|
COENZYME Q10 100MG CAPSULE
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 87701040816
|
| Hospital Charge Code |
25000439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
COGENTIN (BENZTROPINE 1MG/1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
25000440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
COGENTIN (BENZTROPINE 1MG/1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
25000440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
COGENTIN (BENZTROPINE) 2MG/2ML
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
25001888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.62
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.99
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
COGENTIN (BENZTROPINE) 2MG/2ML
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
25001888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem Medicaid |
$113.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.62
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Humana KY Medicaid |
$113.14
|
| Rate for Payer: Kentucky WC Medicaid |
$114.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.99
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
COGNITIVE EVAL EA HR
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 96125
|
| Hospital Charge Code |
44000017
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem Medicaid |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Humana KY Medicaid |
$50.90
|
| Rate for Payer: Kentucky WC Medicaid |
$51.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.88
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
COGNITIVE EVAL EA HR
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 96125
|
| Hospital Charge Code |
44000017
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.88
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
COLACE (DOCSATE SOD 100MG/10ML
|
Facility
|
IP
|
$9.85
|
|
|
Service Code
|
NDC 121187000
|
| Hospital Charge Code |
25000442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.36
|
| Rate for Payer: Humana Commercial |
$8.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.67
|
| Rate for Payer: Ohio Health Group HMO |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Payer |
$8.67
|
|
|
COLACE (DOCSATE SOD 100MG/10ML
|
Facility
|
OP
|
$9.85
|
|
|
Service Code
|
NDC 121187000
|
| Hospital Charge Code |
25000442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Anthem Medicaid |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna Commercial |
$8.18
|
| Rate for Payer: First Health Commercial |
$9.36
|
| Rate for Payer: Humana Commercial |
$8.37
|
| Rate for Payer: Humana KY Medicaid |
$3.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.67
|
| Rate for Payer: Ohio Health Group HMO |
$7.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$9.46
|
| Rate for Payer: United Healthcare All Payer |
$8.67
|
|
|
COLACE (DOCUSATE SO 100MG/1CAP
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 904718361
|
| Hospital Charge Code |
25000441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
|
|
COLACE (DOCUSATE SO 100MG/1CAP
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 904718361
|
| Hospital Charge Code |
25000441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
COLAZAL 750 MGA CAPSULE
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 54007928
|
| Hospital Charge Code |
25000443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
COLAZAL 750 MGA CAPSULE
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 54007928
|
| Hospital Charge Code |
25000443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
COLCHICINE 0.6 MG TA .6MG/1TAB
|
Facility
|
OP
|
$24.19
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
25000444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Anthem Medicaid |
$8.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.87
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna Commercial |
$20.08
|
| Rate for Payer: First Health Commercial |
$22.98
|
| Rate for Payer: Humana Commercial |
$20.56
|
| Rate for Payer: Humana KY Medicaid |
$8.32
|
| Rate for Payer: Kentucky WC Medicaid |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.29
|
| Rate for Payer: Ohio Health Group HMO |
$18.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.50
|
| Rate for Payer: PHCS Commercial |
$23.22
|
| Rate for Payer: United Healthcare All Payer |
$21.29
|
|
|
COLCHICINE 0.6 MG TA .6MG/1TAB
|
Facility
|
IP
|
$24.19
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
25000444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.87
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cigna Commercial |
$20.08
|
| Rate for Payer: First Health Commercial |
$22.98
|
| Rate for Payer: Humana Commercial |
$20.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.29
|
| Rate for Payer: Ohio Health Group HMO |
$18.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.50
|
| Rate for Payer: PHCS Commercial |
$23.22
|
| Rate for Payer: United Healthcare All Payer |
$21.29
|
|
|
COLD KNIFE CONE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
COLD KNIFE CONE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
COLD KNIFE CONE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
76102203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.31 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$410.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.31
|
| Rate for Payer: Anthem Medicaid |
$226.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$406.91
|
| Rate for Payer: Healthspan PPO |
$444.17
|
| Rate for Payer: Humana Medicaid |
$226.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$351.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.00
|
| Rate for Payer: Molina Healthcare Passport |
$226.47
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$194.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.73
|
|
|
COLD KNIFE CONE(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
761P2203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.31 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$410.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.31
|
| Rate for Payer: Anthem Medicaid |
$226.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$406.91
|
| Rate for Payer: Healthspan PPO |
$444.17
|
| Rate for Payer: Humana Medicaid |
$226.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$351.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.00
|
| Rate for Payer: Molina Healthcare Passport |
$226.47
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$194.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$228.73
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$945.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$945.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
COLECTOMY - PARTIAL; ABDOMINA
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
76101820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.88 |
| Max. Negotiated Rate |
$3,050.00 |
| Rate for Payer: Aetna Commercial |
$2,692.93
|
| Rate for Payer: Anthem Medicaid |
$967.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,050.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,438.09
|
| Rate for Payer: Healthspan PPO |
$2,271.00
|
| Rate for Payer: Humana Medicaid |
$967.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,466.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.24
|
| Rate for Payer: Molina Healthcare Passport |
$967.88
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.56
|
|
|
COLECTOMY - PARTIAL; ABDOMIN(P
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 44147
|
| Hospital Charge Code |
761P1820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.88 |
| Max. Negotiated Rate |
$3,050.00 |
| Rate for Payer: Aetna Commercial |
$2,692.93
|
| Rate for Payer: Anthem Medicaid |
$967.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,050.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,438.09
|
| Rate for Payer: Healthspan PPO |
$2,271.00
|
| Rate for Payer: Humana Medicaid |
$967.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,466.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.24
|
| Rate for Payer: Molina Healthcare Passport |
$967.88
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.56
|
|
|
COLECTOMY - PARTIAL; WITH ANA
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
76101814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
COLECTOMY - PARTIAL; WITH ANA
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
76101814
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.50 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,944.45
|
| Rate for Payer: Anthem Medicaid |
$920.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,816.00
|
| Rate for Payer: Healthspan PPO |
$1,639.79
|
| Rate for Payer: Humana Medicaid |
$920.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,712.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$938.47
|
| Rate for Payer: Molina Healthcare Passport |
$920.07
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$929.27
|
|
