|
ISOVUE MP37076%PERML10X200MLVL
|
Facility
|
IP
|
$871.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25002741
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$836.35 |
| Rate for Payer: Aetna Commercial |
$670.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.54
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$723.10
|
| Rate for Payer: First Health Commercial |
$827.64
|
| Rate for Payer: Humana Commercial |
$740.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.66
|
| Rate for Payer: Ohio Health Group HMO |
$653.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.13
|
| Rate for Payer: PHCS Commercial |
$836.35
|
| Rate for Payer: United Healthcare All Payer |
$766.66
|
|
|
ISTENT INJECT G2-M-IS/G2W
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
ISTENT INJECT G2-M-IS/G2W
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
ISTENT INJECT G2-W-IS
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
ISTENT INJECT G2-W-IS
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
ISTENT TRABECULAR MICRO BYPASS
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
ISTENT TRABECULAR MICRO BYPASS
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
ISUPREL (ISOPROTERENOL 1MG/5ML
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
25002517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ISUPREL (ISOPROTERENOL 1MG/5ML
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
25002517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
IVAS CATH 10G ALA CARTE BALOON
|
Facility
|
IP
|
$6,893.33
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,068.00 |
| Max. Negotiated Rate |
$6,617.60 |
| Rate for Payer: Aetna Commercial |
$5,307.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,376.80
|
| Rate for Payer: Cash Price |
$3,446.67
|
| Rate for Payer: Cigna Commercial |
$5,721.46
|
| Rate for Payer: First Health Commercial |
$6,548.66
|
| Rate for Payer: Humana Commercial |
$5,859.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,652.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,087.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,514.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,997.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.40
|
| Rate for Payer: PHCS Commercial |
$6,617.60
|
| Rate for Payer: United Healthcare All Payer |
$6,066.13
|
|
|
IVAS CATH 10G ALA CARTE BALOON
|
Facility
|
OP
|
$6,893.33
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,068.00 |
| Max. Negotiated Rate |
$6,617.60 |
| Rate for Payer: Aetna Commercial |
$5,307.86
|
| Rate for Payer: Anthem Medicaid |
$2,370.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,376.80
|
| Rate for Payer: Cash Price |
$3,446.67
|
| Rate for Payer: Cigna Commercial |
$5,721.46
|
| Rate for Payer: First Health Commercial |
$6,548.66
|
| Rate for Payer: Humana Commercial |
$5,859.33
|
| Rate for Payer: Humana KY Medicaid |
$2,370.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,394.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,652.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,087.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,418.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,514.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,997.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.40
|
| Rate for Payer: PHCS Commercial |
$6,617.60
|
| Rate for Payer: United Healthcare All Payer |
$6,066.13
|
|
|
IVAS CATH 11G ALA CARTE BALOON
|
Facility
|
OP
|
$6,893.33
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,068.00 |
| Max. Negotiated Rate |
$6,617.60 |
| Rate for Payer: Aetna Commercial |
$5,307.86
|
| Rate for Payer: Anthem Medicaid |
$2,370.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,376.80
|
| Rate for Payer: Cash Price |
$3,446.67
|
| Rate for Payer: Cigna Commercial |
$5,721.46
|
| Rate for Payer: First Health Commercial |
$6,548.66
|
| Rate for Payer: Humana Commercial |
$5,859.33
|
| Rate for Payer: Humana KY Medicaid |
$2,370.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,394.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,652.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,087.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,418.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,514.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,997.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.40
|
| Rate for Payer: PHCS Commercial |
$6,617.60
|
| Rate for Payer: United Healthcare All Payer |
$6,066.13
|
|
|
IVAS CATH 11G ALA CARTE BALOON
|
Facility
|
IP
|
$6,893.33
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,068.00 |
| Max. Negotiated Rate |
$6,617.60 |
| Rate for Payer: Aetna Commercial |
$5,307.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,376.80
|
| Rate for Payer: Cash Price |
$3,446.67
|
| Rate for Payer: Cigna Commercial |
$5,721.46
|
| Rate for Payer: First Health Commercial |
$6,548.66
|
| Rate for Payer: Humana Commercial |
$5,859.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,652.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,087.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,068.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,514.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,997.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.40
|
| Rate for Payer: PHCS Commercial |
$6,617.60
|
| Rate for Payer: United Healthcare All Payer |
$6,066.13
|
|
|
IVC FILTER
|
Facility
|
OP
|
$8,715.90
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.77 |
| Max. Negotiated Rate |
$8,367.26 |
| Rate for Payer: Aetna Commercial |
$6,711.24
|
| Rate for Payer: Anthem Medicaid |
$2,997.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,798.40
|
| Rate for Payer: Cash Price |
$4,357.95
|
| Rate for Payer: Cigna Commercial |
$7,234.20
|
| Rate for Payer: First Health Commercial |
$8,280.10
|
| Rate for Payer: Humana Commercial |
$7,408.52
|
| Rate for Payer: Humana KY Medicaid |
$2,997.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,027.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,147.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,432.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,057.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,972.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,582.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,013.97
|
| Rate for Payer: PHCS Commercial |
$8,367.26
|
| Rate for Payer: United Healthcare All Payer |
$7,669.99
|
|
|
IVC FILTER
|
Facility
|
IP
|
$8,715.90
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.77 |
| Max. Negotiated Rate |
$8,367.26 |
| Rate for Payer: Aetna Commercial |
$6,711.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,798.40
|
| Rate for Payer: Cash Price |
$4,357.95
|
| Rate for Payer: Cigna Commercial |
$7,234.20
|
| Rate for Payer: First Health Commercial |
$8,280.10
|
| Rate for Payer: Humana Commercial |
$7,408.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,147.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,432.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,669.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,536.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,972.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,582.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,013.97
|
| Rate for Payer: PHCS Commercial |
$8,367.26
|
| Rate for Payer: United Healthcare All Payer |
$7,669.99
|
|
|
IV CHEMO SEQ AD'L HR DIF DRUG
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
33100009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IV CHEMO SEQ AD'L HR DIF DRUG
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
33100009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IV INFUS 1ST HR NON CHEMO
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
IV INFUS 1ST HR NON CHEMO
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
IV INFUS ADTLNL SEQ 1 HR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$64.50
|
| 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: Humana Medicare Advantage |
$65.76
|
| 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 |
$78.91
|
| 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
|
|
|
IV INFUS ADTLNL SEQ 1 HR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
IV INFUS CONCURRENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$34.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.78
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Humana KY Medicaid |
$34.73
|
| Rate for Payer: Kentucky WC Medicaid |
$35.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
IV INFUS CONCURRENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.78
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
IV INJECTION
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
26000009
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
IV INJECTION
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
26000009
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.54 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$82.28
|
| Rate for Payer: Ambetter Exchange |
$31.54
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.85
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$73.07
|
| Rate for Payer: Healthspan PPO |
$77.10
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$182.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.00
|
| Rate for Payer: UHCCP Medicaid |
$106.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.54
|
|
