|
CARBON CONNECTING ROD 3MMX60MM
|
Facility
|
IP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
CARBON CONNECTING ROD 3MMX60MM
|
Facility
|
OP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem Medicaid |
$519.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Humana KY Medicaid |
$519.84
|
| Rate for Payer: Kentucky WC Medicaid |
$525.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
CARBON DIOXIDE DIFFUSION
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
CARBON DIOXIDE DIFFUSION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$188.40 |
| Rate for Payer: Ambetter Exchange |
$50.13
|
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.16
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$87.34
|
| Rate for Payer: Healthspan PPO |
$45.09
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$188.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.17
|
| Rate for Payer: UHCCP Medicaid |
$109.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.13
|
|
|
CARBON DIOXIDE DIFFUSION
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
CARBON DIOXIDE DIFFUSION(P
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460P0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Ambetter Exchange |
$50.13
|
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.16
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$87.34
|
| Rate for Payer: Healthspan PPO |
$45.09
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.17
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.13
|
|
|
CARBON DIOXIDE DIFFUSION(T
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460T0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
CARBON DIOXIDE DIFFUSION(T
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 94729
|
| Hospital Charge Code |
460T0015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
CARBON MONOXIDE QUANTITATIVE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
30000264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CARBON MONOXIDE QUANTITATIVE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
30000264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$12.32
|
| Rate for Payer: Humana Medicare Advantage |
$12.32
|
| Rate for Payer: Kentucky WC Medicaid |
$12.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CARBOPLATIN 50MG/5ML
|
Facility
|
OP
|
$73.03
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25002577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Anthem Medicaid |
$25.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.96
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Cigna Commercial |
$60.61
|
| Rate for Payer: First Health Commercial |
$69.38
|
| Rate for Payer: Humana Commercial |
$62.08
|
| Rate for Payer: Humana KY Medicaid |
$25.12
|
| Rate for Payer: Kentucky WC Medicaid |
$25.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.27
|
| Rate for Payer: Ohio Health Group HMO |
$54.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.39
|
| Rate for Payer: PHCS Commercial |
$70.11
|
| Rate for Payer: United Healthcare All Payer |
$64.27
|
|
|
CARBOPLATIN 50MG/5ML
|
Facility
|
IP
|
$73.03
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25002577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$70.11 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.96
|
| Rate for Payer: Cash Price |
$36.52
|
| Rate for Payer: Cigna Commercial |
$60.61
|
| Rate for Payer: First Health Commercial |
$69.38
|
| Rate for Payer: Humana Commercial |
$62.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.27
|
| Rate for Payer: Ohio Health Group HMO |
$54.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.39
|
| Rate for Payer: PHCS Commercial |
$70.11
|
| Rate for Payer: United Healthcare All Payer |
$64.27
|
|
|
CARBOPLATIN 50MG (FROM 150MG M
|
Facility
|
OP
|
$42.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$14.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.95
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cigna Commercial |
$35.06
|
| Rate for Payer: First Health Commercial |
$40.13
|
| Rate for Payer: Humana Commercial |
$35.90
|
| Rate for Payer: Humana KY Medicaid |
$14.53
|
| Rate for Payer: Kentucky WC Medicaid |
$14.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.17
|
| Rate for Payer: Ohio Health Group HMO |
$31.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.15
|
| Rate for Payer: PHCS Commercial |
$40.55
|
| Rate for Payer: United Healthcare All Payer |
$37.17
|
|
|
CARBOPLATIN 50MG (FROM 150MG M
|
Facility
|
IP
|
$42.24
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$32.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.95
|
| Rate for Payer: Cash Price |
$21.12
|
| Rate for Payer: Cigna Commercial |
$35.06
|
| Rate for Payer: First Health Commercial |
$40.13
|
| Rate for Payer: Humana Commercial |
$35.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.17
|
| Rate for Payer: Ohio Health Group HMO |
$31.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.15
|
| Rate for Payer: PHCS Commercial |
$40.55
|
| Rate for Payer: United Healthcare All Payer |
$37.17
|
|
|
CARBOPLATIN 50MG (FROM 450MG M
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$30.30
|
| Rate for Payer: Anthem Medicaid |
$13.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.69
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cigna Commercial |
$32.66
|
| Rate for Payer: First Health Commercial |
$37.38
|
| Rate for Payer: Humana Commercial |
$33.45
|
| Rate for Payer: Humana KY Medicaid |
$13.53
|
| Rate for Payer: Kentucky WC Medicaid |
$13.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.63
|
| Rate for Payer: Ohio Health Group HMO |
$29.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.15
|
| Rate for Payer: PHCS Commercial |
$37.78
|
| Rate for Payer: United Healthcare All Payer |
$34.63
|
|
|
CARBOPLATIN 50MG (FROM 450MG M
|
Facility
|
IP
|
$39.35
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004028
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$30.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.69
|
| Rate for Payer: Cash Price |
$19.68
|
| Rate for Payer: Cigna Commercial |
$32.66
|
| Rate for Payer: First Health Commercial |
$37.38
|
| Rate for Payer: Humana Commercial |
$33.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.63
|
| Rate for Payer: Ohio Health Group HMO |
$29.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.15
|
| Rate for Payer: PHCS Commercial |
$37.78
|
| Rate for Payer: United Healthcare All Payer |
$34.63
|
|
|
CARBOPLATIN 50MG (FROM 600MG M
|
Facility
|
OP
|
$26.87
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Anthem Medicaid |
$9.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.96
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$22.30
|
| Rate for Payer: First Health Commercial |
$25.53
|
| Rate for Payer: Humana Commercial |
$22.84
|
| Rate for Payer: Humana KY Medicaid |
$9.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.65
|
| Rate for Payer: Ohio Health Group HMO |
$20.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.54
|
| Rate for Payer: PHCS Commercial |
$25.80
|
| Rate for Payer: United Healthcare All Payer |
$23.65
|
|
|
CARBOPLATIN 50MG (FROM 600MG M
|
Facility
|
IP
|
$26.87
|
|
|
Service Code
|
HCPCS J9045
|
| Hospital Charge Code |
25004029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna Commercial |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.96
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna Commercial |
$22.30
|
| Rate for Payer: First Health Commercial |
$25.53
|
| Rate for Payer: Humana Commercial |
$22.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.65
|
| Rate for Payer: Ohio Health Group HMO |
$20.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.54
|
| Rate for Payer: PHCS Commercial |
$25.80
|
| Rate for Payer: United Healthcare All Payer |
$23.65
|
|
|
CARCINOEMBRYONICANTIGEN/CEA
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
30000266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem Medicaid |
$18.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$181.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.96
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Humana KY Medicaid |
$18.96
|
| Rate for Payer: Humana Medicare Advantage |
$18.96
|
| Rate for Payer: Kentucky WC Medicaid |
$19.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
CARCINOEMBRYONICANTIGEN/CEA
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
30000266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$181.48
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
CARDENE 20MG/200ML PREMIX BAG
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
NDC 43066000910
|
| Hospital Charge Code |
25002926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.82
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
CARDENE 20MG/200ML PREMIX BAG
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
NDC 43066000910
|
| Hospital Charge Code |
25002926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Commercial |
$245.63
|
| Rate for Payer: Anthem Medicaid |
$109.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.82
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna Commercial |
$264.77
|
| Rate for Payer: First Health Commercial |
$303.05
|
| Rate for Payer: Humana Commercial |
$271.15
|
| Rate for Payer: Humana KY Medicaid |
$109.70
|
| Rate for Payer: Kentucky WC Medicaid |
$110.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$280.72
|
| Rate for Payer: Ohio Health Group HMO |
$239.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.11
|
| Rate for Payer: PHCS Commercial |
$306.24
|
| Rate for Payer: United Healthcare All Payer |
$280.72
|
|
|
CARDENE (NICARDIPINE 20MG/1CAP
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
NDC 378102077
|
| Hospital Charge Code |
25000377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.63
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cigna Commercial |
$8.12
|
| Rate for Payer: First Health Commercial |
$9.29
|
| Rate for Payer: Humana Commercial |
$8.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.61
|
| Rate for Payer: Ohio Health Group HMO |
$7.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.75
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
CARDENE (NICARDIPINE 20MG/1CAP
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
NDC 378102077
|
| Hospital Charge Code |
25000377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$9.39 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Anthem Medicaid |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.63
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cigna Commercial |
$8.12
|
| Rate for Payer: First Health Commercial |
$9.29
|
| Rate for Payer: Humana Commercial |
$8.31
|
| Rate for Payer: Humana KY Medicaid |
$3.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.61
|
| Rate for Payer: Ohio Health Group HMO |
$7.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.75
|
| Rate for Payer: PHCS Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Payer |
$8.61
|
|
|
CARDENE (NICARDIPINE 25MG/10ML
|
Facility
|
OP
|
$181.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002925
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$54.46 |
| Max. Negotiated Rate |
$174.26 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Anthem Medicaid |
$62.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.59
|
| Rate for Payer: Cash Price |
$90.76
|
| Rate for Payer: Cigna Commercial |
$150.66
|
| Rate for Payer: First Health Commercial |
$172.44
|
| Rate for Payer: Humana Commercial |
$154.29
|
| Rate for Payer: Humana KY Medicaid |
$62.42
|
| Rate for Payer: Kentucky WC Medicaid |
$63.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.74
|
| Rate for Payer: Ohio Health Group HMO |
$136.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.25
|
| Rate for Payer: PHCS Commercial |
$174.26
|
| Rate for Payer: United Healthcare All Payer |
$159.74
|
|
