|
SENOKOT (SENNA) SYRUP 5 ML 5ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 71399823708
|
| Hospital Charge Code |
25001379
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
SENOKOT (SENNA) SYRUP 5 ML 5ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 71399823708
|
| Hospital Charge Code |
25001379
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
SENSATN PLUS 40CC BALLOON PUMP
|
Facility
|
IP
|
$6,706.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,011.86 |
| Max. Negotiated Rate |
$6,437.96 |
| Rate for Payer: Aetna Commercial |
$5,163.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.84
|
| Rate for Payer: Cash Price |
$3,353.10
|
| Rate for Payer: Cigna Commercial |
$5,566.15
|
| Rate for Payer: First Health Commercial |
$6,370.90
|
| Rate for Payer: Humana Commercial |
$5,700.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.28
|
| Rate for Payer: PHCS Commercial |
$6,437.96
|
| Rate for Payer: United Healthcare All Payer |
$5,901.46
|
|
|
SENSATN PLUS 40CC BALLOON PUMP
|
Facility
|
OP
|
$6,706.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,011.86 |
| Max. Negotiated Rate |
$6,437.96 |
| Rate for Payer: Aetna Commercial |
$5,163.78
|
| Rate for Payer: Anthem Medicaid |
$2,306.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.84
|
| Rate for Payer: Cash Price |
$3,353.10
|
| Rate for Payer: Cigna Commercial |
$5,566.15
|
| Rate for Payer: First Health Commercial |
$6,370.90
|
| Rate for Payer: Humana Commercial |
$5,700.28
|
| Rate for Payer: Humana KY Medicaid |
$2,306.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.28
|
| Rate for Payer: PHCS Commercial |
$6,437.96
|
| Rate for Payer: United Healthcare All Payer |
$5,901.46
|
|
|
SENSATN PLUS 50CC BALLOON PUMP
|
Facility
|
IP
|
$6,706.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,011.86 |
| Max. Negotiated Rate |
$6,437.96 |
| Rate for Payer: Aetna Commercial |
$5,163.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.84
|
| Rate for Payer: Cash Price |
$3,353.10
|
| Rate for Payer: Cigna Commercial |
$5,566.15
|
| Rate for Payer: First Health Commercial |
$6,370.90
|
| Rate for Payer: Humana Commercial |
$5,700.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.28
|
| Rate for Payer: PHCS Commercial |
$6,437.96
|
| Rate for Payer: United Healthcare All Payer |
$5,901.46
|
|
|
SENSATN PLUS 50CC BALLOON PUMP
|
Facility
|
OP
|
$6,706.21
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,011.86 |
| Max. Negotiated Rate |
$6,437.96 |
| Rate for Payer: Aetna Commercial |
$5,163.78
|
| Rate for Payer: Anthem Medicaid |
$2,306.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.84
|
| Rate for Payer: Cash Price |
$3,353.10
|
| Rate for Payer: Cigna Commercial |
$5,566.15
|
| Rate for Payer: First Health Commercial |
$6,370.90
|
| Rate for Payer: Humana Commercial |
$5,700.28
|
| Rate for Payer: Humana KY Medicaid |
$2,306.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.28
|
| Rate for Payer: PHCS Commercial |
$6,437.96
|
| Rate for Payer: United Healthcare All Payer |
$5,901.46
|
|
|
SENSITIVI DISK METHOD PER PLAT
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$7.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$7.48
|
| Rate for Payer: Humana Medicare Advantage |
$7.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
SENSITIVI DISK METHOD PER PLAT
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$49.80 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Ambetter Exchange |
$7.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.98
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: Healthspan PPO |
$7.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.48
|
| Rate for Payer: Multiplan PHCS |
$49.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$29.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.48
|
|
|
SENSITIVI DISK METHOD PER PLAT
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.65
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
SENSITIVI DISK METH PER PLA G
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
SENSITIVI DISK METH PER PLA G
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
30001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$7.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$7.48
|
| Rate for Payer: Humana Medicare Advantage |
$7.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$79.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem Medicaid |
$27.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Humana KY Medicaid |
$27.25
|
| Rate for Payer: Kentucky WC Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$79.23
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem Medicaid |
$27.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Humana KY Medicaid |
$27.25
|
| Rate for Payer: Kentucky WC Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$79.23
|
|
| Hospital Charge Code |
636T0093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$79.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
OP
|
$79.23
|
|
| Hospital Charge Code |
636T0093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem Medicaid |
$27.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Humana KY Medicaid |
$27.25
|
| Rate for Payer: Kentucky WC Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Facility
|
IP
|
$79.23
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$76.06 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.80
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cigna Commercial |
$65.76
|
| Rate for Payer: First Health Commercial |
$75.27
|
| Rate for Payer: Humana Commercial |
$67.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.72
|
| Rate for Payer: Ohio Health Group HMO |
$59.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.67
|
| Rate for Payer: PHCS Commercial |
$76.06
|
| Rate for Payer: United Healthcare All Payer |
$69.72
|
|
|
SENSORCAINE 0.25% VIAL (50ML)
|
Professional
|
Both
|
$79.23
|
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$55.46 |
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Multiplan PHCS |
$47.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.46
|
| Rate for Payer: UHCCP Medicaid |
$27.73
|
|
|
SENSORCAINE MPF/EPI 0.5% 10ML
|
Facility
|
OP
|
$78.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003440
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Anthem Medicaid |
$27.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Cash Price |
$39.33
|
| Rate for Payer: Cigna Commercial |
$65.28
|
| Rate for Payer: First Health Commercial |
$74.72
|
| Rate for Payer: Humana Commercial |
$66.85
|
| Rate for Payer: Humana KY Medicaid |
$27.05
|
| Rate for Payer: Kentucky WC Medicaid |
$27.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.21
|
| Rate for Payer: Ohio Health Group HMO |
$58.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.27
|
| Rate for Payer: PHCS Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Payer |
$69.21
|
|
|
SENSORCAINE MPF/EPI 0.5% 10ML
|
Facility
|
IP
|
$78.65
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003440
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$75.50 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.35
|
| Rate for Payer: Cash Price |
$39.33
|
| Rate for Payer: Cigna Commercial |
$65.28
|
| Rate for Payer: First Health Commercial |
$74.72
|
| Rate for Payer: Humana Commercial |
$66.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.21
|
| Rate for Payer: Ohio Health Group HMO |
$58.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.27
|
| Rate for Payer: PHCS Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Payer |
$69.21
|
|
|
SENTINAL NODE NAV GEN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SENTINAL NODE NAV GEN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SENTINOL NODE INJECT MELANO (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340P0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$116.21 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Ambetter Exchange |
$30.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.63
|
| Rate for Payer: Anthem Medicaid |
$113.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.17
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$55.97
|
| Rate for Payer: Healthspan PPO |
$47.96
|
| Rate for Payer: Humana Medicaid |
$113.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.21
|
| Rate for Payer: Molina Healthcare Passport |
$113.93
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.18
|
| Rate for Payer: UHCCP Medicaid |
$23.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.14
|
|
|
SENTINOL NODE INJECT MELANO (T
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340T0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,241.28 |
| Rate for Payer: Aetna Commercial |
$995.61
|
| Rate for Payer: Anthem Medicaid |
$444.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,073.19
|
| Rate for Payer: First Health Commercial |
$1,228.35
|
| Rate for Payer: Humana Commercial |
$1,099.05
|
| Rate for Payer: Humana KY Medicaid |
$444.66
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$449.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,060.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.84
|
| Rate for Payer: Ohio Health Group HMO |
$969.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.17
|
| Rate for Payer: PHCS Commercial |
$1,241.28
|
| Rate for Payer: United Healthcare All Payer |
$1,137.84
|
|
|
SENTINOL NODE INJECT MELANO (T
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
340T0118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$387.90 |
| Max. Negotiated Rate |
$1,241.28 |
| Rate for Payer: Aetna Commercial |
$995.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.54
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,073.19
|
| Rate for Payer: First Health Commercial |
$1,228.35
|
| Rate for Payer: Humana Commercial |
$1,099.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,060.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.84
|
| Rate for Payer: Ohio Health Group HMO |
$969.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.17
|
| Rate for Payer: PHCS Commercial |
$1,241.28
|
| Rate for Payer: United Healthcare All Payer |
$1,137.84
|
|
