|
CHEST ULTRASOUND
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem Medicaid |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Humana KY Medicaid |
$321.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$324.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
|
CHEST ULTRASOUND(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402P0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$131.28 |
| Rate for Payer: Aetna Commercial |
$131.28
|
| Rate for Payer: Ambetter Exchange |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$59.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.76
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$118.97
|
| Rate for Payer: Healthspan PPO |
$123.02
|
| Rate for Payer: Humana Medicaid |
$59.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.48
|
| Rate for Payer: Molina Healthcare Passport |
$59.29
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.07
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.13
|
|
|
CHEST ULTRASOUND(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402T0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
CHEST ULTRASOUND(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
402T0006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
CHILDRENS MOTRIN (E 100MG/5ML
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002937
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.44
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
|
|
CHILDRENS MOTRIN (E 100MG/5ML
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002937
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.73
|
| Rate for Payer: Humana Commercial |
$4.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.38
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.44
|
| Rate for Payer: PHCS Commercial |
$4.78
|
| Rate for Payer: United Healthcare All Payer |
$4.38
|
|
|
Chin Laser Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200178
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
Chin Laser Hair Removal
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
22200178
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| 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: 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
|
|
|
Chin Laser Hair Removal
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
22200178
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| 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 |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| 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: Molina Healthcare Medicaid |
$35.08
|
| 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
|
|
|
Chin LsrHairRem-PP #1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200342
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
Chin LsrHairRem-PP #2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200458
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
|
CHIRHOSTIM 1MCG (16MCG VIAL)
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
25002357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.10 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.23
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
|
CHIRHOSTIM 1MCG (16MCG VIAL)
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
25002357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem Medicaid |
$504.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$61.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.12
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Humana KY Medicaid |
$504.50
|
| Rate for Payer: Humana Medicare Advantage |
$43.79
|
| Rate for Payer: Kentucky WC Medicaid |
$509.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.23
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$96.00 |
| 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 |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$65.00
|
| 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 |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| 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 |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
CHLAMYDIA AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
30001367
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
CHLAMYDOPHILA PNEUMONIAE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
30001366
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CHLAMYDOPHILA PNEUMONIAE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
30001366
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| 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 |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CHLORAMPHENICOL [1 GM] 1GM VL
|
Facility
|
IP
|
$204.65
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
25001960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.63
|
| Rate for Payer: Cash Price |
$102.33
|
| Rate for Payer: Cigna Commercial |
$169.86
|
| Rate for Payer: First Health Commercial |
$194.42
|
| Rate for Payer: Humana Commercial |
$173.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.09
|
| Rate for Payer: Ohio Health Group HMO |
$153.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.21
|
| Rate for Payer: PHCS Commercial |
$196.46
|
| Rate for Payer: United Healthcare All Payer |
$180.09
|
|
|
CHLORAMPHENICOL [1 GM] 1GM VL
|
Facility
|
OP
|
$204.65
|
|
|
Service Code
|
HCPCS J0720
|
| Hospital Charge Code |
25001960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$196.46 |
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Anthem Medicaid |
$70.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.63
|
| Rate for Payer: Cash Price |
$102.33
|
| Rate for Payer: Cigna Commercial |
$169.86
|
| Rate for Payer: First Health Commercial |
$194.42
|
| Rate for Payer: Humana Commercial |
$173.95
|
| Rate for Payer: Humana KY Medicaid |
$70.38
|
| Rate for Payer: Kentucky WC Medicaid |
$71.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.09
|
| Rate for Payer: Ohio Health Group HMO |
$153.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.21
|
| Rate for Payer: PHCS Commercial |
$196.46
|
| Rate for Payer: United Healthcare All Payer |
$180.09
|
|
|
CHLORASEPTIC (PHENOL) SPRA 6OZ
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 78112010256
|
| Hospital Charge Code |
25000415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.02
|
| Rate for Payer: Humana Commercial |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.02
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Payer |
$0.02
|
|
|
CHLORASEPTIC (PHENOL) SPRA 6OZ
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 78112010256
|
| Hospital Charge Code |
25000415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.02
|
| Rate for Payer: Humana Commercial |
$0.02
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.02
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.02
|
| Rate for Payer: United Healthcare All Payer |
$0.02
|
|
|
CHLORIDE - BLOOD
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
30000277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
CHLORIDE - BLOOD
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
30000277
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$4.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.60
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$4.60
|
| Rate for Payer: Humana Medicare Advantage |
$4.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
CHLOROPROC1%+EPI1:200K 30mLMDV
|
Facility
|
IP
|
$125.04
|
|
|
Service Code
|
NDC 63323047537
|
| Hospital Charge Code |
25004308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$96.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.53
|
| Rate for Payer: Cash Price |
$62.52
|
| Rate for Payer: Cigna Commercial |
$103.78
|
| Rate for Payer: First Health Commercial |
$118.79
|
| Rate for Payer: Humana Commercial |
$106.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.04
|
| Rate for Payer: Ohio Health Group HMO |
$93.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.28
|
| Rate for Payer: PHCS Commercial |
$120.04
|
| Rate for Payer: United Healthcare All Payer |
$110.04
|
|
