|
HYTRIN (TERAZOSIN) 2 2MG/1TAB
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 50268076515
|
| Hospital Charge Code |
25000767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
HYTRIN (TERAZOSIN) 5 5MG/1TAB
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 59746038506
|
| Hospital Charge Code |
25000768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
| Rate for Payer: Aetna Commercial |
$3.37
|
|
|
HYTRIN (TERAZOSIN) 5 5MG/1TAB
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 59746038506
|
| Hospital Charge Code |
25000768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
HZV VACC RECOMBINANT IM
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
77000055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$542.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$542.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$264.96
|
| Rate for Payer: Multiplan PHCS |
$325.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$379.40
|
| Rate for Payer: UHCCP Medicaid |
$189.70
|
|
|
HZV VACC RECOMBINANT IM
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
77000055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem Medicaid |
$186.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Humana KY Medicaid |
$186.39
|
| Rate for Payer: Kentucky WC Medicaid |
$188.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
HZV VACC RECOMBINANT IM
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
77000055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
HZV VACC RECOMBINANT IM(T
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
770T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
HZV VACC RECOMBINANT IM(T
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
770T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem Medicaid |
$186.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Humana KY Medicaid |
$186.39
|
| Rate for Payer: Kentucky WC Medicaid |
$188.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
I 123 SOD IODIDE PER 100 UCI 1
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34000052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$69.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Humana KY Medicaid |
$69.12
|
| Rate for Payer: Kentucky WC Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
I 123 SOD IODIDE PER 100 UCI 1
|
Professional
|
Both
|
$201.00
|
|
| Hospital Charge Code |
34000052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$201.00
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Multiplan PHCS |
$120.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.70
|
| Rate for Payer: UHCCP Medicaid |
$70.35
|
|
|
I 123 SOD IODIDE PER 100 UCI 1
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
340T0052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
I 123 SOD IODIDE PER 100 UCI 1
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34000052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
I 123 SOD IODIDE PER 100 UCI 1
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
340T0052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$192.96 |
| Rate for Payer: Aetna Commercial |
$154.77
|
| Rate for Payer: Anthem Medicaid |
$69.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.78
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$166.83
|
| Rate for Payer: First Health Commercial |
$190.95
|
| Rate for Payer: Humana Commercial |
$170.85
|
| Rate for Payer: Humana KY Medicaid |
$69.12
|
| Rate for Payer: Kentucky WC Medicaid |
$69.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.88
|
| Rate for Payer: Ohio Health Group HMO |
$150.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.31
|
| Rate for Payer: PHCS Commercial |
$192.96
|
| Rate for Payer: United Healthcare All Payer |
$176.88
|
|
|
I-131 THYROID (ABLATN GLAND)
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
34000044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
I-131 THYROID (ABLATN GLAND)
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
34000044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem Medicaid |
$375.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Humana KY Medicaid |
$375.19
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$379.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
I-131 THYROID (ABLATN GLAND)
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
34000044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem Medicaid |
$141.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,091.00
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$265.27
|
| Rate for Payer: Healthspan PPO |
$239.34
|
| Rate for Payer: Humana Medicaid |
$141.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.10
|
| Rate for Payer: Molina Healthcare Passport |
$141.27
|
| Rate for Payer: Multiplan PHCS |
$654.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$763.70
|
| Rate for Payer: UHCCP Medicaid |
$381.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.68
|
|
|
I-131 THYROID (ABLATN GLAND)(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
340P0044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$239.47
|
| Rate for Payer: Anthem Medicaid |
$141.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$265.27
|
| Rate for Payer: Healthspan PPO |
$239.34
|
| Rate for Payer: Humana Medicaid |
$141.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.10
|
| Rate for Payer: Molina Healthcare Passport |
$141.27
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$142.68
|
|
|
I-131 THYROID (ABLATN GLAND)(T
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
340T0044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$759.36 |
| Rate for Payer: Aetna Commercial |
$609.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.98
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: Cigna Commercial |
$656.53
|
| Rate for Payer: First Health Commercial |
$751.45
|
| Rate for Payer: Humana Commercial |
$672.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.08
|
| Rate for Payer: Ohio Health Group HMO |
$593.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.21
|
| Rate for Payer: PHCS Commercial |
$759.36
|
| Rate for Payer: United Healthcare All Payer |
$696.08
|
|
|
I-131 THYROID (ABLATN GLAND)(T
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
340T0044
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$759.36 |
| Rate for Payer: Aetna Commercial |
$609.07
|
| Rate for Payer: Anthem Medicaid |
$272.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$215.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$301.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$290.44
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: Cash Price |
$395.50
|
| Rate for Payer: Cigna Commercial |
$656.53
|
| Rate for Payer: First Health Commercial |
$751.45
|
| Rate for Payer: Humana Commercial |
$672.35
|
| Rate for Payer: Humana KY Medicaid |
$272.02
|
| Rate for Payer: Humana Medicare Advantage |
$215.14
|
| Rate for Payer: Kentucky WC Medicaid |
$274.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.08
|
| Rate for Payer: Ohio Health Group HMO |
$593.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.21
|
| Rate for Payer: PHCS Commercial |
$759.36
|
| Rate for Payer: United Healthcare All Payer |
$696.08
|
|
|
IABP BALLOON CATH 7.5 34CC
|
Facility
|
OP
|
$4,899.90
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.99 |
| Max. Negotiated Rate |
$4,703.90 |
| Rate for Payer: Aetna Commercial |
$3,772.92
|
| Rate for Payer: Anthem Medicaid |
$1,685.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,821.92
|
| Rate for Payer: Cash Price |
$2,449.95
|
| Rate for Payer: Cigna Commercial |
$4,066.92
|
| Rate for Payer: First Health Commercial |
$4,654.90
|
| Rate for Payer: Humana Commercial |
$4,164.92
|
| Rate for Payer: Humana KY Medicaid |
$1,685.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,017.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,311.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,674.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$636.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.97
|
| Rate for Payer: PHCS Commercial |
$4,703.90
|
| Rate for Payer: United Healthcare All Payer |
$4,311.91
|
|
|
IABP BALLOON CATH 7.5 34CC
|
Facility
|
IP
|
$4,899.90
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.99 |
| Max. Negotiated Rate |
$4,703.90 |
| Rate for Payer: Humana Commercial |
$4,164.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,017.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,469.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,311.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,674.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$979.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$636.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.97
|
| Rate for Payer: PHCS Commercial |
$4,703.90
|
| Rate for Payer: United Healthcare All Payer |
$4,311.91
|
| Rate for Payer: Aetna Commercial |
$3,772.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,821.92
|
| Rate for Payer: Cash Price |
$2,449.95
|
| Rate for Payer: Cigna Commercial |
$4,066.92
|
| Rate for Payer: First Health Commercial |
$4,654.90
|
|
|
IABP OPEN
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
48100005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$283.53 |
| Max. Negotiated Rate |
$2,093.76 |
| Rate for Payer: Aetna Commercial |
$1,679.37
|
| Rate for Payer: Anthem Medicaid |
$750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.18
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,810.23
|
| Rate for Payer: First Health Commercial |
$2,071.95
|
| Rate for Payer: Humana Commercial |
$1,853.85
|
| Rate for Payer: Humana KY Medicaid |
$750.05
|
| Rate for Payer: Kentucky WC Medicaid |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.11
|
| Rate for Payer: PHCS Commercial |
$2,093.76
|
| Rate for Payer: United Healthcare All Payer |
$1,919.28
|
|
|
IABP OPEN
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
48100005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$283.53 |
| Max. Negotiated Rate |
$2,093.76 |
| Rate for Payer: Aetna Commercial |
$1,679.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.18
|
| Rate for Payer: Cash Price |
$1,090.50
|
| Rate for Payer: Cigna Commercial |
$1,810.23
|
| Rate for Payer: First Health Commercial |
$2,071.95
|
| Rate for Payer: Humana Commercial |
$1,853.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.11
|
| Rate for Payer: PHCS Commercial |
$2,093.76
|
| Rate for Payer: United Healthcare All Payer |
$1,919.28
|
|
|
IABP OPEN
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
76101326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
IABP OPEN
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33970
|
| Hospital Charge Code |
76101326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.75 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$634.77
|
| Rate for Payer: Anthem Medicaid |
$462.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$580.26
|
| Rate for Payer: Healthspan PPO |
$624.10
|
| Rate for Payer: Humana Medicaid |
$462.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.00
|
| Rate for Payer: Molina Healthcare Passport |
$462.75
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.38
|
|
