|
MYCOPHENOLATE 200MG/ML SUSP5ML
|
Facility
|
OP
|
$74.25
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25003764
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna Commercial |
$57.17
|
| Rate for Payer: Anthem Medicaid |
$25.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.92
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Cigna Commercial |
$61.63
|
| Rate for Payer: First Health Commercial |
$70.54
|
| Rate for Payer: Humana Commercial |
$63.11
|
| Rate for Payer: Humana KY Medicaid |
$25.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.34
|
| Rate for Payer: Ohio Health Group HMO |
$55.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.02
|
| Rate for Payer: PHCS Commercial |
$71.28
|
| Rate for Payer: United Healthcare All Payer |
$65.34
|
|
|
MYCOPLASMA GENITALIUM PCR
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
MYCOPLASMA GENITALIUM PCR
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
MYCOPLASMA PNEUMONIAE MOL DET
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
30001383
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
MYCOPLASMA PNEUMONIAE MOL DET
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
30001383
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
MYCOSTATIN(NYSTATIN)1000 15GM
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 72578008901
|
| Hospital Charge Code |
25001030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Anthem Medicaid |
$1.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna Commercial |
$4.81
|
| Rate for Payer: First Health Commercial |
$5.51
|
| Rate for Payer: Humana Commercial |
$4.93
|
| Rate for Payer: Humana KY Medicaid |
$1.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.10
|
| Rate for Payer: Ohio Health Group HMO |
$4.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.80
|
| Rate for Payer: PHCS Commercial |
$5.57
|
| Rate for Payer: United Healthcare All Payer |
$5.10
|
|
|
MYCOSTATIN(NYSTATIN)1000 15GM
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 72578008901
|
| Hospital Charge Code |
25001030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cigna Commercial |
$4.81
|
| Rate for Payer: First Health Commercial |
$5.51
|
| Rate for Payer: Humana Commercial |
$4.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.10
|
| Rate for Payer: Ohio Health Group HMO |
$4.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.80
|
| Rate for Payer: PHCS Commercial |
$5.57
|
| Rate for Payer: United Healthcare All Payer |
$5.10
|
|
|
MYCOSTATIN (NYSTATIN)100 15GM
|
Facility
|
IP
|
$5.87
|
|
|
Service Code
|
NDC 713067815
|
| Hospital Charge Code |
25001028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$4.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.58
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna Commercial |
$4.87
|
| Rate for Payer: First Health Commercial |
$5.58
|
| Rate for Payer: Humana Commercial |
$4.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.17
|
| Rate for Payer: Ohio Health Group HMO |
$4.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.82
|
| Rate for Payer: PHCS Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Payer |
$5.17
|
|
|
MYCOSTATIN (NYSTATIN)100 15GM
|
Facility
|
OP
|
$5.87
|
|
|
Service Code
|
NDC 713067815
|
| Hospital Charge Code |
25001028
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$4.52
|
| Rate for Payer: Anthem Medicaid |
$2.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.58
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cigna Commercial |
$4.87
|
| Rate for Payer: First Health Commercial |
$5.58
|
| Rate for Payer: Humana Commercial |
$4.99
|
| Rate for Payer: Humana KY Medicaid |
$2.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.17
|
| Rate for Payer: Ohio Health Group HMO |
$4.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.82
|
| Rate for Payer: PHCS Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Payer |
$5.17
|
|
|
MYCOSTATIN TOPICAL PWDR 1 15GM
|
Facility
|
IP
|
$6.29
|
|
|
Service Code
|
NDC 574200815
|
| Hospital Charge Code |
25001029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.91
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna Commercial |
$5.22
|
| Rate for Payer: First Health Commercial |
$5.98
|
| Rate for Payer: Humana Commercial |
$5.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.54
|
| Rate for Payer: Ohio Health Group HMO |
$4.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.95
|
| Rate for Payer: PHCS Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Payer |
$5.54
|
|
|
MYCOSTATIN TOPICAL PWDR 1 15GM
|
Facility
|
OP
|
$6.29
|
|
|
Service Code
|
NDC 574200815
|
| Hospital Charge Code |
25001029
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Anthem Medicaid |
$2.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.91
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna Commercial |
$5.22
|
| Rate for Payer: First Health Commercial |
$5.98
|
| Rate for Payer: Humana Commercial |
$5.35
|
| Rate for Payer: Humana KY Medicaid |
$2.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.54
|
| Rate for Payer: Ohio Health Group HMO |
$4.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.95
|
| Rate for Payer: PHCS Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Payer |
$5.54
|
|
|
MYDRIACYL (TROPICAMIDE)1% 15ML
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 24208058564
|
| Hospital Charge Code |
25003243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem Medicaid |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Humana KY Medicaid |
$0.21
|
| Rate for Payer: Kentucky WC Medicaid |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
MYDRIACYL (TROPICAMIDE)1% 15ML
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 24208058564
|
| Hospital Charge Code |
25003243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
MYELOGPHY 2/> SPINE REGIONS
|
Facility
|
IP
|
$2,539.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
32000274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.07 |
| Max. Negotiated Rate |
$2,437.44 |
| Rate for Payer: Aetna Commercial |
$1,955.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,980.42
|
| Rate for Payer: Cash Price |
$1,269.50
|
| Rate for Payer: Cigna Commercial |
$2,107.37
|
| Rate for Payer: First Health Commercial |
$2,412.05
|
| Rate for Payer: Humana Commercial |
$2,158.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,081.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,873.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,234.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,904.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.09
|
| Rate for Payer: PHCS Commercial |
$2,437.44
|
| Rate for Payer: United Healthcare All Payer |
$2,234.32
|
|
|
MYELOGPHY 2/> SPINE REGIONS
|
Professional
|
Both
|
$2,539.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
32000274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.32 |
| Max. Negotiated Rate |
$2,539.00 |
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Anthem Medicaid |
$221.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,539.00
|
| Rate for Payer: Cash Price |
$1,269.50
|
| Rate for Payer: Cash Price |
$1,269.50
|
| Rate for Payer: Cigna Commercial |
$413.33
|
| Rate for Payer: Healthspan PPO |
$330.64
|
| Rate for Payer: Humana Medicaid |
$221.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.30
|
| Rate for Payer: Molina Healthcare Passport |
$221.86
|
| Rate for Payer: Multiplan PHCS |
$1,523.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,777.30
|
| Rate for Payer: UHCCP Medicaid |
$888.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.08
|
|
|
MYELOGPHY 2/> SPINE REGIONS
|
Facility
|
OP
|
$2,539.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
32000274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.07 |
| Max. Negotiated Rate |
$2,437.44 |
| Rate for Payer: Aetna Commercial |
$1,955.03
|
| Rate for Payer: Anthem Medicaid |
$873.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,980.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,269.50
|
| Rate for Payer: Cash Price |
$1,269.50
|
| Rate for Payer: Cigna Commercial |
$2,107.37
|
| Rate for Payer: First Health Commercial |
$2,412.05
|
| Rate for Payer: Humana Commercial |
$2,158.15
|
| Rate for Payer: Humana KY Medicaid |
$873.16
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$882.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,081.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,873.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$890.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,234.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,904.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.09
|
| Rate for Payer: PHCS Commercial |
$2,437.44
|
| Rate for Payer: United Healthcare All Payer |
$2,234.32
|
|
|
MYELOGPHY 2/> SPINE REGIONS(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
320P0274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$413.33 |
| Rate for Payer: Aetna Commercial |
$352.87
|
| Rate for Payer: Anthem Medicaid |
$221.86
|
| 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 |
$413.33
|
| Rate for Payer: Healthspan PPO |
$330.64
|
| Rate for Payer: Humana Medicaid |
$221.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.30
|
| Rate for Payer: Molina Healthcare Passport |
$221.86
|
| 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 |
$224.08
|
|
|
MYELOGPHY 2/> SPINE REGIONS(T
|
Facility
|
IP
|
$2,364.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
320T0274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.32 |
| Max. Negotiated Rate |
$2,269.44 |
| Rate for Payer: Aetna Commercial |
$1,820.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,843.92
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,962.12
|
| Rate for Payer: First Health Commercial |
$2,245.80
|
| Rate for Payer: Humana Commercial |
$2,009.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,938.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,744.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,080.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,773.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$732.84
|
| Rate for Payer: PHCS Commercial |
$2,269.44
|
| Rate for Payer: United Healthcare All Payer |
$2,080.32
|
|
|
MYELOGPHY 2/> SPINE REGIONS(T
|
Facility
|
OP
|
$2,364.00
|
|
|
Service Code
|
HCPCS 72270
|
| Hospital Charge Code |
320T0274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.32 |
| Max. Negotiated Rate |
$2,269.44 |
| Rate for Payer: Aetna Commercial |
$1,820.28
|
| Rate for Payer: Anthem Medicaid |
$812.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,843.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,962.12
|
| Rate for Payer: First Health Commercial |
$2,245.80
|
| Rate for Payer: Humana Commercial |
$2,009.40
|
| Rate for Payer: Humana KY Medicaid |
$812.98
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$821.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,938.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,744.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$829.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,080.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,773.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$732.84
|
| Rate for Payer: PHCS Commercial |
$2,269.44
|
| Rate for Payer: United Healthcare All Payer |
$2,080.32
|
|
|
MYELOGRAM - CERVICAL
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.13 |
| Max. Negotiated Rate |
$1,728.96 |
| Rate for Payer: Aetna Commercial |
$1,386.77
|
| Rate for Payer: Anthem Medicaid |
$619.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$1,494.83
|
| Rate for Payer: First Health Commercial |
$1,710.95
|
| Rate for Payer: Humana Commercial |
$1,530.85
|
| Rate for Payer: Humana KY Medicaid |
$619.36
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$625.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.31
|
| Rate for Payer: PHCS Commercial |
$1,728.96
|
| Rate for Payer: United Healthcare All Payer |
$1,584.88
|
|
|
MYELOGRAM - CERVICAL
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.31 |
| Max. Negotiated Rate |
$1,801.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$98.31
|
| Rate for Payer: Anthem Medicaid |
$101.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,801.00
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$217.90
|
| Rate for Payer: Humana Medicaid |
$101.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.51
|
| Rate for Payer: Molina Healthcare Passport |
$101.48
|
| Rate for Payer: Multiplan PHCS |
$1,080.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.70
|
| Rate for Payer: UHCCP Medicaid |
$103.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.49
|
|
|
MYELOGRAM - CERVICAL
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
32000006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.13 |
| Max. Negotiated Rate |
$1,728.96 |
| Rate for Payer: Aetna Commercial |
$1,386.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.78
|
| Rate for Payer: Cash Price |
$900.50
|
| Rate for Payer: Cigna Commercial |
$1,494.83
|
| Rate for Payer: First Health Commercial |
$1,710.95
|
| Rate for Payer: Humana Commercial |
$1,530.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.31
|
| Rate for Payer: PHCS Commercial |
$1,728.96
|
| Rate for Payer: United Healthcare All Payer |
$1,584.88
|
|
|
MYELOGRAM - CERVICAL(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
320P0006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.31 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$98.31
|
| Rate for Payer: Anthem Medicaid |
$101.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$217.90
|
| Rate for Payer: Humana Medicaid |
$101.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$160.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.51
|
| Rate for Payer: Molina Healthcare Passport |
$101.48
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$103.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.49
|
|
|
MYELOGRAM - CERVICAL(T
|
Facility
|
IP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
320T0006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
|
MYELOGRAM - CERVICAL(T
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
HCPCS 62302
|
| Hospital Charge Code |
320T0006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$1,440.96 |
| Rate for Payer: Aetna Commercial |
$1,155.77
|
| Rate for Payer: Anthem Medicaid |
$516.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cash Price |
$750.50
|
| Rate for Payer: Cigna Commercial |
$1,245.83
|
| Rate for Payer: First Health Commercial |
$1,425.95
|
| Rate for Payer: Humana Commercial |
$1,275.85
|
| Rate for Payer: Humana KY Medicaid |
$516.19
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$521.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.31
|
| Rate for Payer: PHCS Commercial |
$1,440.96
|
| Rate for Payer: United Healthcare All Payer |
$1,320.88
|
|
