|
CALIBRATED TAP 3.5MM
|
Facility
|
OP
|
$3,104.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.53 |
| Max. Negotiated Rate |
$2,979.89 |
| Rate for Payer: Aetna Commercial |
$2,390.12
|
| Rate for Payer: Anthem Medicaid |
$1,067.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.16
|
| Rate for Payer: Cash Price |
$1,552.03
|
| Rate for Payer: Cigna Commercial |
$2,576.36
|
| Rate for Payer: First Health Commercial |
$2,948.85
|
| Rate for Payer: Humana Commercial |
$2,638.44
|
| Rate for Payer: Humana KY Medicaid |
$1,067.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,078.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,545.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.26
|
| Rate for Payer: PHCS Commercial |
$2,979.89
|
| Rate for Payer: United Healthcare All Payer |
$2,731.56
|
|
|
CALIBRATED TAP 4.5MM
|
Facility
|
IP
|
$3,104.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.53 |
| Max. Negotiated Rate |
$2,979.89 |
| Rate for Payer: Aetna Commercial |
$2,390.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.16
|
| Rate for Payer: Cash Price |
$1,552.03
|
| Rate for Payer: Cigna Commercial |
$2,576.36
|
| Rate for Payer: First Health Commercial |
$2,948.85
|
| Rate for Payer: Humana Commercial |
$2,638.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,545.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.26
|
| Rate for Payer: PHCS Commercial |
$2,979.89
|
| Rate for Payer: United Healthcare All Payer |
$2,731.56
|
|
|
CALIBRATED TAP 4.5MM
|
Facility
|
OP
|
$3,104.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.53 |
| Max. Negotiated Rate |
$2,979.89 |
| Rate for Payer: Aetna Commercial |
$2,390.12
|
| Rate for Payer: Anthem Medicaid |
$1,067.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.16
|
| Rate for Payer: Cash Price |
$1,552.03
|
| Rate for Payer: Cigna Commercial |
$2,576.36
|
| Rate for Payer: First Health Commercial |
$2,948.85
|
| Rate for Payer: Humana Commercial |
$2,638.44
|
| Rate for Payer: Humana KY Medicaid |
$1,067.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,078.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,545.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.26
|
| Rate for Payer: PHCS Commercial |
$2,979.89
|
| Rate for Payer: United Healthcare All Payer |
$2,731.56
|
|
|
CALM AFTER THE STORM
|
Professional
|
Both
|
$94.00
|
|
| Hospital Charge Code |
22200125
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.80
|
| Rate for Payer: UHCCP Medicaid |
$32.90
|
|
|
CALM AFTER THE STORM EYE CRE
|
Professional
|
Both
|
$75.00
|
|
| Hospital Charge Code |
22200126
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
|
|
CALM IT DOWN KIT
|
Professional
|
Both
|
$220.00
|
|
| Hospital Charge Code |
22200133
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
|
|
CALMOSEPTINE TUBE OINT 120GM
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 10135070104
|
| Hospital Charge Code |
25000366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.10
|
| Rate for Payer: First Health Commercial |
$0.11
|
| Rate for Payer: Humana Commercial |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.11
|
| Rate for Payer: Ohio Health Group HMO |
$0.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Payer |
$0.11
|
|
|
CALMOSEPTINE TUBE OINT 120GM
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 10135070104
|
| Hospital Charge Code |
25000366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Anthem Medicaid |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.10
|
| Rate for Payer: First Health Commercial |
$0.11
|
| Rate for Payer: Humana Commercial |
$0.10
|
| Rate for Payer: Humana KY Medicaid |
$0.04
|
| Rate for Payer: Kentucky WC Medicaid |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.11
|
| Rate for Payer: Ohio Health Group HMO |
$0.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Payer |
$0.11
|
|
|
CALORIC VEST TEST BITHERMAL
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
|
CALORIC VEST TEST BITHERMAL
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Anthem Medicaid |
$31.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$452.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$67.18
|
| Rate for Payer: Humana Medicaid |
$31.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.33
|
| Rate for Payer: Molina Healthcare Passport |
$31.70
|
| Rate for Payer: Multiplan PHCS |
$271.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$316.40
|
| Rate for Payer: UHCCP Medicaid |
$158.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.02
|
|
|
CALORIC VEST TEST BITHERMAL
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$433.92 |
| Rate for Payer: Aetna Commercial |
$348.04
|
| Rate for Payer: Anthem Medicaid |
$155.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cash Price |
$226.00
|
| Rate for Payer: Cigna Commercial |
$375.16
|
| Rate for Payer: First Health Commercial |
$429.40
|
| Rate for Payer: Humana Commercial |
$384.20
|
| Rate for Payer: Humana KY Medicaid |
$155.44
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$157.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.76
|
| Rate for Payer: Ohio Health Group HMO |
$339.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.12
|
| Rate for Payer: PHCS Commercial |
$433.92
|
| Rate for Payer: United Healthcare All Payer |
$397.76
|
|
|
CALORIC VEST TEST BITHERMAL(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470P0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Anthem Medicaid |
$31.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$67.18
|
| Rate for Payer: Humana Medicaid |
$31.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.33
|
| Rate for Payer: Molina Healthcare Passport |
$31.70
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.02
|
|
|
CALORIC VEST TEST BITHERMAL(T
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470T0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
CALORIC VEST TEST BITHERMAL(T
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470T0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Anthem Medicaid |
$16.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$34.16
|
| Rate for Payer: Humana Medicaid |
$16.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.42
|
| Rate for Payer: Molina Healthcare Passport |
$16.10
|
| Rate for Payer: Multiplan PHCS |
$241.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.40
|
| Rate for Payer: UHCCP Medicaid |
$140.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.26
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
CALORIC VEST TEST MONOTHERMA(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470P0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Anthem Medicaid |
$16.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$34.16
|
| Rate for Payer: Humana Medicaid |
$16.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.42
|
| Rate for Payer: Molina Healthcare Passport |
$16.10
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.26
|
|
|
CALORIC VEST TEST MONOTHERMA(T
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470T0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
CALORIC VEST TEST MONOTHERMA(T
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470T0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
[C]AMBIEN (ZOLPIDEM) 5MG TAB
|
Facility
|
OP
|
$60.09
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
25000067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
[C]AMBIEN (ZOLPIDEM) 5MG TAB
|
Facility
|
IP
|
$60.09
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
25000067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
CAMPATH 10MG (30MG/ML VIAL)
|
Facility
|
OP
|
$9,255.63
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
25001838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,203.23 |
| Max. Negotiated Rate |
$8,885.40 |
| Rate for Payer: Aetna Commercial |
$7,126.84
|
| Rate for Payer: Anthem Medicaid |
$3,183.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,324.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,219.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,254.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,137.86
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cigna Commercial |
$7,682.17
|
| Rate for Payer: First Health Commercial |
$8,792.85
|
| Rate for Payer: Humana Commercial |
$7,867.29
|
| Rate for Payer: Humana KY Medicaid |
$3,183.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,324.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,215.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,589.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,830.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,246.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,941.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,851.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,203.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,869.25
|
| Rate for Payer: PHCS Commercial |
$8,885.40
|
| Rate for Payer: United Healthcare All Payer |
$8,144.95
|
|
|
CAMPATH 10MG (30MG/ML VIAL)
|
Facility
|
IP
|
$9,255.63
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
25001838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,203.23 |
| Max. Negotiated Rate |
$8,885.40 |
| Rate for Payer: Humana Commercial |
$7,867.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,589.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,830.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,776.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,941.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,851.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,203.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,869.25
|
| Rate for Payer: PHCS Commercial |
$8,885.40
|
| Rate for Payer: United Healthcare All Payer |
$8,144.95
|
| Rate for Payer: Aetna Commercial |
$7,126.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,219.39
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cigna Commercial |
$7,682.17
|
| Rate for Payer: First Health Commercial |
$8,792.85
|
|
|
CAMPOSAR 20MG (100MG)
|
Facility
|
IP
|
$224.92
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$215.92 |
| Rate for Payer: Aetna Commercial |
$173.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.44
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cigna Commercial |
$186.68
|
| Rate for Payer: First Health Commercial |
$213.67
|
| Rate for Payer: Humana Commercial |
$191.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.93
|
| Rate for Payer: Ohio Health Group HMO |
$168.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.73
|
| Rate for Payer: PHCS Commercial |
$215.92
|
| Rate for Payer: United Healthcare All Payer |
$197.93
|
|
