|
CUBICIN (GENERIC) 1MG (500MG)
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$63.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$63.97
|
| Rate for Payer: Kentucky WC Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
CUBICIN RF 500MG (AIC) VIAL
|
Facility
|
IP
|
$1,025.49
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.31 |
| Max. Negotiated Rate |
$984.47 |
| Rate for Payer: Aetna Commercial |
$789.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.88
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cigna Commercial |
$851.16
|
| Rate for Payer: First Health Commercial |
$974.22
|
| Rate for Payer: Humana Commercial |
$871.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.43
|
| Rate for Payer: Ohio Health Group HMO |
$769.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.90
|
| Rate for Payer: PHCS Commercial |
$984.47
|
| Rate for Payer: United Healthcare All Payer |
$902.43
|
|
|
CUBICIN RF 500MG (AIC) VIAL
|
Facility
|
OP
|
$1,025.49
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.31 |
| Max. Negotiated Rate |
$984.47 |
| Rate for Payer: Aetna Commercial |
$789.63
|
| Rate for Payer: Anthem Medicaid |
$352.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.88
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cigna Commercial |
$851.16
|
| Rate for Payer: First Health Commercial |
$974.22
|
| Rate for Payer: Humana Commercial |
$871.67
|
| Rate for Payer: Humana KY Medicaid |
$352.67
|
| Rate for Payer: Kentucky WC Medicaid |
$356.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.43
|
| Rate for Payer: Ohio Health Group HMO |
$769.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.90
|
| Rate for Payer: PHCS Commercial |
$984.47
|
| Rate for Payer: United Healthcare All Payer |
$902.43
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$9.22
|
| Rate for Payer: Healthspan PPO |
$6.95
|
| Rate for Payer: Multiplan PHCS |
$59.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.30
|
| Rate for Payer: UHCCP Medicaid |
$34.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.98
|
|
|
CULTURE ACID FAST
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
30001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
CULTURE ACID FAST
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
30001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$10.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$10.80
|
| Rate for Payer: Humana Medicare Advantage |
$10.80
|
| Rate for Payer: Kentucky WC Medicaid |
$10.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
CULTURE BLOOD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
30001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| 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 |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| 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 |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| 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 |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CULTURE BLOOD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
30001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| 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 |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
CULTURE; ENVIROMENTAL
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
30001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem Medicaid |
$9.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.48
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Humana KY Medicaid |
$9.63
|
| Rate for Payer: Kentucky WC Medicaid |
$9.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.68
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
CULTURE; ENVIROMENTAL
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
30001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$21.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.48
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cigna Commercial |
$23.24
|
| Rate for Payer: First Health Commercial |
$26.60
|
| Rate for Payer: Humana Commercial |
$23.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.64
|
| Rate for Payer: Ohio Health Group HMO |
$21.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.68
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
CULTURE GENITAL
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
CULTURE GENITAL
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$8.62
|
| Rate for Payer: Humana Medicare Advantage |
$8.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
CULTURE LEGIONELLA
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.62
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna Commercial |
$5.81
|
| Rate for Payer: First Health Commercial |
$6.65
|
| Rate for Payer: Humana Commercial |
$5.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.16
|
| Rate for Payer: Ohio Health Group HMO |
$5.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.17
|
| Rate for Payer: PHCS Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Payer |
$6.16
|
|
|
CULTURE LEGIONELLA
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna Commercial |
$5.81
|
| Rate for Payer: First Health Commercial |
$6.65
|
| Rate for Payer: Humana Commercial |
$5.95
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.16
|
| Rate for Payer: Ohio Health Group HMO |
$5.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.17
|
| Rate for Payer: PHCS Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Payer |
$6.16
|
|
|
CULTURELLE(LACTOVB RHAMN) CAPS
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 49100036374
|
| Hospital Charge Code |
25000500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
CULTURELLE(LACTOVB RHAMN) CAPS
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 49100036374
|
| Hospital Charge Code |
25000500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
CULTURE OTHR SPECIMN AEROBIC
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$8.62
|
| Rate for Payer: Humana Medicare Advantage |
$8.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
CULTURE REFERRED FOR ID FUNG
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
CULTURE REFERRED FOR ID FUNG
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
CULTURE STOOL
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
30001248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
CULTURE STOOL
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
30001248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$9.89
|
| Rate for Payer: Multiplan PHCS |
$88.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.90
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.66
|
|
|
CULTURE STOOL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
30001248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$9.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$9.44
|
| Rate for Payer: Humana Medicare Advantage |
$9.44
|
| Rate for Payer: Kentucky WC Medicaid |
$9.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
