|
ANTHOLOGY SO PORUS SZ 9
|
Facility
|
IP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY SO PORUS SZ 9
|
Facility
|
OP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem Medicaid |
$8,384.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Humana KY Medicaid |
$8,384.28
|
| Rate for Payer: Kentucky WC Medicaid |
$8,469.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTIBODY IDENT RBC PANEL
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
30001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
ANTIBODY IDENT RBC PANEL
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
30001229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.97 |
| Max. Negotiated Rate |
$465.32 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
ANTIBODY SCREEN RBC EACH
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
30001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$9.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$9.77
|
| Rate for Payer: Humana Medicare Advantage |
$9.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
ANTIBODY SCREEN RBC EACH
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
30001227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
ANTICOAG CITRAT DXTRSE S 500ML
|
Facility
|
IP
|
$117.27
|
|
|
Service Code
|
NDC 942064104
|
| Hospital Charge Code |
25002837
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.18 |
| 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 |
$93.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.92
|
| 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 |
$35.18 |
| 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 |
$93.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.92
|
| 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 |
51000181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Ambetter Exchange |
$10.58
|
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.58
|
| 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 |
$13.75
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.58
|
|
|
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 |
$21.00 |
| Rate for Payer: Ambetter Exchange |
$10.58
|
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.58
|
| 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 |
$13.75
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.58
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
48000102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10.50 |
| 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 |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
ANTICOAG MGMT PT WARFARIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 93793
|
| Hospital Charge Code |
48000102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10.50 |
| 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 |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
ANTIGEN SCREEN COMPAT BLD EA
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
30001234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$6.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.35
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$6.35
|
| Rate for Payer: Humana Medicare Advantage |
$6.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
ANTIGEN SCREEN COMPAT BLD EA
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
30001234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
ANTINUCLEAR ANTIBODY TITER
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
30000977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
ANTINUCLEAR ANTIBODY TITER
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
30000977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$11.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| 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 |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
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 |
$55.11 |
| 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 |
$146.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.76
|
| 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 |
$55.11 |
| 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 |
$146.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.76
|
| Rate for Payer: PHCS Commercial |
$176.36
|
| Rate for Payer: United Healthcare All Payer |
$161.66
|
|
|
ANTIVERT (MECLIZIN 12.5MG/1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 60687077501
|
| Hospital Charge Code |
25000234
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| 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: 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 |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ANTIVERT (MECLIZIN 12.5MG/1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 60687077501
|
| Hospital Charge Code |
25000234
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| 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 |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ANTIVERT (MECLIZINE) 25MG/1TAB
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
25000235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| 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 |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ANTIVERT (MECLIZINE) 25MG/1TAB
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 60687073001
|
| Hospital Charge Code |
25000235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| 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 |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ANTI-XA (UFH)
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
30000610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
ANTI-XA (UFH)
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
30000610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$13.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.09
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$13.09
|
| Rate for Payer: Humana Medicare Advantage |
$13.09
|
| Rate for Payer: Kentucky WC Medicaid |
$13.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
ANTIZOL 15MG (1.5GM/1.5ML VL)
|
Facility
|
IP
|
$1,599.33
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
25002065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.80 |
| Max. Negotiated Rate |
$1,535.36 |
| Rate for Payer: Aetna Commercial |
$1,231.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.48
|
| Rate for Payer: Cash Price |
$799.66
|
| Rate for Payer: Cigna Commercial |
$1,327.44
|
| Rate for Payer: First Health Commercial |
$1,519.36
|
| Rate for Payer: Humana Commercial |
$1,359.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,407.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,279.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.54
|
| Rate for Payer: PHCS Commercial |
$1,535.36
|
| Rate for Payer: United Healthcare All Payer |
$1,407.41
|
|
