|
CALORIC VEST TEST BITHERMAL
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
CALORIC VEST TEST BITHERMAL
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$283.80 |
| Rate for Payer: Ambetter Exchange |
$36.28
|
| Rate for Payer: Anthem Medicaid |
$31.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.54
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$67.18
|
| Rate for Payer: Humana Medicaid |
$31.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.33
|
| Rate for Payer: Molina Healthcare Passport |
$31.70
|
| Rate for Payer: Multiplan PHCS |
$283.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.16
|
| Rate for Payer: UHCCP Medicaid |
$165.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.28
|
|
|
CALORIC VEST TEST BITHERMAL
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem Medicaid |
$162.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Humana KY Medicaid |
$162.66
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
CALORIC VEST TEST BITHERMAL(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470P0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Ambetter Exchange |
$36.28
|
| Rate for Payer: Anthem Medicaid |
$31.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.54
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$67.18
|
| Rate for Payer: Humana Medicaid |
$31.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.33
|
| Rate for Payer: Molina Healthcare Passport |
$31.70
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.16
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.28
|
|
|
CALORIC VEST TEST BITHERMAL(T
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470T0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.44
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
CALORIC VEST TEST BITHERMAL(T
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
470T0002
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Aetna Commercial |
$267.96
|
| Rate for Payer: Anthem Medicaid |
$119.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$288.84
|
| Rate for Payer: First Health Commercial |
$330.60
|
| Rate for Payer: Humana Commercial |
$295.80
|
| Rate for Payer: Humana KY Medicaid |
$119.68
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$120.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$285.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$306.24
|
| Rate for Payer: Ohio Health Group HMO |
$261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.12
|
| Rate for Payer: PHCS Commercial |
$334.08
|
| Rate for Payer: United Healthcare All Payer |
$306.24
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem Medicaid |
$142.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Humana KY Medicaid |
$142.03
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$143.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
CALORIC VEST TEST MONOTHERMAL
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$247.80 |
| Rate for Payer: Ambetter Exchange |
$20.39
|
| Rate for Payer: Anthem Medicaid |
$16.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.47
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$34.16
|
| Rate for Payer: Humana Medicaid |
$16.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.42
|
| Rate for Payer: Molina Healthcare Passport |
$16.10
|
| Rate for Payer: Multiplan PHCS |
$247.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.51
|
| Rate for Payer: UHCCP Medicaid |
$144.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.39
|
|
|
CALORIC VEST TEST MONOTHERMA(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470P0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Ambetter Exchange |
$20.39
|
| Rate for Payer: Anthem Medicaid |
$16.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$20.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.47
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$34.16
|
| Rate for Payer: Humana Medicaid |
$16.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$20.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.42
|
| Rate for Payer: Molina Healthcare Passport |
$16.10
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.51
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.39
|
|
|
CALORIC VEST TEST MONOTHERMA(T
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470T0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
CALORIC VEST TEST MONOTHERMA(T
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
470T0003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$116.24 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$116.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Humana KY Medicaid |
$116.24
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$117.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.22
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
[C]AMBIEN (ZOLPIDEM) 5MG TAB
|
Facility
|
IP
|
$60.09
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
25000067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
[C]AMBIEN (ZOLPIDEM) 5MG TAB
|
Facility
|
OP
|
$60.09
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
25000067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
CAMPATH 10MG (30MG/ML VIAL)
|
Facility
|
IP
|
$9,255.63
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
25001838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,776.69 |
| Max. Negotiated Rate |
$8,885.40 |
| Rate for Payer: Aetna Commercial |
$7,126.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,219.39
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cigna Commercial |
$7,682.17
|
| Rate for Payer: First Health Commercial |
$8,792.85
|
| Rate for Payer: Humana Commercial |
$7,867.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,589.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,830.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,776.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,941.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,404.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,052.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,386.38
|
| Rate for Payer: PHCS Commercial |
$8,885.40
|
| Rate for Payer: United Healthcare All Payer |
$8,144.95
|
|
|
CAMPATH 10MG (30MG/ML VIAL)
|
Facility
|
OP
|
$9,255.63
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
25001838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,440.70 |
| Max. Negotiated Rate |
$8,885.40 |
| Rate for Payer: Aetna Commercial |
$7,126.84
|
| Rate for Payer: Anthem Medicaid |
$3,183.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,440.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,219.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,416.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,294.95
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cash Price |
$4,627.81
|
| Rate for Payer: Cigna Commercial |
$7,682.17
|
| Rate for Payer: First Health Commercial |
$8,792.85
|
| Rate for Payer: Humana Commercial |
$7,867.29
|
| Rate for Payer: Humana KY Medicaid |
$3,183.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,440.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,215.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,589.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,830.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,928.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,246.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,941.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,404.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,052.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,386.38
|
| Rate for Payer: PHCS Commercial |
$8,885.40
|
| Rate for Payer: United Healthcare All Payer |
$8,144.95
|
|
|
CAMPOSAR 20MG (100MG)
|
Facility
|
OP
|
$224.92
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$215.92 |
| Rate for Payer: Aetna Commercial |
$173.19
|
| Rate for Payer: Anthem Medicaid |
$77.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.44
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cigna Commercial |
$186.68
|
| Rate for Payer: First Health Commercial |
$213.67
|
| Rate for Payer: Humana Commercial |
$191.18
|
| Rate for Payer: Humana KY Medicaid |
$77.35
|
| Rate for Payer: Kentucky WC Medicaid |
$78.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.93
|
| Rate for Payer: Ohio Health Group HMO |
$168.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.19
|
| Rate for Payer: PHCS Commercial |
$215.92
|
| Rate for Payer: United Healthcare All Payer |
$197.93
|
|
|
CAMPOSAR 20MG (100MG)
|
Facility
|
IP
|
$224.92
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$215.92 |
| Rate for Payer: Aetna Commercial |
$173.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.44
|
| Rate for Payer: Cash Price |
$112.46
|
| Rate for Payer: Cigna Commercial |
$186.68
|
| Rate for Payer: First Health Commercial |
$213.67
|
| Rate for Payer: Humana Commercial |
$191.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.93
|
| Rate for Payer: Ohio Health Group HMO |
$168.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.19
|
| Rate for Payer: PHCS Commercial |
$215.92
|
| Rate for Payer: United Healthcare All Payer |
$197.93
|
|
|
CAMPTOSAR 20MG (40MG)
|
Facility
|
OP
|
$77.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Anthem Medicaid |
$26.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.62
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Cigna Commercial |
$64.51
|
| Rate for Payer: First Health Commercial |
$73.83
|
| Rate for Payer: Humana Commercial |
$66.06
|
| Rate for Payer: Humana KY Medicaid |
$26.73
|
| Rate for Payer: Kentucky WC Medicaid |
$27.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.39
|
| Rate for Payer: Ohio Health Group HMO |
$58.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$74.61
|
| Rate for Payer: United Healthcare All Payer |
$68.39
|
|
|
CAMPTOSAR 20MG (40MG)
|
Facility
|
IP
|
$77.72
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
25002626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$74.61 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.62
|
| Rate for Payer: Cash Price |
$38.86
|
| Rate for Payer: Cigna Commercial |
$64.51
|
| Rate for Payer: First Health Commercial |
$73.83
|
| Rate for Payer: Humana Commercial |
$66.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.39
|
| Rate for Payer: Ohio Health Group HMO |
$58.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$74.61
|
| Rate for Payer: United Healthcare All Payer |
$68.39
|
|
|
CAMPYLOBACTER EIA
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001413
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$16.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| 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 |
$16.07
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Kentucky WC Medicaid |
$16.23
|
| 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 |
$19.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.39
|
| 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
|
|
|
CAMPYLOBACTER EIA
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001413
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000069
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
CANALITH REPOSITIONING PROC
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000069
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
CANASA 1000 MG SUPP RECT
|
Facility
|
OP
|
$22.85
|
|
|
Service Code
|
NDC 70710130207
|
| Hospital Charge Code |
25000368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Anthem Medicaid |
$7.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.82
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna Commercial |
$18.97
|
| Rate for Payer: First Health Commercial |
$21.71
|
| Rate for Payer: Humana Commercial |
$19.42
|
| Rate for Payer: Humana KY Medicaid |
$7.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.11
|
| Rate for Payer: Ohio Health Group HMO |
$17.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.77
|
| Rate for Payer: PHCS Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Payer |
$20.11
|
|
