|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELEOS COLLAR 28MM 12*120
|
Facility
|
IP
|
$23,341.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,002.38 |
| Max. Negotiated Rate |
$22,407.60 |
| Rate for Payer: Aetna Commercial |
$17,972.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,206.17
|
| Rate for Payer: Cash Price |
$11,670.62
|
| Rate for Payer: Cigna Commercial |
$19,373.24
|
| Rate for Payer: First Health Commercial |
$22,174.19
|
| Rate for Payer: Humana Commercial |
$19,840.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,139.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,002.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,540.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,505.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,673.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,306.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,105.46
|
| Rate for Payer: PHCS Commercial |
$22,407.60
|
| Rate for Payer: United Healthcare All Payer |
$20,540.30
|
|
|
ELEOS COLLAR 28MM 12*120
|
Facility
|
OP
|
$23,341.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,002.38 |
| Max. Negotiated Rate |
$22,407.60 |
| Rate for Payer: Aetna Commercial |
$17,972.76
|
| Rate for Payer: Anthem Medicaid |
$8,027.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,206.17
|
| Rate for Payer: Cash Price |
$11,670.62
|
| Rate for Payer: Cigna Commercial |
$19,373.24
|
| Rate for Payer: First Health Commercial |
$22,174.19
|
| Rate for Payer: Humana Commercial |
$19,840.06
|
| Rate for Payer: Humana KY Medicaid |
$8,027.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,108.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,139.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,002.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,188.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,540.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,505.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,673.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,306.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,105.46
|
| Rate for Payer: PHCS Commercial |
$22,407.60
|
| Rate for Payer: United Healthcare All Payer |
$20,540.30
|
|
|
ELEOS DISTAL FEM RT 65MM
|
Facility
|
OP
|
$37,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,141.25 |
| Max. Negotiated Rate |
$35,652.00 |
| Rate for Payer: Aetna Commercial |
$28,595.88
|
| Rate for Payer: Anthem Medicaid |
$12,771.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,967.25
|
| Rate for Payer: Cash Price |
$18,568.75
|
| Rate for Payer: Cigna Commercial |
$30,824.12
|
| Rate for Payer: First Health Commercial |
$35,280.62
|
| Rate for Payer: Humana Commercial |
$31,566.88
|
| Rate for Payer: Humana KY Medicaid |
$12,771.59
|
| Rate for Payer: Kentucky WC Medicaid |
$12,901.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,452.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,407.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,141.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,027.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,681.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,853.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,309.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,624.88
|
| Rate for Payer: PHCS Commercial |
$35,652.00
|
| Rate for Payer: United Healthcare All Payer |
$32,681.00
|
|
|
ELEOS DISTAL FEM RT 65MM
|
Facility
|
IP
|
$37,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,141.25 |
| Max. Negotiated Rate |
$35,652.00 |
| Rate for Payer: Aetna Commercial |
$28,595.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,967.25
|
| Rate for Payer: Cash Price |
$18,568.75
|
| Rate for Payer: Cigna Commercial |
$30,824.12
|
| Rate for Payer: First Health Commercial |
$35,280.62
|
| Rate for Payer: Humana Commercial |
$31,566.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,452.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,407.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,141.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,681.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,853.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,309.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,624.88
|
| Rate for Payer: PHCS Commercial |
$35,652.00
|
| Rate for Payer: United Healthcare All Payer |
$32,681.00
|
|
|
ELEOS STEM SPLINED ST 15*100MM
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELEOS STEM SPLINED ST 15*100MM
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELEOS STEM SPLINED ST 16*100MM
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELEOS STEM SPLINED ST 16*100MM
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELEOS STEM SPLINED ST 18*100MM
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELEOS STEM SPLINED ST 18*100MM
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
ELIDEL(PIMECROLIMUS)1%CRM30GM
|
Facility
|
OP
|
$28.62
|
|
|
Service Code
|
NDC 68682011001
|
| Hospital Charge Code |
25000610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Anthem Medicaid |
$9.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.32
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: First Health Commercial |
$27.19
|
| Rate for Payer: Humana Commercial |
$24.33
|
| Rate for Payer: Humana KY Medicaid |
$9.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.19
|
| Rate for Payer: Ohio Health Group HMO |
$21.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.75
|
| Rate for Payer: PHCS Commercial |
$27.48
|
| Rate for Payer: United Healthcare All Payer |
$25.19
|
|
|
ELIDEL(PIMECROLIMUS)1%CRM30GM
|
Facility
|
IP
|
$28.62
|
|
|
Service Code
|
NDC 68682011001
|
| Hospital Charge Code |
25000610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.32
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: First Health Commercial |
$27.19
|
| Rate for Payer: Humana Commercial |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.19
|
| Rate for Payer: Ohio Health Group HMO |
$21.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.75
|
| Rate for Payer: PHCS Commercial |
$27.48
|
| Rate for Payer: United Healthcare All Payer |
$25.19
|
|
|
ELIGARD 22.5MG SYRINGE
|
Facility
|
IP
|
$7,385.13
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25003913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,215.54 |
| Max. Negotiated Rate |
$7,089.72 |
| Rate for Payer: Aetna Commercial |
$5,686.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,760.40
|
| Rate for Payer: Cash Price |
$3,692.56
|
| Rate for Payer: Cigna Commercial |
$6,129.66
|
| Rate for Payer: First Health Commercial |
$7,015.87
|
| Rate for Payer: Humana Commercial |
$6,277.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,055.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,450.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,498.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,908.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,095.74
|
| Rate for Payer: PHCS Commercial |
$7,089.72
|
| Rate for Payer: United Healthcare All Payer |
$6,498.91
|
|
|
ELIGARD 22.5MG SYRINGE
|
Facility
|
OP
|
$7,385.13
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25003913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$7,089.72 |
| Rate for Payer: Aetna Commercial |
$5,686.55
|
| Rate for Payer: Anthem Medicaid |
$2,539.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,760.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.82
|
| Rate for Payer: Cash Price |
$3,692.56
|
| Rate for Payer: Cash Price |
$3,692.56
|
| Rate for Payer: Cigna Commercial |
$6,129.66
|
| Rate for Payer: First Health Commercial |
$7,015.87
|
| Rate for Payer: Humana Commercial |
$6,277.36
|
| Rate for Payer: Humana KY Medicaid |
$2,539.75
|
| Rate for Payer: Humana Medicare Advantage |
$155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,565.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,055.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,450.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,590.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,498.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,908.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,095.74
|
| Rate for Payer: PHCS Commercial |
$7,089.72
|
| Rate for Payer: United Healthcare All Payer |
$6,498.91
|
|
|
ELIGARD 7.5MG (30MG SYRINGE)
|
Facility
|
IP
|
$9,846.84
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25002640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,954.05 |
| Max. Negotiated Rate |
$9,452.97 |
| Rate for Payer: Aetna Commercial |
$7,582.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,680.54
|
| Rate for Payer: Cash Price |
$4,923.42
|
| Rate for Payer: Cigna Commercial |
$8,172.88
|
| Rate for Payer: First Health Commercial |
$9,354.50
|
| Rate for Payer: Humana Commercial |
$8,369.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,074.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,665.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,385.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,877.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,566.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,794.32
|
| Rate for Payer: PHCS Commercial |
$9,452.97
|
| Rate for Payer: United Healthcare All Payer |
$8,665.22
|
|
|
ELIGARD 7.5MG (30MG SYRINGE)
|
Facility
|
OP
|
$9,846.84
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25002640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$9,452.97 |
| Rate for Payer: Aetna Commercial |
$7,582.07
|
| Rate for Payer: Anthem Medicaid |
$3,386.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,680.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.82
|
| Rate for Payer: Cash Price |
$4,923.42
|
| Rate for Payer: Cash Price |
$4,923.42
|
| Rate for Payer: Cigna Commercial |
$8,172.88
|
| Rate for Payer: First Health Commercial |
$9,354.50
|
| Rate for Payer: Humana Commercial |
$8,369.81
|
| Rate for Payer: Humana KY Medicaid |
$3,386.33
|
| Rate for Payer: Humana Medicare Advantage |
$155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,420.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,074.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,665.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,385.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,877.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,566.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,794.32
|
| Rate for Payer: PHCS Commercial |
$9,452.97
|
| Rate for Payer: United Healthcare All Payer |
$8,665.22
|
|
|
ELIGARD 7.5 MG SYRINGE
|
Facility
|
IP
|
$2,461.71
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25003772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$738.51 |
| Max. Negotiated Rate |
$2,363.24 |
| Rate for Payer: Aetna Commercial |
$1,895.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,920.13
|
| Rate for Payer: Cash Price |
$1,230.86
|
| Rate for Payer: Cigna Commercial |
$2,043.22
|
| Rate for Payer: First Health Commercial |
$2,338.62
|
| Rate for Payer: Humana Commercial |
$2,092.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,166.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,846.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,141.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.58
|
| Rate for Payer: PHCS Commercial |
$2,363.24
|
| Rate for Payer: United Healthcare All Payer |
$2,166.30
|
|
|
ELIGARD 7.5 MG SYRINGE
|
Facility
|
OP
|
$2,461.71
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25003772
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$2,363.24 |
| Rate for Payer: Aetna Commercial |
$1,895.52
|
| Rate for Payer: Anthem Medicaid |
$846.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,920.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.82
|
| Rate for Payer: Cash Price |
$1,230.86
|
| Rate for Payer: Cash Price |
$1,230.86
|
| Rate for Payer: Cigna Commercial |
$2,043.22
|
| Rate for Payer: First Health Commercial |
$2,338.62
|
| Rate for Payer: Humana Commercial |
$2,092.45
|
| Rate for Payer: Humana KY Medicaid |
$846.58
|
| Rate for Payer: Humana Medicare Advantage |
$155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$855.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,018.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,816.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$863.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,166.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,846.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,141.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.58
|
| Rate for Payer: PHCS Commercial |
$2,363.24
|
| Rate for Payer: United Healthcare All Payer |
$2,166.30
|
|
|
ELIGARD EA 7.5MG[45 MG SYR]
|
Facility
|
OP
|
$14,770.21
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25002641
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$14,179.40 |
| Rate for Payer: Aetna Commercial |
$11,373.06
|
| Rate for Payer: Anthem Medicaid |
$5,079.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,520.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.82
|
| Rate for Payer: Cash Price |
$7,385.10
|
| Rate for Payer: Cash Price |
$7,385.10
|
| Rate for Payer: Cigna Commercial |
$12,259.27
|
| Rate for Payer: First Health Commercial |
$14,031.70
|
| Rate for Payer: Humana Commercial |
$12,554.68
|
| Rate for Payer: Humana KY Medicaid |
$5,079.48
|
| Rate for Payer: Humana Medicare Advantage |
$155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,131.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,111.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,900.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,181.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,997.78
|
| Rate for Payer: Ohio Health Group HMO |
$11,077.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,816.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,850.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.44
|
| Rate for Payer: PHCS Commercial |
$14,179.40
|
| Rate for Payer: United Healthcare All Payer |
$12,997.78
|
|
|
ELIGARD EA 7.5MG[45 MG SYR]
|
Facility
|
IP
|
$14,770.21
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
25002641
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,431.06 |
| Max. Negotiated Rate |
$14,179.40 |
| Rate for Payer: Aetna Commercial |
$11,373.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,520.76
|
| Rate for Payer: Cash Price |
$7,385.10
|
| Rate for Payer: Cigna Commercial |
$12,259.27
|
| Rate for Payer: First Health Commercial |
$14,031.70
|
| Rate for Payer: Humana Commercial |
$12,554.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,111.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,900.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,431.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,997.78
|
| Rate for Payer: Ohio Health Group HMO |
$11,077.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,816.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,850.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.44
|
| Rate for Payer: PHCS Commercial |
$14,179.40
|
| Rate for Payer: United Healthcare All Payer |
$12,997.78
|
|
|
ELIGARD EA 7.5MG[45 MG SYR]
|
Facility
|
OP
|
$903.38
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
636T0084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$867.24 |
| Rate for Payer: Aetna Commercial |
$695.60
|
| Rate for Payer: Anthem Medicaid |
$310.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$155.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$704.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.82
|
| Rate for Payer: Cash Price |
$451.69
|
| Rate for Payer: Cash Price |
$451.69
|
| Rate for Payer: Cigna Commercial |
$749.81
|
| Rate for Payer: First Health Commercial |
$858.21
|
| Rate for Payer: Humana Commercial |
$767.87
|
| Rate for Payer: Humana KY Medicaid |
$310.67
|
| Rate for Payer: Humana Medicare Advantage |
$155.42
|
| Rate for Payer: Kentucky WC Medicaid |
$313.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$740.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$666.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$316.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$794.97
|
| Rate for Payer: Ohio Health Group HMO |
$677.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$722.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$785.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$623.33
|
| Rate for Payer: PHCS Commercial |
$867.24
|
| Rate for Payer: United Healthcare All Payer |
$794.97
|
|
