|
CIRCUMCISION W/REGIONL BLOC(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761P2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$161.22
|
| Rate for Payer: Ambetter Exchange |
$90.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$76.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.19
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$212.89
|
| Rate for Payer: Healthspan PPO |
$258.71
|
| Rate for Payer: Humana Medicaid |
$76.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.80
|
| Rate for Payer: Molina Healthcare Passport |
$76.27
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.29
|
| Rate for Payer: UHCCP Medicaid |
$53.51
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.99
|
|
|
CIRCUMCISION W/REGIONL BLOC(T
|
Facility
|
IP
|
$6,485.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761T2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,945.50 |
| Max. Negotiated Rate |
$6,225.60 |
| Rate for Payer: Aetna Commercial |
$4,993.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.30
|
| Rate for Payer: Cash Price |
$3,242.50
|
| Rate for Payer: Cigna Commercial |
$5,382.55
|
| Rate for Payer: First Health Commercial |
$6,160.75
|
| Rate for Payer: Humana Commercial |
$5,512.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,785.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,641.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,474.65
|
| Rate for Payer: PHCS Commercial |
$6,225.60
|
| Rate for Payer: United Healthcare All Payer |
$5,706.80
|
|
|
CIRCUMCISION W/REGIONL BLOC(T
|
Facility
|
OP
|
$6,485.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
761T2130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$6,225.60 |
| Rate for Payer: Aetna Commercial |
$4,993.45
|
| Rate for Payer: Anthem Medicaid |
$2,230.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$3,242.50
|
| Rate for Payer: Cash Price |
$3,242.50
|
| Rate for Payer: Cigna Commercial |
$5,382.55
|
| Rate for Payer: First Health Commercial |
$6,160.75
|
| Rate for Payer: Humana Commercial |
$5,512.25
|
| Rate for Payer: Humana KY Medicaid |
$2,230.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,785.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,274.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,641.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,474.65
|
| Rate for Payer: PHCS Commercial |
$6,225.60
|
| Rate for Payer: United Healthcare All Payer |
$5,706.80
|
|
|
CISATRACURIUM 10mg/5mL VIAL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
25004153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CISATRACURIUM 10mg/5mL VIAL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
25004153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CISATRACURIUM 200 MG/20 ML
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
NDC 781315395
|
| Hospital Charge Code |
25002460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CISATRACURIUM 200 MG/20 ML
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
NDC 781315395
|
| Hospital Charge Code |
25002460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CISPLATIN 10MG (FROM 100MG MDV
|
Facility
|
OP
|
$22.43
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Anthem Medicaid |
$7.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna Commercial |
$18.62
|
| Rate for Payer: First Health Commercial |
$21.31
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Humana KY Medicaid |
$7.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.74
|
| Rate for Payer: Ohio Health Group HMO |
$16.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.48
|
| Rate for Payer: PHCS Commercial |
$21.53
|
| Rate for Payer: United Healthcare All Payer |
$19.74
|
|
|
CISPLATIN 10MG (FROM 100MG MDV
|
Facility
|
IP
|
$22.43
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna Commercial |
$18.62
|
| Rate for Payer: First Health Commercial |
$21.31
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.74
|
| Rate for Payer: Ohio Health Group HMO |
$16.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.48
|
| Rate for Payer: PHCS Commercial |
$21.53
|
| Rate for Payer: United Healthcare All Payer |
$19.74
|
|
|
CISPLATIN 10MG (FROM 50MG MDV)
|
Facility
|
OP
|
$21.96
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Anthem Medicaid |
$7.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.13
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: Cigna Commercial |
$18.23
|
| Rate for Payer: First Health Commercial |
$20.86
|
| Rate for Payer: Humana Commercial |
$18.67
|
| Rate for Payer: Humana KY Medicaid |
$7.55
|
| Rate for Payer: Kentucky WC Medicaid |
$7.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.32
|
| Rate for Payer: Ohio Health Group HMO |
$16.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.15
|
| Rate for Payer: PHCS Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Payer |
$19.32
|
|
|
CISPLATIN 10MG (FROM 50MG MDV)
|
Facility
|
IP
|
$21.96
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
25004030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.13
|
| Rate for Payer: Cash Price |
$10.98
|
| Rate for Payer: Cigna Commercial |
$18.23
|
| Rate for Payer: First Health Commercial |
$20.86
|
| Rate for Payer: Humana Commercial |
$18.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.32
|
| Rate for Payer: Ohio Health Group HMO |
$16.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.15
|
| Rate for Payer: PHCS Commercial |
$21.08
|
| Rate for Payer: United Healthcare All Payer |
$19.32
|
|
|
CITROBACTER OMPA MRKC GENES
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CITROBACTER OMPA MRKC GENES
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001309
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
CK ISOENZYMES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Ambetter Exchange |
$13.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$11.75
|
| Rate for Payer: Healthspan PPO |
$14.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.39
|
| Rate for Payer: Multiplan PHCS |
$97.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.41
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.39
|
|
|
CK ISOENZYMES
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
CK ISOENZYMES
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
[C]KLONOPIN (.5MG/1TAB)
|
Facility
|
IP
|
$60.03
|
|
|
Service Code
|
NDC 93083205
|
| Hospital Charge Code |
25000072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Aetna Commercial |
$46.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.82
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.82
|
| Rate for Payer: First Health Commercial |
$57.03
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.42
|
| Rate for Payer: PHCS Commercial |
$57.63
|
| Rate for Payer: United Healthcare All Payer |
$52.83
|
|
|
[C]KLONOPIN (.5MG/1TAB)
|
Facility
|
OP
|
$60.03
|
|
|
Service Code
|
NDC 93083205
|
| Hospital Charge Code |
25000072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Aetna Commercial |
$46.22
|
| Rate for Payer: Anthem Medicaid |
$20.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.82
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.82
|
| Rate for Payer: First Health Commercial |
$57.03
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Humana KY Medicaid |
$20.64
|
| Rate for Payer: Kentucky WC Medicaid |
$20.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.42
|
| Rate for Payer: PHCS Commercial |
$57.63
|
| Rate for Payer: United Healthcare All Payer |
$52.83
|
|
|
CLADOSPORIUM HERBARUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000648
|
|
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
|
|
|
CLADOSPORIUM HERBARUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000648
|
|
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
|
|
|
CLADRIBINE 1MG/ML(10MG/10ML)VL
|
Facility
|
OP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
25002585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem Medicaid |
$815.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.14
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Humana KY Medicaid |
$815.30
|
| Rate for Payer: Humana Medicare Advantage |
$9.73
|
| Rate for Payer: Kentucky WC Medicaid |
$823.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$831.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,896.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.82
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
CLADRIBINE 1MG/ML(10MG/10ML)VL
|
Facility
|
IP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
25002585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$711.23 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,896.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.82
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
CLAMS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000858
|
|
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
|
|
|
CLAMS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000858
|
|
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
|
|
|
CLARIA MRI SURESCAN CRT-D
|
Facility
|
OP
|
$96,159.60
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,847.88 |
| Max. Negotiated Rate |
$92,313.22 |
| Rate for Payer: Aetna Commercial |
$74,042.89
|
| Rate for Payer: Anthem Medicaid |
$33,069.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75,004.49
|
| Rate for Payer: Cash Price |
$48,079.80
|
| Rate for Payer: Cigna Commercial |
$79,812.47
|
| Rate for Payer: First Health Commercial |
$91,351.62
|
| Rate for Payer: Humana Commercial |
$81,735.66
|
| Rate for Payer: Humana KY Medicaid |
$33,069.29
|
| Rate for Payer: Kentucky WC Medicaid |
$33,405.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,850.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,965.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,847.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,732.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,620.45
|
| Rate for Payer: Ohio Health Group HMO |
$72,119.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76,927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83,658.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66,350.12
|
| Rate for Payer: PHCS Commercial |
$92,313.22
|
| Rate for Payer: United Healthcare All Payer |
$84,620.45
|
|
