
$9.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.81
|
| Rate for Payer: PHCS Commercial |
$11.81
|
| Rate for Payer: United Healthcare All Payer |
$10.82
|
|
|
DDAVP(DESMOPRESSIN .25MG/2.5ML
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 24208034205
|
| Hospital Charge Code |
25002983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna Commercial |
$9.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Cash Price |
$6.15
|
| Rate for Payer: Cigna Commercial |
$10.21
|
| Rate for Payer: First Health Commercial |
$11.68
|
| Rate for Payer: Humana Commercial |
$10.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.82
|
| Rate for Payer: Ohio Health Group HMO |
$9.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.81
|
| Rate for Payer: PHCS Commercial |
$11.81
|
| Rate for Payer: United Healthcare All Payer |
$10.82
|
|
|
D DIMER QUANTITATIVE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
30000601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$10.18
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
D DIMER QUANTITATIVE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
30000601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
