|
[C]ROXANOL CONC 20MG 20MG/1ML
|
Facility
|
IP
|
$60.55
|
|
|
Service Code
|
NDC 406800330
|
| Hospital Charge Code |
25002773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cigna Commercial |
$50.26
|
| Rate for Payer: First Health Commercial |
$57.52
|
| Rate for Payer: Humana Commercial |
$51.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.28
|
| Rate for Payer: Ohio Health Group HMO |
$45.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.77
|
| Rate for Payer: PHCS Commercial |
$58.13
|
| Rate for Payer: United Healthcare All Payer |
$53.28
|
|
|
[C]ROXANOL CONC 20MG 20MG/1ML
|
Facility
|
OP
|
$60.55
|
|
|
Service Code
|
NDC 406800330
|
| Hospital Charge Code |
25002773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$46.62
|
| Rate for Payer: Anthem Medicaid |
$20.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cigna Commercial |
$50.26
|
| Rate for Payer: First Health Commercial |
$57.52
|
| Rate for Payer: Humana Commercial |
$51.47
|
| Rate for Payer: Humana KY Medicaid |
$20.82
|
| Rate for Payer: Kentucky WC Medicaid |
$21.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.28
|
| Rate for Payer: Ohio Health Group HMO |
$45.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.77
|
| Rate for Payer: PHCS Commercial |
$58.13
|
| Rate for Payer: United Healthcare All Payer |
$53.28
|
|
|
CRPA (C-REACTIVE PROTEIN)
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
30000979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$4.56
|
| Rate for Payer: Healthspan PPO |
$12.00
|
| Rate for Payer: Multiplan PHCS |
$49.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.40
|
| Rate for Payer: UHCCP Medicaid |
$28.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.11
|
|
|
CRPA (C-REACTIVE PROTEIN)
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
30000979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
CRPA (C-REACTIVE PROTEIN)
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
30000979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
CRT CROME HF MRI SURESCAN
|
Facility
|
IP
|
$90,534.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,769.47 |
| Max. Negotiated Rate |
$86,913.02 |
| Rate for Payer: Aetna Commercial |
$69,711.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,616.83
|
| Rate for Payer: Cash Price |
$45,267.20
|
| Rate for Payer: Cigna Commercial |
$75,143.55
|
| Rate for Payer: First Health Commercial |
$86,007.68
|
| Rate for Payer: Humana Commercial |
$76,954.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,238.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,814.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,160.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,670.27
|
| Rate for Payer: Ohio Health Group HMO |
$67,900.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,769.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,065.66
|
| Rate for Payer: PHCS Commercial |
$86,913.02
|
| Rate for Payer: United Healthcare All Payer |
$79,670.27
|
|
|
CRT CROME HF MRI SURESCAN
|
Facility
|
OP
|
$90,534.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,769.47 |
| Max. Negotiated Rate |
$86,913.02 |
| Rate for Payer: Aetna Commercial |
$69,711.49
|
| Rate for Payer: Anthem Medicaid |
$31,134.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,616.83
|
| Rate for Payer: Cash Price |
$45,267.20
|
| Rate for Payer: Cigna Commercial |
$75,143.55
|
| Rate for Payer: First Health Commercial |
$86,007.68
|
| Rate for Payer: Humana Commercial |
$76,954.24
|
| Rate for Payer: Humana KY Medicaid |
$31,134.78
|
| Rate for Payer: Kentucky WC Medicaid |
$31,451.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,238.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,814.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,160.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,759.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,670.27
|
| Rate for Payer: Ohio Health Group HMO |
$67,900.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,769.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,065.66
|
| Rate for Payer: PHCS Commercial |
$86,913.02
|
| Rate for Payer: United Healthcare All Payer |
$79,670.27
|
|
|
CRT ULTRA TIB INS SZ 2 10MM
|
Facility
|
IP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 10MM
|
Facility
|
OP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem Medicaid |
$3,043.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Humana KY Medicaid |
$3,043.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,074.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,104.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 12MM
|
Facility
|
IP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 12MM
|
Facility
|
OP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem Medicaid |
$3,043.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Humana KY Medicaid |
$3,043.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,074.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,104.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 14MM
|
Facility
|
OP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem Medicaid |
$3,043.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Humana KY Medicaid |
$3,043.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,074.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,104.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 14MM
|
Facility
|
IP
|
$8,849.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.39 |
| Max. Negotiated Rate |
$8,495.21 |
| Rate for Payer: Aetna Commercial |
$6,813.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,902.36
|
| Rate for Payer: Cash Price |
$4,424.59
|
| Rate for Payer: Cigna Commercial |
$7,344.82
|
| Rate for Payer: First Health Commercial |
$8,406.72
|
| Rate for Payer: Humana Commercial |
$7,521.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,530.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,787.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,636.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,150.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,743.25
|
| Rate for Payer: PHCS Commercial |
$8,495.21
|
| Rate for Payer: United Healthcare All Payer |
$7,787.28
|
|
|
CRT ULTRA TIB INS SZ 2 16MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CRT ULTRA TIB INS SZ 2 16MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CRYO OF CERVIX
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.09
|
| Rate for Payer: Anthem Medicaid |
$69.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$738.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$217.78
|
| Rate for Payer: Healthspan PPO |
$209.72
|
| Rate for Payer: Humana Medicaid |
$69.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Molina Healthcare Passport |
$69.82
|
| Rate for Payer: Multiplan PHCS |
$442.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$516.60
|
| Rate for Payer: UHCCP Medicaid |
$112.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.52
|
|
|
CRYO OF CERVIX
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.78
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
CRYO OF CERVIX
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem Medicaid |
$253.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Humana KY Medicaid |
$253.80
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.78
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
CRYO OF CERVIX(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761P2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.09
|
| Rate for Payer: Anthem Medicaid |
$69.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$217.78
|
| Rate for Payer: Healthspan PPO |
$209.72
|
| Rate for Payer: Humana Medicaid |
$69.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Molina Healthcare Passport |
$69.82
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$112.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.52
|
|
|
CRYO OF CERVIX(T
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761T2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$388.39 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
CRYO OF CERVIX(T
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761T2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
CRYOPRECIPITATED AHF PRECIP 4
|
Facility
|
OP
|
$753.05
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
38000007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$722.93 |
| Rate for Payer: Aetna Commercial |
$579.85
|
| Rate for Payer: Anthem Medicaid |
$258.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$587.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.36
|
| Rate for Payer: Cash Price |
$376.52
|
| Rate for Payer: Cash Price |
$376.52
|
| Rate for Payer: Cigna Commercial |
$625.03
|
| Rate for Payer: First Health Commercial |
$715.40
|
| Rate for Payer: Humana Commercial |
$640.09
|
| Rate for Payer: Humana KY Medicaid |
$258.97
|
| Rate for Payer: Humana Medicare Advantage |
$54.34
|
| Rate for Payer: Kentucky WC Medicaid |
$261.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.68
|
| Rate for Payer: Ohio Health Group HMO |
$564.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.45
|
| Rate for Payer: PHCS Commercial |
$722.93
|
| Rate for Payer: United Healthcare All Payer |
$662.68
|
|
|
CRYOPRECIPITATED AHF PRECIP 4
|
Facility
|
IP
|
$753.05
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
38000007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.90 |
| Max. Negotiated Rate |
$722.93 |
| Rate for Payer: Aetna Commercial |
$579.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$587.38
|
| Rate for Payer: Cash Price |
$376.52
|
| Rate for Payer: Cigna Commercial |
$625.03
|
| Rate for Payer: First Health Commercial |
$715.40
|
| Rate for Payer: Humana Commercial |
$640.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.68
|
| Rate for Payer: Ohio Health Group HMO |
$564.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.45
|
| Rate for Payer: PHCS Commercial |
$722.93
|
| Rate for Payer: United Healthcare All Payer |
$662.68
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$217.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$217.00
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$219.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.61
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$631.00 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.55
|
| Rate for Payer: Anthem Medicaid |
$43.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$631.00
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$172.70
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$43.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.86
|
| Rate for Payer: Molina Healthcare Passport |
$43.00
|
| Rate for Payer: Multiplan PHCS |
$378.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.70
|
| Rate for Payer: UHCCP Medicaid |
$58.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.43
|
|
