|
TYPHOID VACCINE IM
|
Facility
|
OP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem Medicaid |
$100.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Humana KY Medicaid |
$100.68
|
| Rate for Payer: Kentucky WC Medicaid |
$101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.00
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM
|
Facility
|
IP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.00
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM
|
Professional
|
Both
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
77000035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.12 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Anthem Medicaid |
$89.12
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Humana Medicaid |
$89.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.90
|
| Rate for Payer: Molina Healthcare Passport |
$89.12
|
| Rate for Payer: Multiplan PHCS |
$175.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$204.93
|
| Rate for Payer: UHCCP Medicaid |
$102.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.01
|
|
|
TYPHOID VACCINE IM(T
|
Facility
|
OP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
770T0035
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem Medicaid |
$100.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Humana KY Medicaid |
$100.68
|
| Rate for Payer: Kentucky WC Medicaid |
$101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.00
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYPHOID VACCINE IM(T
|
Facility
|
IP
|
$292.75
|
|
|
Service Code
|
HCPCS 90691
|
| Hospital Charge Code |
770T0035
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$281.04 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$228.34
|
| Rate for Payer: Cash Price |
$146.38
|
| Rate for Payer: Cigna Commercial |
$242.98
|
| Rate for Payer: First Health Commercial |
$278.11
|
| Rate for Payer: Humana Commercial |
$248.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$240.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$257.62
|
| Rate for Payer: Ohio Health Group HMO |
$219.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.00
|
| Rate for Payer: PHCS Commercial |
$281.04
|
| Rate for Payer: United Healthcare All Payer |
$257.62
|
|
|
TYSABRI 300 MG/15ML VL EA 1 MG
|
Facility
|
OP
|
$10,287.72
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
25002259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$9,876.21 |
| Rate for Payer: Aetna Commercial |
$7,921.54
|
| Rate for Payer: Anthem Medicaid |
$3,537.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,024.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.58
|
| Rate for Payer: Cash Price |
$5,143.86
|
| Rate for Payer: Cash Price |
$5,143.86
|
| Rate for Payer: Cigna Commercial |
$8,538.81
|
| Rate for Payer: First Health Commercial |
$9,773.33
|
| Rate for Payer: Humana Commercial |
$8,744.56
|
| Rate for Payer: Humana KY Medicaid |
$3,537.95
|
| Rate for Payer: Humana Medicare Advantage |
$24.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,573.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,435.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,592.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,608.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,053.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,715.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,230.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,950.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,098.53
|
| Rate for Payer: PHCS Commercial |
$9,876.21
|
| Rate for Payer: United Healthcare All Payer |
$9,053.19
|
|
|
TYSABRI 300 MG/15ML VL EA 1 MG
|
Facility
|
IP
|
$10,287.72
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
25002259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,086.32 |
| Max. Negotiated Rate |
$9,876.21 |
| Rate for Payer: Aetna Commercial |
$7,921.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,024.42
|
| Rate for Payer: Cash Price |
$5,143.86
|
| Rate for Payer: Cigna Commercial |
$8,538.81
|
| Rate for Payer: First Health Commercial |
$9,773.33
|
| Rate for Payer: Humana Commercial |
$8,744.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,435.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,592.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,086.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,053.19
|
| Rate for Payer: Ohio Health Group HMO |
$7,715.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,230.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,950.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,098.53
|
| Rate for Payer: PHCS Commercial |
$9,876.21
|
| Rate for Payer: United Healthcare All Payer |
$9,053.19
|
|
|
TZANCK SMEAR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$5.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TZANCK SMEAR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
TZANCK SMEAR
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$5.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30002031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Ambetter Exchange |
$5.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.19
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$28.16
|
| Rate for Payer: Healthspan PPO |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.99
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.79
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.99
|
|
|
TZANCK SMEAR (P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300P2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Ambetter Exchange |
$5.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.19
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$28.16
|
| Rate for Payer: Healthspan PPO |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.99
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.79
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.99
|
|
|
TZANCK SMEAR (T
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300T2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
TZANCK SMEAR (T
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
300T2031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$5.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
U2 FEM AUG PSA POST #4 8MM
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
U2 FEM AUG PSA POST #4 8MM
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
UA W/ MICRO
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna Commercial |
$5.97
|
| Rate for Payer: Ambetter Exchange |
$3.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: Healthspan PPO |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.17
|
| Rate for Payer: Multiplan PHCS |
$25.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$15.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.17
|
|
|
UA W/ MICRO
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$3.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$3.17
|
| Rate for Payer: Humana Medicare Advantage |
$3.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
UA W/ MICRO
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
UDENYCA 6MG/0.6ML SYRINGE
|
Facility
|
OP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25002736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.04 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem Medicaid |
$7,825.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.65
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Humana KY Medicaid |
$7,825.01
|
| Rate for Payer: Humana Medicare Advantage |
$136.04
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.09
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA 6MG/0.6ML SYRINGE
|
Facility
|
IP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25002736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,826.12 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.09
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA OBI 0.5MG(6MG/0.6ML)
|
Facility
|
IP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25004491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,826.12 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.09
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
UDENYCA OBI 0.5MG(6MG/0.6ML)
|
Facility
|
OP
|
$22,753.75
|
|
|
Service Code
|
HCPCS Q5111
|
| Hospital Charge Code |
25004491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.04 |
| Max. Negotiated Rate |
$21,843.60 |
| Rate for Payer: Aetna Commercial |
$17,520.39
|
| Rate for Payer: Anthem Medicaid |
$7,825.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,747.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.65
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cash Price |
$11,376.88
|
| Rate for Payer: Cigna Commercial |
$18,885.61
|
| Rate for Payer: First Health Commercial |
$21,616.06
|
| Rate for Payer: Humana Commercial |
$19,340.69
|
| Rate for Payer: Humana KY Medicaid |
$7,825.01
|
| Rate for Payer: Humana Medicare Advantage |
$136.04
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.09
|
| Rate for Payer: PHCS Commercial |
$21,843.60
|
| Rate for Payer: United Healthcare All Payer |
$20,023.30
|
|
|
ULNA COMPONENT LRG LEFT
|
Facility
|
IP
|
$11,803.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,540.90 |
| Max. Negotiated Rate |
$11,330.89 |
| Rate for Payer: Aetna Commercial |
$9,088.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,206.35
|
| Rate for Payer: Cash Price |
$5,901.50
|
| Rate for Payer: Cigna Commercial |
$9,796.50
|
| Rate for Payer: First Health Commercial |
$11,212.86
|
| Rate for Payer: Humana Commercial |
$10,032.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,678.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,710.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,386.65
|
| Rate for Payer: Ohio Health Group HMO |
$8,852.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,442.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,268.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,144.08
|
| Rate for Payer: PHCS Commercial |
$11,330.89
|
| Rate for Payer: United Healthcare All Payer |
$10,386.65
|
|
