|
CARBOCAINE(MEPIVACAINE) 1 30ML
|
Facility
|
OP
|
$115.57
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
25001923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.95 |
| Rate for Payer: Aetna Commercial |
$88.99
|
| Rate for Payer: Anthem Medicaid |
$39.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.14
|
| Rate for Payer: Cash Price |
$57.78
|
| Rate for Payer: Cigna Commercial |
$95.92
|
| Rate for Payer: First Health Commercial |
$109.79
|
| Rate for Payer: Humana Commercial |
$98.23
|
| Rate for Payer: Humana KY Medicaid |
$39.74
|
| Rate for Payer: Kentucky WC Medicaid |
$40.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.70
|
| Rate for Payer: Ohio Health Group HMO |
$86.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.83
|
| Rate for Payer: PHCS Commercial |
$110.95
|
| Rate for Payer: United Healthcare All Payer |
$101.70
|
|
|
CARBOCAINE(MEPIVACAINE) 1 30ML
|
Facility
|
IP
|
$115.57
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
25001923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$110.95 |
| Rate for Payer: Aetna Commercial |
$88.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.14
|
| Rate for Payer: Cash Price |
$57.78
|
| Rate for Payer: Cigna Commercial |
$95.92
|
| Rate for Payer: First Health Commercial |
$109.79
|
| Rate for Payer: Humana Commercial |
$98.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.70
|
| Rate for Payer: Ohio Health Group HMO |
$86.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.83
|
| Rate for Payer: PHCS Commercial |
$110.95
|
| Rate for Payer: United Healthcare All Payer |
$101.70
|
|
|
CARBON CONNECTING ROD 3MMX40MM
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON CONNECTING ROD 3MMX40MM
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON CONNECTING ROD 3MMX50MM
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON CONNECTING ROD 3MMX50MM
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON CONNECTING ROD 3MMX60MM
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON CONNECTING ROD 3MMX60MM
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
CARBON DIOXIDE DIFFUSION
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem Medicaid |
$102.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Humana KY Medicaid |
$102.83
|
| Rate for Payer: Kentucky WC Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.69
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
CARBON DIOXIDE DIFFUSION
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$87.34
|
| Rate for Payer: Healthspan PPO |
$45.09
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$179.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$209.30
|
| Rate for Payer: UHCCP Medicaid |
$104.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
|
|
CARBON DIOXIDE DIFFUSION
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.69
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
CARBON DIOXIDE DIFFUSION(P
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460P0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$87.34
|
| Rate for Payer: Healthspan PPO |
$45.09
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.80
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
|
|
CARBON DIOXIDE DIFFUSION(T
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460T0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CARBON DIOXIDE DIFFUSION(T
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460T0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CARBON MONOXIDE QUANTITATIVE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
30000264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$12.32
|
| Rate for Payer: Humana Medicare Advantage |
$12.32
|
| Rate for Payer: Kentucky WC Medicaid |
$12.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
CARBON MONOXIDE QUANTITATIVE
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
30000264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
CARBOPLATIN 50MG/5ML
|
Facility
|
OP
|
$73.03
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25002577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Anthem Medicaid |
$25.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.96
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Cigna Commercial |
$60.61
|
| Rate for Payer: First Health Commercial |
$69.38
|
| Rate for Payer: Humana Commercial |
$62.08
|
| Rate for Payer: Humana KY Medicaid |
$25.12
|
| Rate for Payer: Kentucky WC Medicaid |
$25.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.27
|
| Rate for Payer: Ohio Health Group HMO |
$54.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.64
|
| Rate for Payer: PHCS Commercial |
$70.11
|
| Rate for Payer: United Healthcare All Payer |
$64.27
|
|
|
CARBOPLATIN 50MG/5ML
|
Facility
|
IP
|
$73.03
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25002577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.96
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Cigna Commercial |
$60.61
|
| Rate for Payer: First Health Commercial |
$69.38
|
| Rate for Payer: Humana Commercial |
$62.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.27
|
| Rate for Payer: Ohio Health Group HMO |
$54.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.64
|
| Rate for Payer: PHCS Commercial |
$70.11
|
| Rate for Payer: United Healthcare All Payer |
$64.27
|
|
|
CARBOPLATIN 50MG (FROM 150MG M
|
Facility
|
IP
|
$42.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$32.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.95
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cigna Commercial |
$35.06
|
| Rate for Payer: First Health Commercial |
$40.13
|
| Rate for Payer: Humana Commercial |
$35.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.17
|
| Rate for Payer: Ohio Health Group HMO |
$31.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.09
|
| Rate for Payer: PHCS Commercial |
$40.55
|
| Rate for Payer: United Healthcare All Payer |
$37.17
|
|
|
CARBOPLATIN 50MG (FROM 150MG M
|
Facility
|
OP
|
$42.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$14.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.95
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cigna Commercial |
$35.06
|
| Rate for Payer: First Health Commercial |
$40.13
|
| Rate for Payer: Humana Commercial |
$35.90
|
| Rate for Payer: Humana KY Medicaid |
$14.53
|
| Rate for Payer: Kentucky WC Medicaid |
$14.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.17
|
| Rate for Payer: Ohio Health Group HMO |
$31.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.09
|
| Rate for Payer: PHCS Commercial |
$40.55
|
| Rate for Payer: United Healthcare All Payer |
$37.17
|
|
|
CARBOPLATIN 50MG (FROM 450MG M
|
Facility
|
IP
|
$39.35
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$30.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.69
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cigna Commercial |
$32.66
|
| Rate for Payer: First Health Commercial |
$37.38
|
| Rate for Payer: Humana Commercial |
$33.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.63
|
| Rate for Payer: Ohio Health Group HMO |
$29.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.20
|
| Rate for Payer: PHCS Commercial |
$37.78
|
| Rate for Payer: United Healthcare All Payer |
$34.63
|
|
|
CARBOPLATIN 50MG (FROM 450MG M
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$30.30
|
| Rate for Payer: Anthem Medicaid |
$13.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.69
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cigna Commercial |
$32.66
|
| Rate for Payer: First Health Commercial |
$37.38
|
| Rate for Payer: Humana Commercial |
$33.45
|
| Rate for Payer: Humana KY Medicaid |
$13.53
|
| Rate for Payer: Kentucky WC Medicaid |
$13.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.63
|
| Rate for Payer: Ohio Health Group HMO |
$29.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.20
|
| Rate for Payer: PHCS Commercial |
$37.78
|
| Rate for Payer: United Healthcare All Payer |
$34.63
|
|
|
CARBOPLATIN 50MG (FROM 600MG M
|
Facility
|
IP
|
$26.87
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.96
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$22.30
|
| Rate for Payer: First Health Commercial |
$25.53
|
| Rate for Payer: Humana Commercial |
$22.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.65
|
| Rate for Payer: Ohio Health Group HMO |
$20.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.33
|
| Rate for Payer: PHCS Commercial |
$25.80
|
| Rate for Payer: United Healthcare All Payer |
$23.65
|
|
|
CARBOPLATIN 50MG (FROM 600MG M
|
Facility
|
OP
|
$26.87
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Anthem Medicaid |
$9.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.96
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$22.30
|
| Rate for Payer: First Health Commercial |
$25.53
|
| Rate for Payer: Humana Commercial |
$22.84
|
| Rate for Payer: Humana KY Medicaid |
$9.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.65
|
| Rate for Payer: Ohio Health Group HMO |
$20.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.33
|
| Rate for Payer: PHCS Commercial |
$25.80
|
| Rate for Payer: United Healthcare All Payer |
$23.65
|
|
|
CARCINOEMBRYONICANTIGEN/CEA
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
30000266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$204.48 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Anthem Medicaid |
$18.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.96
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$176.79
|
| Rate for Payer: First Health Commercial |
$202.35
|
| Rate for Payer: Humana Commercial |
$181.05
|
| Rate for Payer: Humana KY Medicaid |
$18.96
|
| Rate for Payer: Humana Medicare Advantage |
$18.96
|
| Rate for Payer: Kentucky WC Medicaid |
$19.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.44
|
| Rate for Payer: Ohio Health Group HMO |
$159.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.03
|
| Rate for Payer: PHCS Commercial |
$204.48
|
| Rate for Payer: United Healthcare All Payer |
$187.44
|
|
