|
Chest Lsr HairRem-PP #1 50%
|
Professional
|
Both
|
$702.00
|
|
| Hospital Charge Code |
22200348
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$702.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Multiplan PHCS |
$421.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$491.40
|
| Rate for Payer: UHCCP Medicaid |
$245.70
|
|
|
Chest Lsr HairRem-PP#2/3 25%
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
22200464
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$8,464.82
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$5,743.98 |
| Max. Negotiated Rate |
$8,464.82 |
| Rate for Payer: Anthem Medicaid |
$5,743.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,046.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,464.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,162.50
|
| Rate for Payer: Humana KY Medicaid |
$5,743.98
|
| Rate for Payer: Humana Medicare Advantage |
$6,046.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5,801.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,255.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.86
|
|
|
CHEST ULTRASOUND
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna Commercial |
$131.28
|
| Rate for Payer: Anthem Medicaid |
$59.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$887.00
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$118.97
|
| Rate for Payer: Healthspan PPO |
$123.02
|
| Rate for Payer: Humana Medicaid |
$59.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.48
|
| Rate for Payer: Molina Healthcare Passport |
$59.29
|
| Rate for Payer: Multiplan PHCS |
$532.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.90
|
| Rate for Payer: UHCCP Medicaid |
$310.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.88
|
|
|
CHEST ULTRASOUND
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
CHEST ULTRASOUND
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
CHEST ULTRASOUND(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402P0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$131.28
|
| Rate for Payer: Anthem Medicaid |
$59.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$118.97
|
| Rate for Payer: Healthspan PPO |
$123.02
|
| Rate for Payer: Humana Medicaid |
$59.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.48
|
| Rate for Payer: Molina Healthcare Passport |
$59.29
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.88
|
|
|
CHEST ULTRASOUND(T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402T0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
CHEST ULTRASOUND(T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402T0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
CHILDRENS MOTRIN (E 100MG/5ML
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
|
|
CHILDRENS MOTRIN (E 100MG/5ML
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$430,993.47
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$292,459.86 |
| Max. Negotiated Rate |
$430,993.47 |
| Rate for Payer: Anthem Medicaid |
$292,459.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$307,852.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$430,993.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$415,600.85
|
| Rate for Payer: Humana KY Medicaid |
$292,459.86
|
| Rate for Payer: Humana Medicare Advantage |
$307,852.48
|
| Rate for Payer: Kentucky WC Medicaid |
$295,384.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369,422.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$298,309.05
|
|
|
Chin Laser Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200178
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
Chin LsrHairRem-PP #1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200342
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
Chin LsrHairRem-PP #2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200458
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
|
CHIRHOSTIM 1MCG (16MCG VIAL)
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
25002357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem Medicaid |
$504.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.35
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Humana KY Medicaid |
$504.50
|
| Rate for Payer: Humana Medicare Advantage |
$41.74
|
| Rate for Payer: Kentucky WC Medicaid |
$509.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.77
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
|
CHIRHOSTIM 1MCG (16MCG VIAL)
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
25002357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.71 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$454.77
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.00
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$65.00
|
| Rate for Payer: Multiplan PHCS |
$90.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.70
|
| Rate for Payer: UHCCP Medicaid |
$52.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| 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 |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
CHLAMYDOPHILA PNEUMONIAE
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
30001366
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
CHLAMYDOPHILA PNEUMONIAE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
30001366
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| 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 |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
CHLORAMPHENICOL [1 GM] 1GM VL
|
Facility
|
IP
|
$204.65
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
25001960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.63
|
| Rate for Payer: Cash Price |
$102.33
|
| Rate for Payer: Cigna Commercial |
$169.86
|
| Rate for Payer: First Health Commercial |
$194.42
|
| Rate for Payer: Humana Commercial |
$173.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.09
|
| Rate for Payer: Ohio Health Group HMO |
$153.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.44
|
| Rate for Payer: PHCS Commercial |
$196.46
|
| Rate for Payer: United Healthcare All Payer |
$180.09
|
|
|
CHLORAMPHENICOL [1 GM] 1GM VL
|
Facility
|
OP
|
$204.65
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
25001960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Anthem Medicaid |
$70.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.63
|
| Rate for Payer: Cash Price |
$102.33
|
| Rate for Payer: Cigna Commercial |
$169.86
|
| Rate for Payer: First Health Commercial |
$194.42
|
| Rate for Payer: Humana Commercial |
$173.95
|
| Rate for Payer: Humana KY Medicaid |
$70.38
|
| Rate for Payer: Kentucky WC Medicaid |
$71.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.09
|
| Rate for Payer: Ohio Health Group HMO |
$153.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.44
|
| Rate for Payer: PHCS Commercial |
$196.46
|
| Rate for Payer: United Healthcare All Payer |
$180.09
|
|
|
CHLORASEPTIC (PHENOL) SPRA 6OZ
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 78112001104
|
| Hospital Charge Code |
25000415
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.02
|
| Rate for Payer: Humana Commercial |
$0.02
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.02
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Payer |
$0.02
|
| Rate for Payer: Aetna Commercial |
$0.02
|
|
