|
CHOLECYSTOSTOMY W/IMAG
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
76101955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CHOLECYSTOSTOMY W/IMAG(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
761P1955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.22 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$794.55
|
| Rate for Payer: Anthem Medicaid |
$282.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$745.17
|
| Rate for Payer: Healthspan PPO |
$670.06
|
| Rate for Payer: Humana Medicaid |
$282.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.86
|
| Rate for Payer: Molina Healthcare Passport |
$282.22
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.04
|
|
|
CHOLESTEROL
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$9.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.00
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Healthspan PPO |
$4.56
|
| Rate for Payer: Multiplan PHCS |
$31.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.10
|
| Rate for Payer: UHCCP Medicaid |
$18.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.61
|
|
|
CHOLESTEROL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$4.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.35
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$4.35
|
| Rate for Payer: Humana Medicare Advantage |
$4.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
CHOLESTEROL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
30000280
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
CHROMOGENIC FACTOR
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
30001797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.07 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.52
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
CHROMOGENIC FACTOR
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
30001797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem Medicaid |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.89
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Humana KY Medicaid |
$11.89
|
| Rate for Payer: Humana Medicare Advantage |
$11.89
|
| Rate for Payer: Kentucky WC Medicaid |
$12.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.09
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$9,931.77
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$6,739.41 |
| Max. Negotiated Rate |
$9,931.77 |
| Rate for Payer: Anthem Medicaid |
$6,739.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,094.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,931.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,577.06
|
| Rate for Payer: Humana KY Medicaid |
$6,739.41
|
| Rate for Payer: Humana Medicare Advantage |
$7,094.12
|
| Rate for Payer: Kentucky WC Medicaid |
$6,806.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,512.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,874.20
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$12,891.41
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$8,747.74 |
| Max. Negotiated Rate |
$12,891.41 |
| Rate for Payer: Anthem Medicaid |
$8,747.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,208.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,891.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,431.00
|
| Rate for Payer: Humana KY Medicaid |
$8,747.74
|
| Rate for Payer: Humana Medicare Advantage |
$9,208.15
|
| Rate for Payer: Kentucky WC Medicaid |
$8,835.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,049.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,922.70
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$7,507.91
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,094.65 |
| Max. Negotiated Rate |
$7,507.91 |
| Rate for Payer: Anthem Medicaid |
$5,094.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,362.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,507.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,239.77
|
| Rate for Payer: Humana KY Medicaid |
$5,094.65
|
| Rate for Payer: Humana Medicare Advantage |
$5,362.79
|
| Rate for Payer: Kentucky WC Medicaid |
$5,145.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,435.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,196.54
|
|
|
CICLOPIROX 8% SOLUTION 6.6ML
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 45802014167
|
| Hospital Charge Code |
25002938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Anthem Medicaid |
$1.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.57
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.74
|
| Rate for Payer: First Health Commercial |
$3.14
|
| Rate for Payer: Humana Commercial |
$2.80
|
| Rate for Payer: Humana KY Medicaid |
$1.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.90
|
| Rate for Payer: Ohio Health Group HMO |
$2.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.02
|
| Rate for Payer: PHCS Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Payer |
$2.90
|
|
|
CICLOPIROX 8% SOLUTION 6.6ML
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 45802014167
|
| Hospital Charge Code |
25002938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.57
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.74
|
| Rate for Payer: First Health Commercial |
$3.14
|
| Rate for Payer: Humana Commercial |
$2.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.90
|
| Rate for Payer: Ohio Health Group HMO |
$2.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.02
|
| Rate for Payer: PHCS Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Payer |
$2.90
|
|
|
CILOXAN (CIPROFLOXACI)3% 2.5ML
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Anthem Medicaid |
$0.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.42
|
| Rate for Payer: First Health Commercial |
$1.62
|
| Rate for Payer: Humana Commercial |
$1.45
|
| Rate for Payer: Humana KY Medicaid |
$0.59
|
| Rate for Payer: Kentucky WC Medicaid |
$0.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.50
|
| Rate for Payer: Ohio Health Group HMO |
$1.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.53
|
| Rate for Payer: PHCS Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Payer |
$1.50
|
|
|
CILOXAN (CIPROFLOXACI)3% 2.5ML
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.42
|
| Rate for Payer: First Health Commercial |
$1.62
|
| Rate for Payer: Humana Commercial |
$1.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.50
|
| Rate for Payer: Ohio Health Group HMO |
$1.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.53
|
| Rate for Payer: PHCS Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Payer |
$1.50
|
|
|
CILOXAN(CIPROFLOXACIN)3.5GMONT
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
NDC 78084101
|
| Hospital Charge Code |
25002940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
CILOXAN(CIPROFLOXACIN)3.5GMONT
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
NDC 78084101
|
| Hospital Charge Code |
25002940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$755.00 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Anthem Medicaid |
$96.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.00
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$120.01
|
| Rate for Payer: Healthspan PPO |
$126.45
|
| Rate for Payer: Humana Medicaid |
$96.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.04
|
| Rate for Payer: Molina Healthcare Passport |
$96.12
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.08
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
CINE/VID X-RAY THROAT/ESOPH(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320P0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Anthem Medicaid |
$96.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$120.01
|
| Rate for Payer: Healthspan PPO |
$126.45
|
| Rate for Payer: Humana Medicaid |
$96.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.04
|
| Rate for Payer: Molina Healthcare Passport |
$96.12
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.08
|
|
|
CINE/VID X-RAY THROAT/ESOPH(T
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320T0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$628.80 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem Medicaid |
$225.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Humana KY Medicaid |
$225.25
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$227.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$229.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.05
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
|
CINE/VID X-RAY THROAT/ESOPH(T
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320T0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$628.80 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.05
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
|
CINQAIR 10MG/ML VIAL (10ML)
|
Facility
|
OP
|
$5,951.40
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
25002341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$5,713.34 |
| Rate for Payer: Aetna Commercial |
$4,582.58
|
| Rate for Payer: Anthem Medicaid |
$2,046.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,642.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.73
|
| Rate for Payer: Cash Price |
$2,975.70
|
| Rate for Payer: Cash Price |
$2,975.70
|
| Rate for Payer: Cigna Commercial |
$4,939.66
|
| Rate for Payer: First Health Commercial |
$5,653.83
|
| Rate for Payer: Humana Commercial |
$5,058.69
|
| Rate for Payer: Humana KY Medicaid |
$2,046.69
|
| Rate for Payer: Humana Medicare Advantage |
$10.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,067.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,880.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,392.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,087.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,237.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,463.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$773.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,844.93
|
| Rate for Payer: PHCS Commercial |
$5,713.34
|
| Rate for Payer: United Healthcare All Payer |
$5,237.23
|
|
|
CINQAIR 10MG/ML VIAL (10ML)
|
Facility
|
IP
|
$5,951.40
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
25002341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$773.68 |
| Max. Negotiated Rate |
$5,713.34 |
| Rate for Payer: Aetna Commercial |
$4,582.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,642.09
|
| Rate for Payer: Cash Price |
$2,975.70
|
| Rate for Payer: Cigna Commercial |
$4,939.66
|
| Rate for Payer: First Health Commercial |
$5,653.83
|
| Rate for Payer: Humana Commercial |
$5,058.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,880.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,392.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,785.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,237.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,463.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$773.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,844.93
|
| Rate for Payer: PHCS Commercial |
$5,713.34
|
| Rate for Payer: United Healthcare All Payer |
$5,237.23
|
|
