|
SAPPHIRE NC PLUS 5.00*10
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*12
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*12
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*15
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*15
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*18
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*18
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*8
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SAPPHIRE NC PLUS 5.00*8
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
SARILUMAB 150mg PFP
|
Facility
|
IP
|
$4,051.85
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,215.56 |
| Max. Negotiated Rate |
$3,889.78 |
| Rate for Payer: Aetna Commercial |
$3,119.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Cash Price |
$2,025.92
|
| Rate for Payer: Cigna Commercial |
$3,363.04
|
| Rate for Payer: First Health Commercial |
$3,849.26
|
| Rate for Payer: Humana Commercial |
$3,444.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,038.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.78
|
| Rate for Payer: PHCS Commercial |
$3,889.78
|
| Rate for Payer: United Healthcare All Payer |
$3,565.63
|
|
|
SARILUMAB 150mg PFP
|
Facility
|
OP
|
$4,051.85
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,215.56 |
| Max. Negotiated Rate |
$3,889.78 |
| Rate for Payer: Aetna Commercial |
$3,119.92
|
| Rate for Payer: Anthem Medicaid |
$1,393.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Cash Price |
$2,025.92
|
| Rate for Payer: Cigna Commercial |
$3,363.04
|
| Rate for Payer: First Health Commercial |
$3,849.26
|
| Rate for Payer: Humana Commercial |
$3,444.07
|
| Rate for Payer: Humana KY Medicaid |
$1,393.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,038.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.78
|
| Rate for Payer: PHCS Commercial |
$3,889.78
|
| Rate for Payer: United Healthcare All Payer |
$3,565.63
|
|
|
SARILUMAB 200mg PFP
|
Facility
|
IP
|
$4,051.85
|
|
|
Service Code
|
NDC 24592201
|
| Hospital Charge Code |
25004142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,215.56 |
| Max. Negotiated Rate |
$3,889.78 |
| Rate for Payer: Aetna Commercial |
$3,119.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Cash Price |
$2,025.92
|
| Rate for Payer: Cigna Commercial |
$3,363.04
|
| Rate for Payer: First Health Commercial |
$3,849.26
|
| Rate for Payer: Humana Commercial |
$3,444.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,038.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.78
|
| Rate for Payer: PHCS Commercial |
$3,889.78
|
| Rate for Payer: United Healthcare All Payer |
$3,565.63
|
|
|
SARILUMAB 200mg PFP
|
Facility
|
OP
|
$4,051.85
|
|
|
Service Code
|
NDC 24592201
|
| Hospital Charge Code |
25004142
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,215.56 |
| Max. Negotiated Rate |
$3,889.78 |
| Rate for Payer: Aetna Commercial |
$3,119.92
|
| Rate for Payer: Anthem Medicaid |
$1,393.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Cash Price |
$2,025.92
|
| Rate for Payer: Cigna Commercial |
$3,363.04
|
| Rate for Payer: First Health Commercial |
$3,849.26
|
| Rate for Payer: Humana Commercial |
$3,444.07
|
| Rate for Payer: Humana KY Medicaid |
$1,393.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,038.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.78
|
| Rate for Payer: PHCS Commercial |
$3,889.78
|
| Rate for Payer: United Healthcare All Payer |
$3,565.63
|
|
|
SARNA SENSI 30 APPLIC/222 ML
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 316023075
|
| Hospital Charge Code |
25003972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
SARNA SENSI 30 APPLIC/222 ML
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 316023075
|
| Hospital Charge Code |
25003972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
SARS-COV2 ANTIBODIES
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.94
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
SARS-COV2 ANTIBODIES
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$42.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.13
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$42.13
|
| Rate for Payer: Humana Medicare Advantage |
$42.13
|
| Rate for Payer: Kentucky WC Medicaid |
$42.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
SARS-COV2 ANTIBODIES
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
30001808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Ambetter Exchange |
$42.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.56
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.13
|
| Rate for Payer: Multiplan PHCS |
$67.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.77
|
| Rate for Payer: UHCCP Medicaid |
$39.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.13
|
|
|
SARS-COV-2 COVID19 Ag
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
30002047
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
SARS-COV-2 COVID19 Ag
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
30002047
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$41.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.38
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$41.38
|
| Rate for Payer: Humana Medicare Advantage |
$41.38
|
| Rate for Payer: Kentucky WC Medicaid |
$41.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
SARS-COV-2 COVID19 Ag POC
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
30002046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$53.79 |
| Rate for Payer: Ambetter Exchange |
$41.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.66
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.38
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.79
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.38
|
|
|
SARS-COV-2 COVID19 Ag POC
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
30002046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$41.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.38
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$41.38
|
| Rate for Payer: Humana Medicare Advantage |
$41.38
|
| Rate for Payer: Kentucky WC Medicaid |
$41.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
SARS-COV-2 COVID19 Ag POC
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87811
|
| Hospital Charge Code |
30002046
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
SARS-COV-2 COVID-19 AMP PRB
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
30001784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Ambetter Exchange |
$51.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$51.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.57
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.31
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.70
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$51.31
|
|
