|
CALCIUM GLUC 10MG(4.6mEq SDV)
|
Facility
|
OP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25004387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem Medicaid |
$18.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.60
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: First Health Commercial |
$51.88
|
| Rate for Payer: Humana Commercial |
$46.42
|
| Rate for Payer: Humana KY Medicaid |
$18.78
|
| Rate for Payer: Kentucky WC Medicaid |
$18.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.06
|
| Rate for Payer: Ohio Health Group HMO |
$40.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUCONATE 23MEQ/50ML
|
Facility
|
IP
|
$182.98
|
|
|
Service Code
|
NDC 63323036059
|
| Hospital Charge Code |
25003806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.72
|
| Rate for Payer: Cash Price |
$91.49
|
| Rate for Payer: Cigna Commercial |
$151.87
|
| Rate for Payer: First Health Commercial |
$173.83
|
| Rate for Payer: Humana Commercial |
$155.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.02
|
| Rate for Payer: Ohio Health Group HMO |
$137.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.26
|
| Rate for Payer: PHCS Commercial |
$175.66
|
| Rate for Payer: United Healthcare All Payer |
$161.02
|
|
|
CALCIUM GLUCONATE 23MEQ/50ML
|
Facility
|
OP
|
$182.98
|
|
|
Service Code
|
NDC 63323036059
|
| Hospital Charge Code |
25003806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.72
|
| Rate for Payer: Cash Price |
$91.49
|
| Rate for Payer: Cigna Commercial |
$151.87
|
| Rate for Payer: First Health Commercial |
$173.83
|
| Rate for Payer: Humana Commercial |
$155.53
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.02
|
| Rate for Payer: Ohio Health Group HMO |
$137.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.26
|
| Rate for Payer: PHCS Commercial |
$175.66
|
| Rate for Payer: United Healthcare All Payer |
$161.02
|
|
|
CALCIUM SERUM
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
30000259
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CALCIUM SERUM
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
30000259
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$5.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$5.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CALCULUS (STONE) ANALYSIS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
CALCULUS (STONE) ANALYSIS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Ambetter Exchange |
$11.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.90
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Healthspan PPO |
$9.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.58
|
| Rate for Payer: Multiplan PHCS |
$34.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$19.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.58
|
|
|
CALCULUS (STONE) ANALYSIS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$11.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.58
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$11.58
|
| Rate for Payer: Humana Medicare Advantage |
$11.58
|
| Rate for Payer: Kentucky WC Medicaid |
$11.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
CALIBRATED DRILL 6.2M*48.2C
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CALIBRATED DRILL 6.2M*48.2C
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CALIBRATED TAP 3.5MM
|
Facility
|
IP
|
$2,968.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.59 |
| Max. Negotiated Rate |
$2,849.88 |
| Rate for Payer: Aetna Commercial |
$2,285.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,315.52
|
| Rate for Payer: Cash Price |
$1,484.31
|
| Rate for Payer: Cigna Commercial |
$2,463.95
|
| Rate for Payer: First Health Commercial |
$2,820.19
|
| Rate for Payer: Humana Commercial |
$2,523.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,434.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,612.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,226.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,582.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.35
|
| Rate for Payer: PHCS Commercial |
$2,849.88
|
| Rate for Payer: United Healthcare All Payer |
$2,612.39
|
|
|
CALIBRATED TAP 3.5MM
|
Facility
|
OP
|
$2,968.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.59 |
| Max. Negotiated Rate |
$2,849.88 |
| Rate for Payer: Aetna Commercial |
$2,285.84
|
| Rate for Payer: Anthem Medicaid |
$1,020.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,315.52
|
| Rate for Payer: Cash Price |
$1,484.31
|
| Rate for Payer: Cigna Commercial |
$2,463.95
|
| Rate for Payer: First Health Commercial |
$2,820.19
|
| Rate for Payer: Humana Commercial |
$2,523.33
|
| Rate for Payer: Humana KY Medicaid |
$1,020.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,434.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,612.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,226.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,582.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.35
|
| Rate for Payer: PHCS Commercial |
$2,849.88
|
| Rate for Payer: United Healthcare All Payer |
$2,612.39
|
|
|
CALIBRATED TAP 4.5MM
|
Facility
|
IP
|
$2,968.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.59 |
| Max. Negotiated Rate |
$2,849.88 |
| Rate for Payer: Aetna Commercial |
$2,285.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,315.52
|
| Rate for Payer: Cash Price |
$1,484.31
|
| Rate for Payer: Cigna Commercial |
$2,463.95
|
| Rate for Payer: First Health Commercial |
$2,820.19
|
| Rate for Payer: Humana Commercial |
$2,523.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,434.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,612.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,226.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,582.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.35
|
| Rate for Payer: PHCS Commercial |
$2,849.88
|
| Rate for Payer: United Healthcare All Payer |
$2,612.39
|
|
|
CALIBRATED TAP 4.5MM
|
Facility
|
OP
|
$2,968.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.59 |
| Max. Negotiated Rate |
$2,849.88 |
| Rate for Payer: Aetna Commercial |
$2,285.84
|
| Rate for Payer: Anthem Medicaid |
$1,020.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,315.52
|
| Rate for Payer: Cash Price |
$1,484.31
|
| Rate for Payer: Cigna Commercial |
$2,463.95
|
| Rate for Payer: First Health Commercial |
$2,820.19
|
| Rate for Payer: Humana Commercial |
$2,523.33
|
| Rate for Payer: Humana KY Medicaid |
$1,020.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,434.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,612.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,226.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,582.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,048.35
|
| Rate for Payer: PHCS Commercial |
$2,849.88
|
| Rate for Payer: United Healthcare All Payer |
$2,612.39
|
|
|
CALM AFTER THE STORM
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
22200125
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$32.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$32.33
|
| Rate for Payer: Kentucky WC Medicaid |
$32.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
CALM AFTER THE STORM
|
Professional
|
Both
|
$94.00
|
|
| Hospital Charge Code |
22200125
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.80
|
| Rate for Payer: UHCCP Medicaid |
$32.90
|
|
|
CALM AFTER THE STORM
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
22200125
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
CALM AFTER THE STORM EYE CRE
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
22200126
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
CALM AFTER THE STORM EYE CRE
|
Professional
|
Both
|
$75.00
|
|
| Hospital Charge Code |
22200126
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
|
|
CALM AFTER THE STORM EYE CRE
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
22200126
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
CALM IT DOWN KIT
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
22200133
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
CALM IT DOWN KIT
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
22200133
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
CALM IT DOWN KIT
|
Professional
|
Both
|
$220.00
|
|
| Hospital Charge Code |
22200133
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
|
|
CALMOSEPTINE TUBE OINT 120GM
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 10135070104
|
| Hospital Charge Code |
25000366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.10
|
| Rate for Payer: First Health Commercial |
$0.11
|
| Rate for Payer: Humana Commercial |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.11
|
| Rate for Payer: Ohio Health Group HMO |
$0.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Payer |
$0.11
|
|
|
CALMOSEPTINE TUBE OINT 120GM
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 10135070104
|
| Hospital Charge Code |
25000366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Aetna Commercial |
$0.09
|
| Rate for Payer: Anthem Medicaid |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.10
|
| Rate for Payer: First Health Commercial |
$0.11
|
| Rate for Payer: Humana Commercial |
$0.10
|
| Rate for Payer: Humana KY Medicaid |
$0.04
|
| Rate for Payer: Kentucky WC Medicaid |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.11
|
| Rate for Payer: Ohio Health Group HMO |
$0.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Payer |
$0.11
|
|
