|
SEROQUEL (QUETIAP FUM)25MGTAB
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 60687032701
|
| Hospital Charge Code |
25001386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
SEROSAFUSE IMP FASTENER CART 7
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
SEROSAFUSE IMP FASTENER CART 7
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
SERRANATOR 2.5 X 40
|
Facility
|
OP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem Medicaid |
$2,381.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Humana KY Medicaid |
$2,381.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,405.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
SERRANATOR 2.5 X 40
|
Facility
|
IP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
SERZONE 50MG TABLET
|
Facility
|
OP
|
$9.30
|
|
|
Service Code
|
NDC 93717801
|
| Hospital Charge Code |
25001393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Anthem Medicaid |
$3.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.25
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cigna Commercial |
$7.72
|
| Rate for Payer: First Health Commercial |
$8.84
|
| Rate for Payer: Humana Commercial |
$7.91
|
| Rate for Payer: Humana KY Medicaid |
$3.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.18
|
| Rate for Payer: Ohio Health Group HMO |
$6.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.42
|
| Rate for Payer: PHCS Commercial |
$8.93
|
| Rate for Payer: United Healthcare All Payer |
$8.18
|
|
|
SERZONE 50MG TABLET
|
Facility
|
IP
|
$9.30
|
|
|
Service Code
|
NDC 93717801
|
| Hospital Charge Code |
25001393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$7.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.25
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cigna Commercial |
$7.72
|
| Rate for Payer: First Health Commercial |
$8.84
|
| Rate for Payer: Humana Commercial |
$7.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.18
|
| Rate for Payer: Ohio Health Group HMO |
$6.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.42
|
| Rate for Payer: PHCS Commercial |
$8.93
|
| Rate for Payer: United Healthcare All Payer |
$8.18
|
|
|
SERZONE (NEFAZODONE 100MG/1TAB
|
Facility
|
OP
|
$9.37
|
|
|
Service Code
|
NDC 93102406
|
| Hospital Charge Code |
25001392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem Medicaid |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.78
|
| Rate for Payer: First Health Commercial |
$8.90
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Humana KY Medicaid |
$3.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.47
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
SERZONE (NEFAZODONE 100MG/1TAB
|
Facility
|
IP
|
$9.37
|
|
|
Service Code
|
NDC 93102406
|
| Hospital Charge Code |
25001392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.78
|
| Rate for Payer: First Health Commercial |
$8.90
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.47
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
SESAME SEED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SESAME SEED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SET INTRODUCER 12FR
|
Facility
|
OP
|
$1,889.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.89 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,455.03
|
| Rate for Payer: Anthem Medicaid |
$649.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.93
|
| Rate for Payer: Cash Price |
$944.82
|
| Rate for Payer: Cigna Commercial |
$1,568.41
|
| Rate for Payer: First Health Commercial |
$1,795.17
|
| Rate for Payer: Humana Commercial |
$1,606.20
|
| Rate for Payer: Humana KY Medicaid |
$649.85
|
| Rate for Payer: Kentucky WC Medicaid |
$656.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,549.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,417.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.86
|
| Rate for Payer: PHCS Commercial |
$1,814.06
|
| Rate for Payer: United Healthcare All Payer |
$1,662.89
|
|
|
SET INTRODUCER 12FR
|
Facility
|
IP
|
$1,889.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$566.89 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,455.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.93
|
| Rate for Payer: Cash Price |
$944.82
|
| Rate for Payer: Cigna Commercial |
$1,568.41
|
| Rate for Payer: First Health Commercial |
$1,795.17
|
| Rate for Payer: Humana Commercial |
$1,606.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,549.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,417.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,303.86
|
| Rate for Payer: PHCS Commercial |
$1,814.06
|
| Rate for Payer: United Healthcare All Payer |
$1,662.89
|
|
|
SET INTRODUCER 16FR
|
Facility
|
IP
|
$2,033.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,952.17 |
| Rate for Payer: Aetna Commercial |
$1,565.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.14
|
| Rate for Payer: Cash Price |
$1,016.76
|
| Rate for Payer: Cigna Commercial |
$1,687.81
|
| Rate for Payer: First Health Commercial |
$1,931.83
|
| Rate for Payer: Humana Commercial |
$1,728.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.12
|
| Rate for Payer: PHCS Commercial |
$1,952.17
|
| Rate for Payer: United Healthcare All Payer |
$1,789.49
|
|
|
SET INTRODUCER 16FR
|
Facility
|
OP
|
$2,033.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,952.17 |
| Rate for Payer: Aetna Commercial |
$1,565.80
|
| Rate for Payer: Anthem Medicaid |
$699.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.14
|
| Rate for Payer: Cash Price |
$1,016.76
|
| Rate for Payer: Cigna Commercial |
$1,687.81
|
| Rate for Payer: First Health Commercial |
$1,931.83
|
| Rate for Payer: Humana Commercial |
$1,728.48
|
| Rate for Payer: Humana KY Medicaid |
$699.32
|
| Rate for Payer: Kentucky WC Medicaid |
$706.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.12
|
| Rate for Payer: PHCS Commercial |
$1,952.17
|
| Rate for Payer: United Healthcare All Payer |
$1,789.49
|
|
|
SET RADIATION THPY FIELD
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Aetna Commercial |
$481.57
|
| Rate for Payer: Ambetter Exchange |
$396.36
|
| Rate for Payer: Anthem Medicaid |
$195.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$396.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$396.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$475.63
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$431.01
|
| Rate for Payer: Healthspan PPO |
$406.12
|
| Rate for Payer: Humana Medicaid |
$195.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$396.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Healthcare Passport |
$195.53
|
| Rate for Payer: Multiplan PHCS |
$932.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$515.27
|
| Rate for Payer: UHCCP Medicaid |
$543.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$396.36
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem Medicaid |
$534.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Humana KY Medicaid |
$534.42
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$539.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$466.20 |
| Max. Negotiated Rate |
$1,491.84 |
| Rate for Payer: Aetna Commercial |
$1,196.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.12
|
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,289.82
|
| Rate for Payer: First Health Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial |
$1,320.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.26
|
| Rate for Payer: PHCS Commercial |
$1,491.84
|
| Rate for Payer: United Healthcare All Payer |
$1,367.52
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
OP
|
$1,405.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$1,348.80 |
| Rate for Payer: Aetna Commercial |
$1,081.85
|
| Rate for Payer: Anthem Medicaid |
$483.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,095.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$1,166.15
|
| Rate for Payer: First Health Commercial |
$1,334.75
|
| Rate for Payer: Humana Commercial |
$1,194.25
|
| Rate for Payer: Humana KY Medicaid |
$483.18
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$488.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,152.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,036.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$492.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,236.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,053.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.45
|
| Rate for Payer: PHCS Commercial |
$1,348.80
|
| Rate for Payer: United Healthcare All Payer |
$1,236.40
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
IP
|
$1,405.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$421.50 |
| Max. Negotiated Rate |
$1,348.80 |
| Rate for Payer: Aetna Commercial |
$1,081.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,095.90
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$1,166.15
|
| Rate for Payer: First Health Commercial |
$1,334.75
|
| Rate for Payer: Humana Commercial |
$1,194.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,152.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,036.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,236.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,053.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.45
|
| Rate for Payer: PHCS Commercial |
$1,348.80
|
| Rate for Payer: United Healthcare All Payer |
$1,236.40
|
|
|
SET RADIATION THPY FIELD
|
Professional
|
Both
|
$1,405.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$843.00 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: Ambetter Exchange |
$239.13
|
| Rate for Payer: Anthem Medicaid |
$124.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$239.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$239.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.96
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cash Price |
$702.50
|
| Rate for Payer: Cigna Commercial |
$264.17
|
| Rate for Payer: Healthspan PPO |
$236.40
|
| Rate for Payer: Humana Medicaid |
$124.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$239.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.70
|
| Rate for Payer: Molina Healthcare Passport |
$124.22
|
| Rate for Payer: Multiplan PHCS |
$843.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$310.87
|
| Rate for Payer: UHCCP Medicaid |
$491.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$239.13
|
|
|
SET RADIATION THPY FIELD(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333P0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$515.27 |
| Rate for Payer: Aetna Commercial |
$481.57
|
| Rate for Payer: Ambetter Exchange |
$396.36
|
| Rate for Payer: Anthem Medicaid |
$195.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$396.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$396.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$475.63
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$431.01
|
| Rate for Payer: Healthspan PPO |
$406.12
|
| Rate for Payer: Humana Medicaid |
$195.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$396.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Healthcare Passport |
$195.53
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$515.27
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$396.36
|
|
|
SET RADIATION THPY FIELD(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
333P0001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: Ambetter Exchange |
$239.13
|
| Rate for Payer: Anthem Medicaid |
$124.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$239.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$239.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.96
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$264.17
|
| Rate for Payer: Healthspan PPO |
$236.40
|
| Rate for Payer: Humana Medicaid |
$124.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$239.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.70
|
| Rate for Payer: Molina Healthcare Passport |
$124.22
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$310.87
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$239.13
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
OP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333T0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,251.84 |
| Rate for Payer: Aetna Commercial |
$1,004.08
|
| Rate for Payer: Anthem Medicaid |
$448.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cigna Commercial |
$1,082.32
|
| Rate for Payer: First Health Commercial |
$1,238.80
|
| Rate for Payer: Humana Commercial |
$1,108.40
|
| Rate for Payer: Humana KY Medicaid |
$448.45
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$453.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,069.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$962.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$457.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,147.52
|
| Rate for Payer: Ohio Health Group HMO |
$978.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,134.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$899.76
|
| Rate for Payer: PHCS Commercial |
$1,251.84
|
| Rate for Payer: United Healthcare All Payer |
$1,147.52
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333T0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,251.84 |
| Rate for Payer: Aetna Commercial |
$1,004.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.12
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cigna Commercial |
$1,082.32
|
| Rate for Payer: First Health Commercial |
$1,238.80
|
| Rate for Payer: Humana Commercial |
$1,108.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,069.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$962.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,147.52
|
| Rate for Payer: Ohio Health Group HMO |
$978.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,134.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$899.76
|
| Rate for Payer: PHCS Commercial |
$1,251.84
|
| Rate for Payer: United Healthcare All Payer |
$1,147.52
|
|
