|
CAMPOSAR 20MG (100MG)
|
Facility
|
OP
|
$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: 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: Humana KY Medicaid |
$77.35
|
| Rate for Payer: Kentucky WC Medicaid |
$78.14
|
| 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: Molina Healthcare Medicaid |
$78.90
|
| 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
|
| Rate for Payer: Aetna Commercial |
$173.19
|
| Rate for Payer: Anthem Medicaid |
$77.35
|
|
|
CAMPTOSAR 20MG (40MG)
|
Facility
|
OP
|
$77.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Anthem Medicaid |
$26.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.62
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Cigna Commercial |
$64.51
|
| Rate for Payer: First Health Commercial |
$73.83
|
| Rate for Payer: Humana Commercial |
$66.06
|
| Rate for Payer: Humana KY Medicaid |
$26.73
|
| Rate for Payer: Kentucky WC Medicaid |
$27.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.39
|
| Rate for Payer: Ohio Health Group HMO |
$58.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.09
|
| Rate for Payer: PHCS Commercial |
$74.61
|
| Rate for Payer: United Healthcare All Payer |
$68.39
|
|
|
CAMPTOSAR 20MG (40MG)
|
Facility
|
IP
|
$77.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.62
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Cigna Commercial |
$64.51
|
| Rate for Payer: First Health Commercial |
$73.83
|
| Rate for Payer: Humana Commercial |
$66.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.39
|
| Rate for Payer: Ohio Health Group HMO |
$58.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.09
|
| Rate for Payer: PHCS Commercial |
$74.61
|
| Rate for Payer: United Healthcare All Payer |
$68.39
|
|
|
CAMPYLOBACTER EIA
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001413
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$16.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$16.07
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Kentucky WC Medicaid |
$16.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CAMPYLOBACTER EIA
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001413
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000069
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000069
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
CANASA 1000 MG SUPP RECT
|
Facility
|
IP
|
$22.85
|
|
|
Service Code
|
NDC 70710130207
|
| Hospital Charge Code |
25000368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.82
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna Commercial |
$18.97
|
| Rate for Payer: First Health Commercial |
$21.71
|
| Rate for Payer: Humana Commercial |
$19.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.11
|
| Rate for Payer: Ohio Health Group HMO |
$17.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.08
|
| Rate for Payer: PHCS Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Payer |
$20.11
|
|
|
CANASA 1000 MG SUPP RECT
|
Facility
|
OP
|
$22.85
|
|
|
Service Code
|
NDC 70710130207
|
| Hospital Charge Code |
25000368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Anthem Medicaid |
$7.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.82
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna Commercial |
$18.97
|
| Rate for Payer: First Health Commercial |
$21.71
|
| Rate for Payer: Humana Commercial |
$19.42
|
| Rate for Payer: Humana KY Medicaid |
$7.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.11
|
| Rate for Payer: Ohio Health Group HMO |
$17.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.08
|
| Rate for Payer: PHCS Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Payer |
$20.11
|
|
|
CANCIDAS 5MG [50MG VIAL]
|
Facility
|
OP
|
$917.71
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$881.00 |
| Rate for Payer: Aetna Commercial |
$706.64
|
| Rate for Payer: Anthem Medicaid |
$315.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.81
|
| Rate for Payer: Cash Price |
$458.86
|
| Rate for Payer: Cigna Commercial |
$761.70
|
| Rate for Payer: First Health Commercial |
$871.82
|
| Rate for Payer: Humana Commercial |
$780.05
|
| Rate for Payer: Humana KY Medicaid |
$315.60
|
| Rate for Payer: Kentucky WC Medicaid |
$318.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$321.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.58
|
| Rate for Payer: Ohio Health Group HMO |
$688.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.49
|
| Rate for Payer: PHCS Commercial |
$881.00
|
| Rate for Payer: United Healthcare All Payer |
$807.58
|
|
|
CANCIDAS 5MG [50MG VIAL]
|
Facility
|
IP
|
$917.71
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$881.00 |
| Rate for Payer: Aetna Commercial |
$706.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.81
|
| Rate for Payer: Cash Price |
$458.86
|
| Rate for Payer: Cigna Commercial |
$761.70
|
| Rate for Payer: First Health Commercial |
$871.82
|
| Rate for Payer: Humana Commercial |
$780.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.58
|
| Rate for Payer: Ohio Health Group HMO |
$688.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.49
|
| Rate for Payer: PHCS Commercial |
$881.00
|
| Rate for Payer: United Healthcare All Payer |
$807.58
|
|
|
CANCIDAS 5MG [70MG VIAL]
|
Facility
|
OP
|
$930.88
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.01 |
| Max. Negotiated Rate |
$893.64 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem Medicaid |
$320.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.09
|
| Rate for Payer: Cash Price |
$465.44
|
| Rate for Payer: Cigna Commercial |
$772.63
|
| Rate for Payer: First Health Commercial |
$884.34
|
| Rate for Payer: Humana Commercial |
$791.25
|
| Rate for Payer: Humana KY Medicaid |
$320.13
|
| Rate for Payer: Kentucky WC Medicaid |
$323.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.17
|
| Rate for Payer: Ohio Health Group HMO |
$698.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.57
|
| Rate for Payer: PHCS Commercial |
$893.64
|
| Rate for Payer: United Healthcare All Payer |
$819.17
|
|
|
CANCIDAS 5MG [70MG VIAL]
|
Facility
|
IP
|
$930.88
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.01 |
| Max. Negotiated Rate |
$893.64 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.09
|
| Rate for Payer: Cash Price |
$465.44
|
| Rate for Payer: Cigna Commercial |
$772.63
|
| Rate for Payer: First Health Commercial |
$884.34
|
| Rate for Payer: Humana Commercial |
$791.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.17
|
| Rate for Payer: Ohio Health Group HMO |
$698.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.57
|
| Rate for Payer: PHCS Commercial |
$893.64
|
| Rate for Payer: United Healthcare All Payer |
$819.17
|
|
|
CANDIDA ALBICANS (MONILLA) IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CANDIDA ALBICANS (MONILLA) IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CANDIDA ALBICANS PCR
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
CANDIDA ALBICANS PCR
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
CANDIDA ALBICANS PCR
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.50
|
| Rate for Payer: UHCCP Medicaid |
$54.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
CANDIDA GLABRATA PCR
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
CANDIDA GLABRATA PCR
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.50
|
| Rate for Payer: UHCCP Medicaid |
$54.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
CANDIDA GLABRATA PCR
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
CANDIDA SKIN TEST .1ML
|
Facility
|
OP
|
$185.60
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
25002923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$178.18 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Anthem Medicaid |
$63.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.77
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna Commercial |
$154.05
|
| Rate for Payer: First Health Commercial |
$176.32
|
| Rate for Payer: Humana Commercial |
$157.76
|
| Rate for Payer: Humana KY Medicaid |
$63.83
|
| Rate for Payer: Kentucky WC Medicaid |
$64.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.33
|
| Rate for Payer: Ohio Health Group HMO |
$139.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.54
|
| Rate for Payer: PHCS Commercial |
$178.18
|
| Rate for Payer: United Healthcare All Payer |
$163.33
|
|
|
CANDIDA SKIN TEST .1ML
|
Facility
|
IP
|
$185.60
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
25002923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$178.18 |
| Rate for Payer: Aetna Commercial |
$142.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.77
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cigna Commercial |
$154.05
|
| Rate for Payer: First Health Commercial |
$176.32
|
| Rate for Payer: Humana Commercial |
$157.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.33
|
| Rate for Payer: Ohio Health Group HMO |
$139.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.54
|
| Rate for Payer: PHCS Commercial |
$178.18
|
| Rate for Payer: United Healthcare All Payer |
$163.33
|
|
|
CANN REVISION DOWEL 11*32MM
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
CANN REVISION DOWEL 11*32MM
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
