|
FLUBLOK QUAD SYRINGE
|
Facility
|
IP
|
$347.49
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$333.59 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.04
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Cigna Commercial |
$288.42
|
| Rate for Payer: First Health Commercial |
$330.12
|
| Rate for Payer: Humana Commercial |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.79
|
| Rate for Payer: Ohio Health Group HMO |
$260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.77
|
| Rate for Payer: PHCS Commercial |
$333.59
|
| Rate for Payer: United Healthcare All Payer |
$305.79
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
OP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
25004493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem Medicaid |
$44.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Humana KY Medicaid |
$44.05
|
| Rate for Payer: Kentucky WC Medicaid |
$44.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
OP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem Medicaid |
$44.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Humana KY Medicaid |
$44.05
|
| Rate for Payer: Kentucky WC Medicaid |
$44.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
77000023
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FLUCELVAX PFS 24-25
|
Professional
|
Both
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$76.85 |
| Rate for Payer: Ambetter Exchange |
$36.85
|
| Rate for Payer: Anthem Medicaid |
$49.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.22
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.49
|
| Rate for Payer: Molina Healthcare Passport |
$49.50
|
| Rate for Payer: Multiplan PHCS |
$76.85
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.91
|
| Rate for Payer: UHCCP Medicaid |
$44.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.85
|
|
|
FLUCELVAX PFS 24-25
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
77000023
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Ambetter Exchange |
$36.85
|
| Rate for Payer: Anthem Medicaid |
$49.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.22
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.49
|
| Rate for Payer: Molina Healthcare Passport |
$49.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.91
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.85
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
IP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
25004493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
77000023
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
OP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
636T0245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem Medicaid |
$44.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Humana KY Medicaid |
$44.05
|
| Rate for Payer: Kentucky WC Medicaid |
$44.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
IP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
IP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
636T0245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.38
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25 (T
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
770T0023
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FLUCELVAX PFS 24-25 (T
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
770T0023
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Professional
|
Both
|
$129.59
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$90.71 |
| Rate for Payer: Anthem Medicaid |
$34.17
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Humana Medicaid |
$34.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.85
|
| Rate for Payer: Molina Healthcare Passport |
$34.17
|
| Rate for Payer: Multiplan PHCS |
$77.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.71
|
| Rate for Payer: UHCCP Medicaid |
$45.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.51
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Facility
|
IP
|
$129.59
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna Commercial |
$99.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$107.56
|
| Rate for Payer: First Health Commercial |
$123.11
|
| Rate for Payer: Humana Commercial |
$110.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.04
|
| Rate for Payer: Ohio Health Group HMO |
$97.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.42
|
| Rate for Payer: PHCS Commercial |
$124.41
|
| Rate for Payer: United Healthcare All Payer |
$114.04
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Facility
|
OP
|
$129.59
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna Commercial |
$99.78
|
| Rate for Payer: Anthem Medicaid |
$44.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$107.56
|
| Rate for Payer: First Health Commercial |
$123.11
|
| Rate for Payer: Humana Commercial |
$110.15
|
| Rate for Payer: Humana KY Medicaid |
$44.57
|
| Rate for Payer: Kentucky WC Medicaid |
$45.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.04
|
| Rate for Payer: Ohio Health Group HMO |
$97.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.42
|
| Rate for Payer: PHCS Commercial |
$124.41
|
| Rate for Payer: United Healthcare All Payer |
$114.04
|
|
|
FLUCEL VAX QUAD 0.5ML PFS (T
|
Facility
|
OP
|
$129.59
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
636T0193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna Commercial |
$99.78
|
| Rate for Payer: Anthem Medicaid |
$44.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$107.56
|
| Rate for Payer: First Health Commercial |
$123.11
|
| Rate for Payer: Humana Commercial |
$110.15
|
| Rate for Payer: Humana KY Medicaid |
$44.57
|
| Rate for Payer: Kentucky WC Medicaid |
$45.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.04
|
| Rate for Payer: Ohio Health Group HMO |
$97.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.42
|
| Rate for Payer: PHCS Commercial |
$124.41
|
| Rate for Payer: United Healthcare All Payer |
$114.04
|
|
|
FLUCEL VAX QUAD 0.5ML PFS (T
|
Facility
|
IP
|
$129.59
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
636T0193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna Commercial |
$99.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$107.56
|
| Rate for Payer: First Health Commercial |
$123.11
|
| Rate for Payer: Humana Commercial |
$110.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.04
|
| Rate for Payer: Ohio Health Group HMO |
$97.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.42
|
| Rate for Payer: PHCS Commercial |
$124.41
|
| Rate for Payer: United Healthcare All Payer |
$114.04
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Professional
|
Both
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Facility
|
IP
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Facility
|
OP
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
FLUCONAZOLE 400MG/200ML IVPB
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
25002064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
FLUCONAZOLE 400MG/200ML IVPB
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
25002064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
IP
|
$328.81
|
|
|
Service Code
|
NDC 42494034001
|
| Hospital Charge Code |
25004093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$315.66 |
| Rate for Payer: Aetna Commercial |
$253.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.47
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$272.91
|
| Rate for Payer: First Health Commercial |
$312.37
|
| Rate for Payer: Humana Commercial |
$279.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.35
|
| Rate for Payer: Ohio Health Group HMO |
$246.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$226.88
|
| Rate for Payer: PHCS Commercial |
$315.66
|
| Rate for Payer: United Healthcare All Payer |
$289.35
|
|
|
FLUCYTOSINE 500 MG CAPSULE
|
Facility
|
OP
|
$328.81
|
|
|
Service Code
|
NDC 42494034001
|
| Hospital Charge Code |
25004093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$315.66 |
| Rate for Payer: Aetna Commercial |
$253.18
|
| Rate for Payer: Anthem Medicaid |
$113.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.47
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: Cigna Commercial |
$272.91
|
| Rate for Payer: First Health Commercial |
$312.37
|
| Rate for Payer: Humana Commercial |
$279.49
|
| Rate for Payer: Humana KY Medicaid |
$113.08
|
| Rate for Payer: Kentucky WC Medicaid |
$114.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.35
|
| Rate for Payer: Ohio Health Group HMO |
$246.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$226.88
|
| Rate for Payer: PHCS Commercial |
$315.66
|
| Rate for Payer: United Healthcare All Payer |
$289.35
|
|
