|
CANASA 1000 MG SUPP RECT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CANCIDAS 5MG [50MG VIAL]
|
Facility
|
OP
|
$917.71
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.31 |
| Max. Negotiated Rate |
$881.00 |
| Rate for Payer: Aetna Commercial |
$706.64
|
| Rate for Payer: Anthem Medicaid |
$315.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.81
|
| Rate for Payer: Cash Price |
$458.86
|
| Rate for Payer: Cigna Commercial |
$761.70
|
| Rate for Payer: First Health Commercial |
$871.82
|
| Rate for Payer: Humana Commercial |
$780.05
|
| Rate for Payer: Humana KY Medicaid |
$315.60
|
| Rate for Payer: Kentucky WC Medicaid |
$318.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$321.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.58
|
| Rate for Payer: Ohio Health Group HMO |
$688.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.22
|
| Rate for Payer: PHCS Commercial |
$881.00
|
| Rate for Payer: United Healthcare All Payer |
$807.58
|
|
|
CANCIDAS 5MG [50MG VIAL]
|
Facility
|
IP
|
$917.71
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.31 |
| Max. Negotiated Rate |
$881.00 |
| Rate for Payer: Aetna Commercial |
$706.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.81
|
| Rate for Payer: Cash Price |
$458.86
|
| Rate for Payer: Cigna Commercial |
$761.70
|
| Rate for Payer: First Health Commercial |
$871.82
|
| Rate for Payer: Humana Commercial |
$780.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$752.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$807.58
|
| Rate for Payer: Ohio Health Group HMO |
$688.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.22
|
| Rate for Payer: PHCS Commercial |
$881.00
|
| Rate for Payer: United Healthcare All Payer |
$807.58
|
|
|
CANCIDAS 5MG [70MG VIAL]
|
Facility
|
OP
|
$930.88
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$893.64 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem Medicaid |
$320.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.09
|
| Rate for Payer: Cash Price |
$465.44
|
| Rate for Payer: Cigna Commercial |
$772.63
|
| Rate for Payer: First Health Commercial |
$884.34
|
| Rate for Payer: Humana Commercial |
$791.25
|
| Rate for Payer: Humana KY Medicaid |
$320.13
|
| Rate for Payer: Kentucky WC Medicaid |
$323.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.17
|
| Rate for Payer: Ohio Health Group HMO |
$698.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.31
|
| Rate for Payer: PHCS Commercial |
$893.64
|
| Rate for Payer: United Healthcare All Payer |
$819.17
|
|
|
CANCIDAS 5MG [70MG VIAL]
|
Facility
|
IP
|
$930.88
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
25001917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$893.64 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.09
|
| Rate for Payer: Cash Price |
$465.44
|
| Rate for Payer: Cigna Commercial |
$772.63
|
| Rate for Payer: First Health Commercial |
$884.34
|
| Rate for Payer: Humana Commercial |
$791.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.17
|
| Rate for Payer: Ohio Health Group HMO |
$698.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.31
|
| Rate for Payer: PHCS Commercial |
$893.64
|
| Rate for Payer: United Healthcare All Payer |
$819.17
|
|
|
CANDIDA ALBICANS (MONILLA) IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CANDIDA ALBICANS (MONILLA) IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000827
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CANDIDA ALBICANS PCR
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
CANDIDA ALBICANS PCR
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
CANDIDA ALBICANS PCR
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001364
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$98.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$57.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
CANDIDA GLABRATA PCR
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
CANDIDA GLABRATA PCR
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
CANDIDA GLABRATA PCR
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
30001365
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$98.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$57.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
CANDIDA SKIN TEST .1ML
|
Facility
|
IP
|
$188.20
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
25002923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$180.67 |
| Rate for Payer: Aetna Commercial |
$144.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.80
|
| Rate for Payer: Cash Price |
$94.10
|
| Rate for Payer: Cigna Commercial |
$156.21
|
| Rate for Payer: First Health Commercial |
$178.79
|
| Rate for Payer: Humana Commercial |
$159.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.62
|
| Rate for Payer: Ohio Health Group HMO |
$141.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.86
|
| Rate for Payer: PHCS Commercial |
$180.67
|
| Rate for Payer: United Healthcare All Payer |
$165.62
|
|
|
CANDIDA SKIN TEST .1ML
|
Facility
|
OP
|
$188.20
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
25002923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$180.67 |
| Rate for Payer: Aetna Commercial |
$144.91
|
| Rate for Payer: Anthem Medicaid |
$64.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.80
|
| Rate for Payer: Cash Price |
$94.10
|
| Rate for Payer: Cigna Commercial |
$156.21
|
| Rate for Payer: First Health Commercial |
$178.79
|
| Rate for Payer: Humana Commercial |
$159.97
|
| Rate for Payer: Humana KY Medicaid |
$64.72
|
| Rate for Payer: Kentucky WC Medicaid |
$65.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.62
|
| Rate for Payer: Ohio Health Group HMO |
$141.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.86
|
| Rate for Payer: PHCS Commercial |
$180.67
|
| Rate for Payer: United Healthcare All Payer |
$165.62
|
|
|
CANN REVISION DOWEL 11*32MM
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
CANN REVISION DOWEL 11*32MM
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
CANNULA 7.0
|
Facility
|
OP
|
$466.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$448.31 |
| Rate for Payer: Aetna Commercial |
$359.58
|
| Rate for Payer: Anthem Medicaid |
$160.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.25
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$443.64
|
| Rate for Payer: Humana Commercial |
$396.94
|
| Rate for Payer: Humana KY Medicaid |
$160.60
|
| Rate for Payer: Kentucky WC Medicaid |
$162.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.95
|
| Rate for Payer: Ohio Health Group HMO |
$350.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.22
|
| Rate for Payer: PHCS Commercial |
$448.31
|
| Rate for Payer: United Healthcare All Payer |
$410.95
|
|
|
CANNULA 7.0
|
Facility
|
IP
|
$466.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$448.31 |
| Rate for Payer: Aetna Commercial |
$359.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.25
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: First Health Commercial |
$443.64
|
| Rate for Payer: Humana Commercial |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.95
|
| Rate for Payer: Ohio Health Group HMO |
$350.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.22
|
| Rate for Payer: PHCS Commercial |
$448.31
|
| Rate for Payer: United Healthcare All Payer |
$410.95
|
|
|
CANNULATED REVISION DOWEL10*32
|
Facility
|
IP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
CANNULATED REVISION DOWEL10*32
|
Facility
|
OP
|
$7,188.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,156.51 |
| Max. Negotiated Rate |
$6,900.84 |
| Rate for Payer: Aetna Commercial |
$5,535.05
|
| Rate for Payer: Anthem Medicaid |
$2,472.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.94
|
| Rate for Payer: Cash Price |
$3,594.19
|
| Rate for Payer: Cigna Commercial |
$5,966.36
|
| Rate for Payer: First Health Commercial |
$6,828.96
|
| Rate for Payer: Humana Commercial |
$6,110.12
|
| Rate for Payer: Humana KY Medicaid |
$2,472.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,894.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,325.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,750.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,253.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,959.98
|
| Rate for Payer: PHCS Commercial |
$6,900.84
|
| Rate for Payer: United Healthcare All Payer |
$6,325.77
|
|
|
CANNULATED SCREW 6.5*120*20MM
|
Facility
|
OP
|
$1,985.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.68 |
| Max. Negotiated Rate |
$1,906.18 |
| Rate for Payer: Aetna Commercial |
$1,528.91
|
| Rate for Payer: Anthem Medicaid |
$682.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.77
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cigna Commercial |
$1,648.05
|
| Rate for Payer: First Health Commercial |
$1,886.32
|
| Rate for Payer: Humana Commercial |
$1,687.76
|
| Rate for Payer: Humana KY Medicaid |
$682.85
|
| Rate for Payer: Kentucky WC Medicaid |
$689.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,370.06
|
| Rate for Payer: PHCS Commercial |
$1,906.18
|
| Rate for Payer: United Healthcare All Payer |
$1,747.33
|
|
|
CANNULATED SCREW 6.5*120*20MM
|
Facility
|
IP
|
$1,985.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.68 |
| Max. Negotiated Rate |
$1,906.18 |
| Rate for Payer: Aetna Commercial |
$1,528.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.77
|
| Rate for Payer: Cash Price |
$992.80
|
| Rate for Payer: Cigna Commercial |
$1,648.05
|
| Rate for Payer: First Health Commercial |
$1,886.32
|
| Rate for Payer: Humana Commercial |
$1,687.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,628.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,747.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,489.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,370.06
|
| Rate for Payer: PHCS Commercial |
$1,906.18
|
| Rate for Payer: United Healthcare All Payer |
$1,747.33
|
|
|
CANNULA TWIST-IN 6MM*7CM
|
Facility
|
IP
|
$449.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.81 |
| Max. Negotiated Rate |
$431.40 |
| Rate for Payer: Aetna Commercial |
$346.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.52
|
| Rate for Payer: Cash Price |
$224.69
|
| Rate for Payer: Cigna Commercial |
$372.99
|
| Rate for Payer: First Health Commercial |
$426.91
|
| Rate for Payer: Humana Commercial |
$381.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.45
|
| Rate for Payer: Ohio Health Group HMO |
$337.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.07
|
| Rate for Payer: PHCS Commercial |
$431.40
|
| Rate for Payer: United Healthcare All Payer |
$395.45
|
|
|
CANNULA TWIST-IN 6MM*7CM
|
Facility
|
OP
|
$449.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.81 |
| Max. Negotiated Rate |
$431.40 |
| Rate for Payer: Aetna Commercial |
$346.02
|
| Rate for Payer: Anthem Medicaid |
$154.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.52
|
| Rate for Payer: Cash Price |
$224.69
|
| Rate for Payer: Cigna Commercial |
$372.99
|
| Rate for Payer: First Health Commercial |
$426.91
|
| Rate for Payer: Humana Commercial |
$381.97
|
| Rate for Payer: Humana KY Medicaid |
$154.54
|
| Rate for Payer: Kentucky WC Medicaid |
$156.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.45
|
| Rate for Payer: Ohio Health Group HMO |
$337.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.07
|
| Rate for Payer: PHCS Commercial |
$431.40
|
| Rate for Payer: United Healthcare All Payer |
$395.45
|
|
