|
FLUDARA(FLUDARABINE) 50MG/2ML
|
Facility
|
OP
|
$1,481.75
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
25002615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.65 |
| Max. Negotiated Rate |
$1,422.48 |
| Rate for Payer: Aetna Commercial |
$1,140.95
|
| Rate for Payer: Anthem Medicaid |
$509.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$71.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,155.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$100.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.73
|
| Rate for Payer: Cash Price |
$740.88
|
| Rate for Payer: Cash Price |
$740.88
|
| Rate for Payer: Cigna Commercial |
$1,229.85
|
| Rate for Payer: First Health Commercial |
$1,407.66
|
| Rate for Payer: Humana Commercial |
$1,259.49
|
| Rate for Payer: Humana KY Medicaid |
$509.57
|
| Rate for Payer: Humana Medicare Advantage |
$71.65
|
| Rate for Payer: Kentucky WC Medicaid |
$514.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,215.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,093.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$519.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,303.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,111.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.41
|
| Rate for Payer: PHCS Commercial |
$1,422.48
|
| Rate for Payer: United Healthcare All Payer |
$1,303.94
|
|
|
FLUDARA(FLUDARABINE) 50MG/2ML
|
Facility
|
IP
|
$1,481.75
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
25002615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$444.52 |
| Max. Negotiated Rate |
$1,422.48 |
| Rate for Payer: Aetna Commercial |
$1,140.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,155.77
|
| Rate for Payer: Cash Price |
$740.88
|
| Rate for Payer: Cigna Commercial |
$1,229.85
|
| Rate for Payer: First Health Commercial |
$1,407.66
|
| Rate for Payer: Humana Commercial |
$1,259.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,215.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,093.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,303.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,111.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.41
|
| Rate for Payer: PHCS Commercial |
$1,422.48
|
| Rate for Payer: United Healthcare All Payer |
$1,303.94
|
|
|
FLUID CELL COUNT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001538
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
FLUID CELL COUNT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001538
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
FLUID CHOLESTEROL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
30000516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$8.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$8.10
|
| Rate for Payer: Humana Medicare Advantage |
$8.10
|
| Rate for Payer: Kentucky WC Medicaid |
$8.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
FLUID CHOLESTEROL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
30000516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.64
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
FLUID CREATININE
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30001830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLUID CREATININE
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
30001830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLUID PH
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
30000466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$3.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.58
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$3.58
|
| Rate for Payer: Humana Medicare Advantage |
$3.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
FLUID PH
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
30000466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
FLUID PROTEIN
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
30000495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$4.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$4.00
|
| Rate for Payer: Humana Medicare Advantage |
$4.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
FLUID PROTEIN
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
30000495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
FLUID TRIGLYCERIDE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
FLUID TRIGLYCERIDE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
FLUMIST QUAD 23-24 SPRAY
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
77000026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Anthem Medicaid |
$27.79
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.35
|
| Rate for Payer: Molina Healthcare Passport |
$27.79
|
| Rate for Payer: Multiplan PHCS |
$75.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.20
|
| Rate for Payer: UHCCP Medicaid |
$44.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.07
|
|
|
FLUMIST QUAD 23-24 SPRAY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
77000026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
FLUMIST QUAD 23-24 SPRAY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
77000026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$43.33
|
| Rate for Payer: Kentucky WC Medicaid |
$43.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
FLUMIST QUAD 23-24 SPRAY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
770T0026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
FLUMIST QUAD 23-24 SPRAY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
770T0026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$43.33
|
| Rate for Payer: Kentucky WC Medicaid |
$43.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
FLUMIST TRIV 24-25
|
Professional
|
Both
|
$38.99
|
|
|
Service Code
|
HCPCS 90660
|
| Hospital Charge Code |
63600255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: Ambetter Exchange |
$28.87
|
| Rate for Payer: Anthem Medicaid |
$29.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.64
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Healthspan PPO |
$28.59
|
| Rate for Payer: Humana Medicaid |
$29.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.72
|
| Rate for Payer: Molina Healthcare Passport |
$29.14
|
| Rate for Payer: Multiplan PHCS |
$23.39
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.53
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.87
|
|
|
FLUMIST TRIV 24-25
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
HCPCS 90660
|
| Hospital Charge Code |
63600255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Anthem Medicaid |
$13.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.41
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.36
|
| Rate for Payer: First Health Commercial |
$37.04
|
| Rate for Payer: Humana Commercial |
$33.14
|
| Rate for Payer: Humana KY Medicaid |
$13.41
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.31
|
| Rate for Payer: Ohio Health Group HMO |
$29.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Payer |
$34.31
|
|
|
FLUMIST TRIV 24-25
|
Facility
|
IP
|
$38.99
|
|
|
Service Code
|
HCPCS 90660
|
| Hospital Charge Code |
63600255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.41
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.36
|
| Rate for Payer: First Health Commercial |
$37.04
|
| Rate for Payer: Humana Commercial |
$33.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.31
|
| Rate for Payer: Ohio Health Group HMO |
$29.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Payer |
$34.31
|
|
|
FLUMIST TRIV 24-25
|
Facility
|
IP
|
$38.99
|
|
|
Service Code
|
HCPCS 90660
|
| Hospital Charge Code |
636T0255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.41
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.36
|
| Rate for Payer: First Health Commercial |
$37.04
|
| Rate for Payer: Humana Commercial |
$33.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.31
|
| Rate for Payer: Ohio Health Group HMO |
$29.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Payer |
$34.31
|
|
|
FLUMIST TRIV 24-25
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
HCPCS 90660
|
| Hospital Charge Code |
636T0255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Anthem Medicaid |
$13.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.41
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.36
|
| Rate for Payer: First Health Commercial |
$37.04
|
| Rate for Payer: Humana Commercial |
$33.14
|
| Rate for Payer: Humana KY Medicaid |
$13.41
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.31
|
| Rate for Payer: Ohio Health Group HMO |
$29.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$37.43
|
| Rate for Payer: United Healthcare All Payer |
$34.31
|
|
|
FLUOCINONIDE-E 0.05% CRM 30GM
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 51672125402
|
| Hospital Charge Code |
25003899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.11
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna Commercial |
$8.63
|
| Rate for Payer: First Health Commercial |
$9.88
|
| Rate for Payer: Humana Commercial |
$8.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.15
|
| Rate for Payer: Ohio Health Group HMO |
$7.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.18
|
| Rate for Payer: PHCS Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Payer |
$9.15
|
|
