|
KETOROLAC 15mg/1mL SDV
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25004283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.56 |
| Rate for Payer: Aetna Commercial |
$61.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.20
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cigna Commercial |
$66.19
|
| Rate for Payer: First Health Commercial |
$75.76
|
| Rate for Payer: Humana Commercial |
$67.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.18
|
| Rate for Payer: Ohio Health Group HMO |
$59.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.72
|
| Rate for Payer: PHCS Commercial |
$76.56
|
| Rate for Payer: United Healthcare All Payer |
$70.18
|
|
|
KETOROLAC 15mg/1mL SDV
|
Facility
|
OP
|
$79.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25004283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.56 |
| Rate for Payer: Aetna Commercial |
$61.41
|
| Rate for Payer: Anthem Medicaid |
$27.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.20
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cigna Commercial |
$66.19
|
| Rate for Payer: First Health Commercial |
$75.76
|
| Rate for Payer: Humana Commercial |
$67.79
|
| Rate for Payer: Humana KY Medicaid |
$27.43
|
| Rate for Payer: Kentucky WC Medicaid |
$27.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.18
|
| Rate for Payer: Ohio Health Group HMO |
$59.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.72
|
| Rate for Payer: PHCS Commercial |
$76.56
|
| Rate for Payer: United Healthcare All Payer |
$70.18
|
|
|
KETOTIFEN FUMARATE 0.025% 10ML
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 24208060110
|
| Hospital Charge Code |
25003150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.04
|
| Rate for Payer: First Health Commercial |
$0.05
|
| Rate for Payer: Humana Commercial |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
KETOTIFEN FUMARATE 0.025% 10ML
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 24208060110
|
| Hospital Charge Code |
25003150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.04
|
| Rate for Payer: First Health Commercial |
$0.05
|
| Rate for Payer: Humana Commercial |
$0.04
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
KEYTRUDA 100MG/4ML VIAL
|
Facility
|
IP
|
$30,894.31
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
25002657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,016.26 |
| Max. Negotiated Rate |
$29,658.54 |
| Rate for Payer: Aetna Commercial |
$23,788.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,097.56
|
| Rate for Payer: Cash Price |
$15,447.16
|
| Rate for Payer: Cigna Commercial |
$25,642.28
|
| Rate for Payer: First Health Commercial |
$29,349.59
|
| Rate for Payer: Humana Commercial |
$26,260.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,333.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,800.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,268.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,186.99
|
| Rate for Payer: Ohio Health Group HMO |
$23,170.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,178.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,016.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,577.24
|
| Rate for Payer: PHCS Commercial |
$29,658.54
|
| Rate for Payer: United Healthcare All Payer |
$27,186.99
|
|
|
KEYTRUDA 100MG/4ML VIAL
|
Facility
|
OP
|
$30,894.31
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
25002657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$29,658.54 |
| Rate for Payer: Aetna Commercial |
$23,788.62
|
| Rate for Payer: Anthem Medicaid |
$10,624.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$55.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,097.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$78.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.24
|
| Rate for Payer: Cash Price |
$15,447.16
|
| Rate for Payer: Cash Price |
$15,447.16
|
| Rate for Payer: Cigna Commercial |
$25,642.28
|
| Rate for Payer: First Health Commercial |
$29,349.59
|
| Rate for Payer: Humana Commercial |
$26,260.16
|
| Rate for Payer: Humana KY Medicaid |
$10,624.55
|
| Rate for Payer: Humana Medicare Advantage |
$55.73
|
| Rate for Payer: Kentucky WC Medicaid |
$10,732.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,333.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,800.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,837.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,186.99
|
| Rate for Payer: Ohio Health Group HMO |
$23,170.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,178.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,016.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,577.24
|
| Rate for Payer: PHCS Commercial |
$29,658.54
|
| Rate for Payer: United Healthcare All Payer |
$27,186.99
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
34000032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.03 |
| Max. Negotiated Rate |
$1,181.76 |
| Rate for Payer: Aetna Commercial |
$947.87
|
| Rate for Payer: Anthem Medicaid |
$423.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$615.50
|
| Rate for Payer: Cash Price |
$615.50
|
| Rate for Payer: Cigna Commercial |
$1,021.73
|
| Rate for Payer: First Health Commercial |
$1,169.45
|
| Rate for Payer: Humana Commercial |
$1,046.35
|
| Rate for Payer: Humana KY Medicaid |
$423.34
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$427.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,009.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$908.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$431.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,083.28
|
| Rate for Payer: Ohio Health Group HMO |
$923.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.61
|
| Rate for Payer: PHCS Commercial |
$1,181.76
|
| Rate for Payer: United Healthcare All Payer |
$1,083.28
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
34000032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.03 |
| Max. Negotiated Rate |
$1,181.76 |
| Rate for Payer: Aetna Commercial |
$947.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$960.18
|
| Rate for Payer: Cash Price |
$615.50
|
| Rate for Payer: Cigna Commercial |
$1,021.73
|
| Rate for Payer: First Health Commercial |
$1,169.45
|
| Rate for Payer: Humana Commercial |
$1,046.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,009.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$908.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,083.28
|
| Rate for Payer: Ohio Health Group HMO |
$923.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.61
|
| Rate for Payer: PHCS Commercial |
$1,181.76
|
| Rate for Payer: United Healthcare All Payer |
$1,083.28
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
34000032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna Commercial |
$524.86
|
| Rate for Payer: Anthem Medicaid |
$169.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,231.00
|
| Rate for Payer: Cash Price |
$615.50
|
| Rate for Payer: Cash Price |
$615.50
|
| Rate for Payer: Cigna Commercial |
$410.70
|
| Rate for Payer: Healthspan PPO |
$524.59
|
| Rate for Payer: Humana Medicaid |
$169.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.91
|
| Rate for Payer: Molina Healthcare Passport |
$169.52
|
| Rate for Payer: Multiplan PHCS |
$738.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$861.70
|
| Rate for Payer: UHCCP Medicaid |
$430.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.22
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
340P0032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$524.86 |
| Rate for Payer: Aetna Commercial |
$524.86
|
| Rate for Payer: Anthem Medicaid |
$169.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$410.70
|
| Rate for Payer: Healthspan PPO |
$524.59
|
| Rate for Payer: Humana Medicaid |
$169.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.91
|
| Rate for Payer: Molina Healthcare Passport |
$169.52
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.22
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE(T
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
340T0032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$1,095.36 |
| Rate for Payer: Aetna Commercial |
$878.57
|
| Rate for Payer: Anthem Medicaid |
$392.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$947.03
|
| Rate for Payer: First Health Commercial |
$1,083.95
|
| Rate for Payer: Humana Commercial |
$969.85
|
| Rate for Payer: Humana KY Medicaid |
$392.39
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$396.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$935.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.08
|
| Rate for Payer: Ohio Health Group HMO |
$855.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.71
|
| Rate for Payer: PHCS Commercial |
$1,095.36
|
| Rate for Payer: United Healthcare All Payer |
$1,004.08
|
|
|
K FLOW/FUNCT IMAGE MULTIPLE(T
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
340T0032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$1,095.36 |
| Rate for Payer: Aetna Commercial |
$878.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.98
|
| Rate for Payer: Cash Price |
$570.50
|
| Rate for Payer: Cigna Commercial |
$947.03
|
| Rate for Payer: First Health Commercial |
$1,083.95
|
| Rate for Payer: Humana Commercial |
$969.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$935.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.08
|
| Rate for Payer: Ohio Health Group HMO |
$855.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.71
|
| Rate for Payer: PHCS Commercial |
$1,095.36
|
| Rate for Payer: United Healthcare All Payer |
$1,004.08
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
34000031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
34000031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna Commercial |
$295.83
|
| Rate for Payer: Anthem Medicaid |
$163.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$325.61
|
| Rate for Payer: Healthspan PPO |
$295.68
|
| Rate for Payer: Humana Medicaid |
$163.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.04
|
| Rate for Payer: Molina Healthcare Passport |
$163.76
|
| Rate for Payer: Multiplan PHCS |
$505.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$589.40
|
| Rate for Payer: UHCCP Medicaid |
$294.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.40
|
|
|
K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
34000031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$109.46 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$261.02
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
K FLOW/FUNCT IMAGE W/DRUG(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
340P0031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$325.61 |
| Rate for Payer: Aetna Commercial |
$295.83
|
| Rate for Payer: Anthem Medicaid |
$163.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$325.61
|
| Rate for Payer: Healthspan PPO |
$295.68
|
| Rate for Payer: Humana Medicaid |
$163.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.04
|
| Rate for Payer: Molina Healthcare Passport |
$163.76
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.40
|
|
|
K FLOW/FUNCT IMAGE W/DRUG(T
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
340T0031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$654.36 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem Medicaid |
$229.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Humana KY Medicaid |
$229.38
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.77
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
K FLOW/FUNCT IMAGE W/DRUG(T
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
340T0031
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.77
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
34000030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$1,237.00 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Anthem Medicaid |
$161.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,237.00
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$335.19
|
| Rate for Payer: Healthspan PPO |
$358.64
|
| Rate for Payer: Humana Medicaid |
$161.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.35
|
| Rate for Payer: Molina Healthcare Passport |
$161.13
|
| Rate for Payer: Multiplan PHCS |
$742.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$865.90
|
| Rate for Payer: UHCCP Medicaid |
$432.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.74
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
IP
|
$1,237.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
34000030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$160.81 |
| Max. Negotiated Rate |
$1,187.52 |
| Rate for Payer: Aetna Commercial |
$952.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$964.86
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$1,026.71
|
| Rate for Payer: First Health Commercial |
$1,175.15
|
| Rate for Payer: Humana Commercial |
$1,051.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,014.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$912.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,088.56
|
| Rate for Payer: Ohio Health Group HMO |
$927.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.47
|
| Rate for Payer: PHCS Commercial |
$1,187.52
|
| Rate for Payer: United Healthcare All Payer |
$1,088.56
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
34000030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$160.81 |
| Max. Negotiated Rate |
$1,187.52 |
| Rate for Payer: Aetna Commercial |
$952.49
|
| Rate for Payer: Anthem Medicaid |
$425.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$964.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cash Price |
$618.50
|
| Rate for Payer: Cigna Commercial |
$1,026.71
|
| Rate for Payer: First Health Commercial |
$1,175.15
|
| Rate for Payer: Humana Commercial |
$1,051.45
|
| Rate for Payer: Humana KY Medicaid |
$425.40
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$429.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,014.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$912.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$433.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,088.56
|
| Rate for Payer: Ohio Health Group HMO |
$927.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.47
|
| Rate for Payer: PHCS Commercial |
$1,187.52
|
| Rate for Payer: United Healthcare All Payer |
$1,088.56
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340P0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$358.82 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Anthem Medicaid |
$161.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$335.19
|
| Rate for Payer: Healthspan PPO |
$358.64
|
| Rate for Payer: Humana Medicaid |
$161.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.35
|
| Rate for Payer: Molina Healthcare Passport |
$161.13
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.74
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(T
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340T0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(T
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340T0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem Medicaid |
$365.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Humana KY Medicaid |
$365.22
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$21,573.82
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$14,639.38 |
| Max. Negotiated Rate |
$21,573.82 |
| Rate for Payer: Anthem Medicaid |
$14,639.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,409.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,573.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,803.32
|
| Rate for Payer: Humana KY Medicaid |
$14,639.38
|
| Rate for Payer: Humana Medicare Advantage |
$15,409.87
|
| Rate for Payer: Kentucky WC Medicaid |
$14,785.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,491.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,932.16
|
|
