|
ANTHOLOGY SO PORUS SZ 7
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY SO PORUS SZ 8
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY SO PORUS SZ 8
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY SO PORUS SZ 9
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY SO PORUS SZ 9
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTIBODY IDENT RBC PANEL
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
30001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
ANTIBODY IDENT RBC PANEL
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
30001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.76
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
ANTIBODY SCREEN RBC EACH
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
30001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem Medicaid |
$9.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Humana KY Medicaid |
$9.77
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$9.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
ANTIBODY SCREEN RBC EACH
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
30001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
ANTICOAG CITRAT DXTRSE S 500ML
|
Facility
|
IP
|
$117.27
|
|
|
Service Code
|
NDC 942064104
|
| Hospital Charge Code |
25002837
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$90.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.47
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: First Health Commercial |
$111.41
|
| Rate for Payer: Humana Commercial |
$99.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.20
|
| Rate for Payer: Ohio Health Group HMO |
$87.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.58
|
| Rate for Payer: United Healthcare All Payer |
$103.20
|
|
|
ANTICOAG CITRAT DXTRSE S 500ML
|
Facility
|
OP
|
$117.27
|
|
|
Service Code
|
NDC 942064104
|
| Hospital Charge Code |
25002837
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$90.30
|
| Rate for Payer: Anthem Medicaid |
$40.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.47
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cigna Commercial |
$97.33
|
| Rate for Payer: First Health Commercial |
$111.41
|
| Rate for Payer: Humana Commercial |
$99.68
|
| Rate for Payer: Humana KY Medicaid |
$40.33
|
| Rate for Payer: Kentucky WC Medicaid |
$40.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.20
|
| Rate for Payer: Ohio Health Group HMO |
$87.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.58
|
| Rate for Payer: United Healthcare All Payer |
$103.20
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
48000102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$16.90
|
| Rate for Payer: Humana Medicaid |
$9.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.55
|
| Rate for Payer: Molina Healthcare Passport |
$9.36
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.45
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
48000102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$12.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$12.04
|
| Rate for Payer: Kentucky WC Medicaid |
$12.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
48000102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
51000181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$16.90
|
| Rate for Payer: Humana Medicaid |
$9.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.55
|
| Rate for Payer: Molina Healthcare Passport |
$9.36
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.45
|
|
|
ANTIGEN SCREEN COMPAT BLD EA
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
30001234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$6.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.35
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$6.35
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$6.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
ANTIGEN SCREEN COMPAT BLD EA
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
30001234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
ANTINUCLEAR ANTIBODY TITER
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
30000977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
ANTINUCLEAR ANTIBODY TITER
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
30000977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$11.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$11.16
|
| Rate for Payer: Humana Medicare Advantage |
$11.16
|
| Rate for Payer: Kentucky WC Medicaid |
$11.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
ANTIVEN SPIDER 2.5ML VL 6000UN
|
Facility
|
OP
|
$183.71
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$176.36 |
| Rate for Payer: Aetna Commercial |
$141.46
|
| Rate for Payer: Anthem Medicaid |
$63.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.29
|
| Rate for Payer: Cash Price |
$91.86
|
| Rate for Payer: Cigna Commercial |
$152.48
|
| Rate for Payer: First Health Commercial |
$174.52
|
| Rate for Payer: Humana Commercial |
$156.15
|
| Rate for Payer: Humana KY Medicaid |
$63.18
|
| Rate for Payer: Kentucky WC Medicaid |
$63.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.66
|
| Rate for Payer: Ohio Health Group HMO |
$137.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.95
|
| Rate for Payer: PHCS Commercial |
$176.36
|
| Rate for Payer: United Healthcare All Payer |
$161.66
|
|
|
ANTIVEN SPIDER 2.5ML VL 6000UN
|
Facility
|
IP
|
$183.71
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$176.36 |
| Rate for Payer: Aetna Commercial |
$141.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.29
|
| Rate for Payer: Cash Price |
$91.86
|
| Rate for Payer: Cigna Commercial |
$152.48
|
| Rate for Payer: First Health Commercial |
$174.52
|
| Rate for Payer: Humana Commercial |
$156.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.66
|
| Rate for Payer: Ohio Health Group HMO |
$137.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.95
|
| Rate for Payer: PHCS Commercial |
$176.36
|
| Rate for Payer: United Healthcare All Payer |
$161.66
|
|
|
ANTIVERT (MECLIZIN 12.5MG/1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 60687077501
|
| Hospital Charge Code |
25000234
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ANTIVERT (MECLIZIN 12.5MG/1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 60687077501
|
| Hospital Charge Code |
25000234
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ANTIVERT (MECLIZINE) 25MG/1TAB
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
25000235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ANTIVERT (MECLIZINE) 25MG/1TAB
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
25000235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
