|
TRUEPATH DEVICE
|
Facility
|
IP
|
$9,808.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.04 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$7,552.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,650.24
|
| Rate for Payer: Cash Price |
$4,904.00
|
| Rate for Payer: Cigna Commercial |
$8,140.64
|
| Rate for Payer: First Health Commercial |
$9,317.60
|
| Rate for Payer: Humana Commercial |
$8,336.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,042.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,238.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.48
|
| Rate for Payer: PHCS Commercial |
$9,415.68
|
| Rate for Payer: United Healthcare All Payer |
$8,631.04
|
|
|
TRUEPATH DEVICE
|
Facility
|
OP
|
$9,808.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,275.04 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$7,552.16
|
| Rate for Payer: Anthem Medicaid |
$3,372.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,650.24
|
| Rate for Payer: Cash Price |
$4,904.00
|
| Rate for Payer: Cigna Commercial |
$8,140.64
|
| Rate for Payer: First Health Commercial |
$9,317.60
|
| Rate for Payer: Humana Commercial |
$8,336.80
|
| Rate for Payer: Humana KY Medicaid |
$3,372.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,407.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,042.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,238.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,040.48
|
| Rate for Payer: PHCS Commercial |
$9,415.68
|
| Rate for Payer: United Healthcare All Payer |
$8,631.04
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 0^
|
Facility
|
IP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 0^
|
Facility
|
OP
|
$4,989.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.64 |
| Max. Negotiated Rate |
$4,789.92 |
| Rate for Payer: Aetna Commercial |
$3,841.92
|
| Rate for Payer: Anthem Medicaid |
$1,715.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,891.81
|
| Rate for Payer: Cash Price |
$2,494.75
|
| Rate for Payer: Cigna Commercial |
$4,141.28
|
| Rate for Payer: First Health Commercial |
$4,740.02
|
| Rate for Payer: Humana Commercial |
$4,241.08
|
| Rate for Payer: Humana KY Medicaid |
$1,715.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,496.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,390.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,546.74
|
| Rate for Payer: PHCS Commercial |
$4,789.92
|
| Rate for Payer: United Healthcare All Payer |
$4,390.76
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 12
|
Facility
|
IP
|
$5,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.57 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$4,306.87
|
| Rate for Payer: First Health Commercial |
$4,929.55
|
| Rate for Payer: Humana Commercial |
$4,410.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,254.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,829.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,566.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.59
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 12
|
Facility
|
OP
|
$5,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.57 |
| Max. Negotiated Rate |
$4,981.44 |
| Rate for Payer: Aetna Commercial |
$3,995.53
|
| Rate for Payer: Anthem Medicaid |
$1,784.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,047.42
|
| Rate for Payer: Cash Price |
$2,594.50
|
| Rate for Payer: Cigna Commercial |
$4,306.87
|
| Rate for Payer: First Health Commercial |
$4,929.55
|
| Rate for Payer: Humana Commercial |
$4,410.65
|
| Rate for Payer: Humana KY Medicaid |
$1,784.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,254.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,829.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,566.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,891.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.59
|
| Rate for Payer: PHCS Commercial |
$4,981.44
|
| Rate for Payer: United Healthcare All Payer |
$4,566.32
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 24
|
Facility
|
IP
|
$5,101.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.20 |
| Max. Negotiated Rate |
$4,897.44 |
| Rate for Payer: Aetna Commercial |
$3,928.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,979.17
|
| Rate for Payer: Cash Price |
$2,550.75
|
| Rate for Payer: Cigna Commercial |
$4,234.24
|
| Rate for Payer: First Health Commercial |
$4,846.42
|
| Rate for Payer: Humana Commercial |
$4,336.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,183.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,764.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,489.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,826.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.46
|
| Rate for Payer: PHCS Commercial |
$4,897.44
|
| Rate for Payer: United Healthcare All Payer |
$4,489.32
|
|
|
TRUESPAN MEN RPR W/PEEK IMP 24
|
Facility
|
OP
|
$5,101.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.20 |
| Max. Negotiated Rate |
$4,897.44 |
| Rate for Payer: Aetna Commercial |
$3,928.16
|
| Rate for Payer: Anthem Medicaid |
$1,754.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,979.17
|
| Rate for Payer: Cash Price |
$2,550.75
|
| Rate for Payer: Cigna Commercial |
$4,234.24
|
| Rate for Payer: First Health Commercial |
$4,846.42
|
| Rate for Payer: Humana Commercial |
$4,336.28
|
| Rate for Payer: Humana KY Medicaid |
$1,754.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,772.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,183.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,764.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,789.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,489.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,826.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.46
|
| Rate for Payer: PHCS Commercial |
$4,897.44
|
| Rate for Payer: United Healthcare All Payer |
$4,489.32
|
|
|
TRUNION KIT FOR UNIV II
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
TRUNION KIT FOR UNIV II
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
TRUSOPT 2% EYE EQUIV DROPS
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 42571014126
|
| Hospital Charge Code |
25001605
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
TRUSOPT 2% EYE EQUIV DROPS
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 42571014126
|
| Hospital Charge Code |
25001605
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem Medicaid |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Humana KY Medicaid |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$0.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
TRUVADA 200/300MG TABLET
|
Facility
|
OP
|
$133.41
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
25001606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$128.07 |
| Rate for Payer: Aetna Commercial |
$102.73
|
| Rate for Payer: Anthem Medicaid |
$45.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Cash Price |
$66.70
|
| Rate for Payer: Cigna Commercial |
$110.73
|
| Rate for Payer: First Health Commercial |
$126.74
|
| Rate for Payer: Humana Commercial |
$113.40
|
| Rate for Payer: Humana KY Medicaid |
$45.88
|
| Rate for Payer: Kentucky WC Medicaid |
$46.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.40
|
| Rate for Payer: Ohio Health Group HMO |
$100.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.36
|
| Rate for Payer: PHCS Commercial |
$128.07
|
| Rate for Payer: United Healthcare All Payer |
$117.40
|
|
|
TRUVADA 200/300MG TABLET
|
Facility
|
IP
|
$133.41
|
|
|
Service Code
|
NDC 61958070101
|
| Hospital Charge Code |
25001606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$128.07 |
| Rate for Payer: Aetna Commercial |
$102.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Cash Price |
$66.70
|
| Rate for Payer: Cigna Commercial |
$110.73
|
| Rate for Payer: First Health Commercial |
$126.74
|
| Rate for Payer: Humana Commercial |
$113.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.40
|
| Rate for Payer: Ohio Health Group HMO |
$100.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.36
|
| Rate for Payer: PHCS Commercial |
$128.07
|
| Rate for Payer: United Healthcare All Payer |
$117.40
|
|
|
TRUXIMA 10mg (100mg Vial)
|
Facility
|
OP
|
$4,608.25
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25003880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.89 |
| Max. Negotiated Rate |
$4,423.92 |
| Rate for Payer: Aetna Commercial |
$3,548.35
|
| Rate for Payer: Anthem Medicaid |
$1,584.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.45
|
| Rate for Payer: Cash Price |
$2,304.12
|
| Rate for Payer: Cash Price |
$2,304.12
|
| Rate for Payer: Cigna Commercial |
$3,824.85
|
| Rate for Payer: First Health Commercial |
$4,377.84
|
| Rate for Payer: Humana Commercial |
$3,917.01
|
| Rate for Payer: Humana KY Medicaid |
$1,584.78
|
| Rate for Payer: Humana Medicare Advantage |
$35.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$921.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.56
|
| Rate for Payer: PHCS Commercial |
$4,423.92
|
| Rate for Payer: United Healthcare All Payer |
$4,055.26
|
|
|
TRUXIMA 10mg (100mg Vial)
|
Facility
|
IP
|
$4,608.25
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25003880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$599.07 |
| Max. Negotiated Rate |
$4,423.92 |
| Rate for Payer: Aetna Commercial |
$3,548.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.44
|
| Rate for Payer: Cash Price |
$2,304.12
|
| Rate for Payer: Cigna Commercial |
$3,824.85
|
| Rate for Payer: First Health Commercial |
$4,377.84
|
| Rate for Payer: Humana Commercial |
$3,917.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,055.26
|
| Rate for Payer: Ohio Health Group HMO |
$3,456.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$921.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.56
|
| Rate for Payer: PHCS Commercial |
$4,423.92
|
| Rate for Payer: United Healthcare All Payer |
$4,055.26
|
|
|
TRUXIMA 10mg (500mg Vial)
|
Facility
|
OP
|
$23,041.24
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25003881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.89 |
| Max. Negotiated Rate |
$22,119.59 |
| Rate for Payer: Aetna Commercial |
$17,741.75
|
| Rate for Payer: Anthem Medicaid |
$7,923.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,972.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.45
|
| Rate for Payer: Cash Price |
$11,520.62
|
| Rate for Payer: Cash Price |
$11,520.62
|
| Rate for Payer: Cigna Commercial |
$19,124.23
|
| Rate for Payer: First Health Commercial |
$21,889.18
|
| Rate for Payer: Humana Commercial |
$19,585.05
|
| Rate for Payer: Humana KY Medicaid |
$7,923.88
|
| Rate for Payer: Humana Medicare Advantage |
$35.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8,004.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,893.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,004.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,082.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,276.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,280.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,142.78
|
| Rate for Payer: PHCS Commercial |
$22,119.59
|
| Rate for Payer: United Healthcare All Payer |
$20,276.29
|
|
|
TRUXIMA 10mg (500mg Vial)
|
Facility
|
IP
|
$23,041.24
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
25003881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,995.36 |
| Max. Negotiated Rate |
$22,119.59 |
| Rate for Payer: Aetna Commercial |
$17,741.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,972.17
|
| Rate for Payer: Cash Price |
$11,520.62
|
| Rate for Payer: Cigna Commercial |
$19,124.23
|
| Rate for Payer: First Health Commercial |
$21,889.18
|
| Rate for Payer: Humana Commercial |
$19,585.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,893.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,004.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,276.29
|
| Rate for Payer: Ohio Health Group HMO |
$17,280.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,608.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,995.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,142.78
|
| Rate for Payer: PHCS Commercial |
$22,119.59
|
| Rate for Payer: United Healthcare All Payer |
$20,276.29
|
|
|
TRY ME KIT - ACNE
|
Professional
|
Both
|
$20.00
|
|
| Hospital Charge Code |
22200137
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
|
|
TRY ME KIT - AGING
|
Professional
|
Both
|
$20.00
|
|
| Hospital Charge Code |
22200135
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
|
|
TRY ME KIT - SENSITIVE
|
Professional
|
Both
|
$20.00
|
|
| Hospital Charge Code |
22200136
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
|
|
TTE W W/O FOL W/CON STRESS
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$2,649.60 |
| Rate for Payer: Aetna Commercial |
$2,125.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,152.80
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: First Health Commercial |
$2,622.00
|
| Rate for Payer: Humana Commercial |
$2,346.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,263.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,036.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$828.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,428.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,070.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$358.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$2,649.60
|
| Rate for Payer: United Healthcare All Payer |
$2,428.80
|
|
|
TTE W W/O FOL W/CON STRESS
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
HCPCS C8928
|
| Hospital Charge Code |
48300014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$2,649.60 |
| Rate for Payer: Aetna Commercial |
$2,125.20
|
| Rate for Payer: Anthem Medicaid |
$949.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,152.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: First Health Commercial |
$2,622.00
|
| Rate for Payer: Humana Commercial |
$2,346.00
|
| Rate for Payer: Humana KY Medicaid |
$949.16
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$958.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,263.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,036.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$968.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,428.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,070.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$358.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$2,649.60
|
| Rate for Payer: United Healthcare All Payer |
$2,428.80
|
|
|
TTE W W/O FOL W/CON STRESS
|
Professional
|
Both
|
$2,760.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48300014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,760.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$266.92
|
| Rate for Payer: Healthspan PPO |
$319.29
|
| Rate for Payer: Humana Medicaid |
$126.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.60
|
| Rate for Payer: Molina Healthcare Passport |
$126.08
|
| Rate for Payer: Multiplan PHCS |
$1,656.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,932.00
|
| Rate for Payer: UHCCP Medicaid |
$966.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
|
|
TTE W W/O FOL W/CON STRESS (P
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
483P0014
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$266.92
|
| Rate for Payer: Healthspan PPO |
$319.29
|
| Rate for Payer: Humana Medicaid |
$126.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.60
|
| Rate for Payer: Molina Healthcare Passport |
$126.08
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
|
