|
XYLOCAINE(LIDOCAINE 250MG/50ML
|
Facility
IP
|
$77.32
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna Commercial |
$59.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.31
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna Commercial |
$64.18
|
| Rate for Payer: First Health Commercial |
$73.45
|
| Rate for Payer: Humana Commercial |
$65.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.04
|
| Rate for Payer: Ohio Health Group HMO |
$57.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.97
|
| Rate for Payer: PHCS Commercial |
$74.23
|
|
|
XYLOCAINE(LIDOCAINE 250MG/50ML
|
Facility
OP
|
$77.32
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna Commercial |
$59.54
|
| Rate for Payer: Anthem Medicaid |
$26.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.31
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna Commercial |
$64.18
|
| Rate for Payer: First Health Commercial |
$73.45
|
| Rate for Payer: Humana Commercial |
$65.72
|
| Rate for Payer: Humana KY Medicaid |
$26.59
|
| Rate for Payer: Kentucky WC Medicaid |
$26.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.04
|
| Rate for Payer: Ohio Health Group HMO |
$57.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.97
|
| Rate for Payer: PHCS Commercial |
$74.23
|
| Rate for Payer: United Healthcare All Payer |
$68.04
|
|
|
XYLOCAINE (LIDOCAINE) 2%/50 ML
|
Facility
OP
|
$109.13
|
|
| Hospital Charge Code |
25003852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Aetna Commercial |
$84.03
|
| Rate for Payer: Anthem Medicaid |
$37.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cigna Commercial |
$90.58
|
| Rate for Payer: First Health Commercial |
$103.67
|
| Rate for Payer: Humana Commercial |
$92.76
|
| Rate for Payer: Humana KY Medicaid |
$37.53
|
| Rate for Payer: Kentucky WC Medicaid |
$37.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.03
|
| Rate for Payer: Ohio Health Group HMO |
$81.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.83
|
| Rate for Payer: PHCS Commercial |
$104.76
|
| Rate for Payer: United Healthcare All Payer |
$96.03
|
|
|
XYLOCAINE (LIDOCAINE) 2%/50 ML
|
Facility
IP
|
$109.13
|
|
| Hospital Charge Code |
25003852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Aetna Commercial |
$84.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$54.56
|
| Rate for Payer: Cigna Commercial |
$90.58
|
| Rate for Payer: First Health Commercial |
$103.67
|
| Rate for Payer: Humana Commercial |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.03
|
| Rate for Payer: Ohio Health Group HMO |
$81.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.83
|
| Rate for Payer: PHCS Commercial |
$104.76
|
|
|
XYLOCAINE MPF 1%+EPINEP 1:200K
|
Facility
IP
|
$113.83
|
|
| Hospital Charge Code |
25003622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$87.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.79
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna Commercial |
$94.48
|
| Rate for Payer: First Health Commercial |
$108.14
|
| Rate for Payer: Humana Commercial |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.17
|
| Rate for Payer: Ohio Health Group HMO |
$85.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.29
|
| Rate for Payer: PHCS Commercial |
$109.28
|
|
|
XYLOCAINE MPF 1%+EPINEP 1:200K
|
Facility
OP
|
$113.83
|
|
| Hospital Charge Code |
25003622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$87.65
|
| Rate for Payer: Anthem Medicaid |
$39.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.79
|
| Rate for Payer: Cash Price |
$56.92
|
| Rate for Payer: Cigna Commercial |
$94.48
|
| Rate for Payer: First Health Commercial |
$108.14
|
| Rate for Payer: Humana Commercial |
$96.76
|
| Rate for Payer: Humana KY Medicaid |
$39.15
|
| Rate for Payer: Kentucky WC Medicaid |
$39.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.17
|
| Rate for Payer: Ohio Health Group HMO |
$85.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.29
|
| Rate for Payer: PHCS Commercial |
$109.28
|
| Rate for Payer: United Healthcare All Payer |
$100.17
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
IP
|
$108.03
|
|
| Hospital Charge Code |
636T0123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.71 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.26
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.66
|
| Rate for Payer: First Health Commercial |
$102.63
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.07
|
| Rate for Payer: Ohio Health Group HMO |
$81.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.71
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
OP
|
$108.93
|
|
| Hospital Charge Code |
25004045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$104.57 |
| Rate for Payer: Aetna Commercial |
$83.88
|
| Rate for Payer: Anthem Medicaid |
$37.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.97
|
| Rate for Payer: Cash Price |
$54.47
|
| Rate for Payer: Cigna Commercial |
$90.41
|
| Rate for Payer: First Health Commercial |
$103.48
|
| Rate for Payer: Humana Commercial |
$92.59
|
| Rate for Payer: Humana KY Medicaid |
$37.46
|
| Rate for Payer: Kentucky WC Medicaid |
$37.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.86
|
| Rate for Payer: Ohio Health Group HMO |
$81.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.77
|
| Rate for Payer: PHCS Commercial |
$104.57
|
| Rate for Payer: United Healthcare All Payer |
$95.86
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
IP
|
$108.03
|
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.71 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.26
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.66
|
| Rate for Payer: First Health Commercial |
$102.63
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.07
|
| Rate for Payer: Ohio Health Group HMO |
$81.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.71
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
OP
|
$108.03
|
|
| Hospital Charge Code |
636T0123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.71 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Anthem Medicaid |
$37.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.26
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.66
|
| Rate for Payer: First Health Commercial |
$102.63
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Humana KY Medicaid |
$37.15
|
| Rate for Payer: Kentucky WC Medicaid |
$37.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.07
|
| Rate for Payer: Ohio Health Group HMO |
$81.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.71
|
| Rate for Payer: United Healthcare All Payer |
$95.07
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
OP
|
$108.03
|
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.71 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Anthem Medicaid |
$37.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.26
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.66
|
| Rate for Payer: First Health Commercial |
$102.63
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Humana KY Medicaid |
$37.15
|
| Rate for Payer: Kentucky WC Medicaid |
$37.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.07
|
| Rate for Payer: Ohio Health Group HMO |
$81.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.71
|
| Rate for Payer: United Healthcare All Payer |
$95.07
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Professional
|
$108.03
|
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$108.03 |
| Rate for Payer: Buckeye Medicare Advantage |
$108.03
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Multiplan PHCS |
$64.82
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.62
|
| Rate for Payer: UHCCP Medicaid |
$37.81
|
|
|
XYLOCAINE-MPF 2% AMPUL
|
Facility
IP
|
$108.93
|
|
| Hospital Charge Code |
25004045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$104.57 |
| Rate for Payer: Aetna Commercial |
$83.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.97
|
| Rate for Payer: Cash Price |
$54.47
|
| Rate for Payer: Cigna Commercial |
$90.41
|
| Rate for Payer: First Health Commercial |
$103.48
|
| Rate for Payer: Humana Commercial |
$92.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.86
|
| Rate for Payer: Ohio Health Group HMO |
$81.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.77
|
| Rate for Payer: PHCS Commercial |
$104.57
|
|
|
XYLOCAINE MPF 2% RT TX VI A5ML
|
Facility
OP
|
$75.21
|
|
| Hospital Charge Code |
25003626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Anthem Medicaid |
$25.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.66
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna Commercial |
$62.42
|
| Rate for Payer: First Health Commercial |
$71.45
|
| Rate for Payer: Humana Commercial |
$63.93
|
| Rate for Payer: Humana KY Medicaid |
$25.86
|
| Rate for Payer: Kentucky WC Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.18
|
| Rate for Payer: Ohio Health Group HMO |
$56.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.32
|
| Rate for Payer: PHCS Commercial |
$72.20
|
| Rate for Payer: United Healthcare All Payer |
$66.18
|
|
|
XYLOCAINE MPF 2% RT TX VI A5ML
|
Facility
IP
|
$75.21
|
|
| Hospital Charge Code |
25003626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.66
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cigna Commercial |
$62.42
|
| Rate for Payer: First Health Commercial |
$71.45
|
| Rate for Payer: Humana Commercial |
$63.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.18
|
| Rate for Payer: Ohio Health Group HMO |
$56.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.32
|
| Rate for Payer: PHCS Commercial |
$72.20
|
|
|
YEAST DEFINITIVE IDENTIF
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
30001276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
|
|
YEAST DEFINITIVE IDENTIF
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
30001276
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| 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 |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| 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 |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| 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 |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
YERSINIA ENTEROCOLITIEA
|
Facility
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001266
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
YERSINIA ENTEROCOLITIEA
|
Facility
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001266
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
|
|
YERVOY 1mg (200mg Vial)
|
Facility
IP
|
$179,181.82
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23,293.64 |
| Max. Negotiated Rate |
$172,014.55 |
| Rate for Payer: Aetna Commercial |
$137,970.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139,761.82
|
| Rate for Payer: Cash Price |
$89,590.91
|
| Rate for Payer: Cigna Commercial |
$148,720.91
|
| Rate for Payer: First Health Commercial |
$170,222.73
|
| Rate for Payer: Humana Commercial |
$152,304.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146,929.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132,236.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53,754.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$157,680.00
|
| Rate for Payer: Ohio Health Group HMO |
$134,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35,836.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,293.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,546.36
|
| Rate for Payer: PHCS Commercial |
$172,014.55
|
|
|
YERVOY 1mg (200mg Vial)
|
Facility
OP
|
$179,181.82
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$172,014.55 |
| Rate for Payer: Aetna Commercial |
$137,970.00
|
| Rate for Payer: Anthem Medicaid |
$61,620.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139,761.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.77
|
| Rate for Payer: Cash Price |
$89,590.91
|
| Rate for Payer: Cash Price |
$89,590.91
|
| Rate for Payer: Cigna Commercial |
$148,720.91
|
| Rate for Payer: First Health Commercial |
$170,222.73
|
| Rate for Payer: Humana Commercial |
$152,304.55
|
| Rate for Payer: Humana KY Medicaid |
$61,620.63
|
| Rate for Payer: Humana Medicare Advantage |
$172.42
|
| Rate for Payer: Kentucky WC Medicaid |
$62,247.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146,929.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132,236.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$62,856.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$157,680.00
|
| Rate for Payer: Ohio Health Group HMO |
$134,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35,836.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,293.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55,546.36
|
| Rate for Payer: PHCS Commercial |
$172,014.55
|
| Rate for Payer: United Healthcare All Payer |
$157,680.00
|
|
|
YERVOY 1mg (50mg Vial)
|
Facility
IP
|
$44,795.57
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,823.42 |
| Max. Negotiated Rate |
$43,003.75 |
| Rate for Payer: Aetna Commercial |
$34,492.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34,940.54
|
| Rate for Payer: Cash Price |
$22,397.78
|
| Rate for Payer: Cigna Commercial |
$37,180.32
|
| Rate for Payer: First Health Commercial |
$42,555.79
|
| Rate for Payer: Humana Commercial |
$38,076.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36,732.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33,059.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,438.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$39,420.10
|
| Rate for Payer: Ohio Health Group HMO |
$33,596.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,959.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,823.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,886.63
|
| Rate for Payer: PHCS Commercial |
$43,003.75
|
|
|
YERVOY 1mg (50mg Vial)
|
Facility
OP
|
$44,795.57
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.42 |
| Max. Negotiated Rate |
$43,003.75 |
| Rate for Payer: Aetna Commercial |
$34,492.59
|
| Rate for Payer: Anthem Medicaid |
$15,405.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34,940.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.77
|
| Rate for Payer: Cash Price |
$22,397.78
|
| Rate for Payer: Cash Price |
$22,397.78
|
| Rate for Payer: Cigna Commercial |
$37,180.32
|
| Rate for Payer: First Health Commercial |
$42,555.79
|
| Rate for Payer: Humana Commercial |
$38,076.23
|
| Rate for Payer: Humana KY Medicaid |
$15,405.20
|
| Rate for Payer: Humana Medicare Advantage |
$172.42
|
| Rate for Payer: Kentucky WC Medicaid |
$15,561.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36,732.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33,059.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,714.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$39,420.10
|
| Rate for Payer: Ohio Health Group HMO |
$33,596.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,959.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,823.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,886.63
|
| Rate for Payer: PHCS Commercial |
$43,003.75
|
| Rate for Payer: United Healthcare All Payer |
$39,420.10
|
|
|
YOKE OSS REINFORCED
|
Facility
IP
|
$8,629.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,644.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,731.03
|
| Rate for Payer: Cash Price |
$4,314.76
|
| Rate for Payer: Cigna Commercial |
$7,162.50
|
| Rate for Payer: First Health Commercial |
$8,198.04
|
| Rate for Payer: Humana Commercial |
$7,335.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,076.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,368.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,588.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,593.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,472.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.15
|
| Rate for Payer: PHCS Commercial |
$8,284.34
|
|
|
YOKE OSS REINFORCED
|
Facility
OP
|
$8,629.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,644.73
|
| Rate for Payer: Anthem Medicaid |
$2,967.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,731.03
|
| Rate for Payer: Cash Price |
$4,314.76
|
| Rate for Payer: Cigna Commercial |
$7,162.50
|
| Rate for Payer: First Health Commercial |
$8,198.04
|
| Rate for Payer: Humana Commercial |
$7,335.09
|
| Rate for Payer: Humana KY Medicaid |
$2,967.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,076.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,368.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,588.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,027.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,593.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,472.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.15
|
| Rate for Payer: PHCS Commercial |
$8,284.34
|
| Rate for Payer: United Healthcare All Payer |
$7,593.98
|
|
