|
CIRCUMCISION NEONATE
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
76102131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$1,365.12 |
| Rate for Payer: Aetna Commercial |
$1,094.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,109.16
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$1,180.26
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: Humana Commercial |
$1,208.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,166.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,049.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,251.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.82
|
| Rate for Payer: PHCS Commercial |
$1,365.12
|
| Rate for Payer: United Healthcare All Payer |
$1,251.36
|
|
|
CIRCUMCISION NEONATE
|
Professional
|
Both
|
$1,422.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
76102131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Aetna Commercial |
$236.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$120.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,422.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$209.22
|
| Rate for Payer: Healthspan PPO |
$357.03
|
| Rate for Payer: Humana Medicaid |
$120.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.35
|
| Rate for Payer: Molina Healthcare Passport |
$120.93
|
| Rate for Payer: Multiplan PHCS |
$853.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$995.40
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.14
|
|
|
CIRCUMCISION NEONATE(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
761P2131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$236.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$120.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$209.22
|
| Rate for Payer: Healthspan PPO |
$357.03
|
| Rate for Payer: Humana Medicaid |
$120.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.35
|
| Rate for Payer: Molina Healthcare Passport |
$120.93
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.14
|
|
|
CIRCUMCISION NEONATE(T
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
761T2131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.61 |
| Max. Negotiated Rate |
$827.01 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem Medicaid |
$274.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Humana KY Medicaid |
$274.09
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$276.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.07
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
CIRCUMCISION NEONATE(T
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
761T2131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.61 |
| Max. Negotiated Rate |
$765.12 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.07
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.34 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Professional
|
Both
|
$6,539.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
76102130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$6,539.00 |
| Rate for Payer: Aetna Commercial |
$161.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$76.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,539.00
|
| Rate for Payer: Cash Price |
$3,269.50
|
| Rate for Payer: Cash Price |
$3,269.50
|
| Rate for Payer: Cigna Commercial |
$212.89
|
| Rate for Payer: Healthspan PPO |
$258.71
|
| Rate for Payer: Humana Medicaid |
$76.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.80
|
| Rate for Payer: Molina Healthcare Passport |
$76.27
|
| Rate for Payer: Multiplan PHCS |
$3,923.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,577.30
|
| Rate for Payer: UHCCP Medicaid |
$53.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.03
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$6,539.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
76102130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.07 |
| Max. Negotiated Rate |
$6,277.44 |
| Rate for Payer: Aetna Commercial |
$5,035.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,100.42
|
| Rate for Payer: Cash Price |
$3,269.50
|
| Rate for Payer: Cigna Commercial |
$5,427.37
|
| Rate for Payer: First Health Commercial |
$6,212.05
|
| Rate for Payer: Humana Commercial |
$5,558.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,361.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,825.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,961.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,754.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,904.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.09
|
| Rate for Payer: PHCS Commercial |
$6,277.44
|
| Rate for Payer: United Healthcare All Payer |
$5,754.32
|
|
|
CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$6,539.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
76102130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.07 |
| Max. Negotiated Rate |
$6,277.44 |
| Rate for Payer: Aetna Commercial |
$5,035.03
|
| Rate for Payer: Anthem Medicaid |
$2,248.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,100.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,269.50
|
| Rate for Payer: Cash Price |
$3,269.50
|
| Rate for Payer: Cigna Commercial |
$5,427.37
|
| Rate for Payer: First Health Commercial |
$6,212.05
|
| Rate for Payer: Humana Commercial |
$5,558.15
|
| Rate for Payer: Humana KY Medicaid |
$2,248.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,271.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,361.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,825.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,293.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,754.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,904.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.09
|
| Rate for Payer: PHCS Commercial |
$6,277.44
|
| Rate for Payer: United Healthcare All Payer |
$5,754.32
|
|
|
CIRCUMCISION W/REGIONL BLOC(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761P2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$161.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$76.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$212.89
|
| Rate for Payer: Healthspan PPO |
$258.71
|
| Rate for Payer: Humana Medicaid |
$76.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.80
|
| Rate for Payer: Molina Healthcare Passport |
$76.27
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$53.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.03
|
|
|
CIRCUMCISION W/REGIONL BLOC(T
|
Facility
|
IP
|
$6,089.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761T2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$791.57 |
| Max. Negotiated Rate |
$5,845.44 |
| Rate for Payer: Aetna Commercial |
$4,688.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,749.42
|
| Rate for Payer: Cash Price |
$3,044.50
|
| Rate for Payer: Cigna Commercial |
$5,053.87
|
| Rate for Payer: First Health Commercial |
$5,784.55
|
| Rate for Payer: Humana Commercial |
$5,175.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,992.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,493.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,826.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,358.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,887.59
|
| Rate for Payer: PHCS Commercial |
$5,845.44
|
| Rate for Payer: United Healthcare All Payer |
$5,358.32
|
|
|
CIRCUMCISION W/REGIONL BLOC(T
|
Facility
|
OP
|
$6,089.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761T2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$791.57 |
| Max. Negotiated Rate |
$5,845.44 |
| Rate for Payer: Aetna Commercial |
$4,688.53
|
| Rate for Payer: Anthem Medicaid |
$2,094.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,749.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,044.50
|
| Rate for Payer: Cash Price |
$3,044.50
|
| Rate for Payer: Cigna Commercial |
$5,053.87
|
| Rate for Payer: First Health Commercial |
$5,784.55
|
| Rate for Payer: Humana Commercial |
$5,175.65
|
| Rate for Payer: Humana KY Medicaid |
$2,094.01
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,115.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,992.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,493.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,136.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,358.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,566.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,887.59
|
| Rate for Payer: PHCS Commercial |
$5,845.44
|
| Rate for Payer: United Healthcare All Payer |
$5,358.32
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$12,060.85
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,184.15 |
| Max. Negotiated Rate |
$12,060.85 |
| Rate for Payer: Anthem Medicaid |
$8,184.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,614.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,060.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,630.10
|
| Rate for Payer: Humana KY Medicaid |
$8,184.15
|
| Rate for Payer: Humana Medicare Advantage |
$8,614.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8,265.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,337.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,347.83
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$22,413.76
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$15,209.34 |
| Max. Negotiated Rate |
$22,413.76 |
| Rate for Payer: Anthem Medicaid |
$15,209.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,009.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,413.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,613.27
|
| Rate for Payer: Humana KY Medicaid |
$15,209.34
|
| Rate for Payer: Humana Medicare Advantage |
$16,009.83
|
| Rate for Payer: Kentucky WC Medicaid |
$15,361.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,211.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,513.53
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$7,831.95
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$5,314.54 |
| Max. Negotiated Rate |
$7,831.95 |
| Rate for Payer: Anthem Medicaid |
$5,314.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,594.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,831.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,552.24
|
| Rate for Payer: Humana KY Medicaid |
$5,314.54
|
| Rate for Payer: Humana Medicare Advantage |
$5,594.25
|
| Rate for Payer: Kentucky WC Medicaid |
$5,367.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,713.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,420.83
|
|
|
CISATRACURIUM 10mg/5mL VIAL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
25004153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CISATRACURIUM 10mg/5mL VIAL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
25004153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CISATRACURIUM 200 MG/20 ML
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
NDC 781315395
|
| Hospital Charge Code |
25002460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CISATRACURIUM 200 MG/20 ML
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
NDC 781315395
|
| Hospital Charge Code |
25002460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CISPLATIN 10MG (FROM 100MG MDV
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Anthem Medicaid |
$7.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna Commercial |
$18.62
|
| Rate for Payer: First Health Commercial |
$21.31
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Humana KY Medicaid |
$7.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.74
|
| Rate for Payer: Ohio Health Group HMO |
$16.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.95
|
| Rate for Payer: PHCS Commercial |
$21.53
|
| Rate for Payer: United Healthcare All Payer |
$19.74
|
|
|
CISPLATIN 10MG (FROM 100MG MDV
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna Commercial |
$18.62
|
| Rate for Payer: First Health Commercial |
$21.31
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.74
|
| Rate for Payer: Ohio Health Group HMO |
$16.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.95
|
| Rate for Payer: PHCS Commercial |
$21.53
|
| Rate for Payer: United Healthcare All Payer |
$19.74
|
|
|
CISPLATIN 10MG (FROM 50MG MDV)
|
Facility
|
IP
|
$21.96
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.13
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: Cigna Commercial |
$18.23
|
| Rate for Payer: First Health Commercial |
$20.86
|
| Rate for Payer: Humana Commercial |
$18.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.32
|
| Rate for Payer: Ohio Health Group HMO |
$16.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.81
|
| Rate for Payer: PHCS Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Payer |
$19.32
|
|
|
CISPLATIN 10MG (FROM 50MG MDV)
|
Facility
|
OP
|
$21.96
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Anthem Medicaid |
$7.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.13
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: Cigna Commercial |
$18.23
|
| Rate for Payer: First Health Commercial |
$20.86
|
| Rate for Payer: Humana Commercial |
$18.67
|
| Rate for Payer: Humana KY Medicaid |
$7.55
|
| Rate for Payer: Kentucky WC Medicaid |
$7.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.32
|
| Rate for Payer: Ohio Health Group HMO |
$16.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.81
|
| Rate for Payer: PHCS Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Payer |
$19.32
|
|
|
CITROBACTER OMPA MRKC GENES
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
CITROBACTER OMPA MRKC GENES
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
