|
DERMABRASION TOTAL FACE
|
Professional
|
Both
|
$4,416.00
|
|
|
Service Code
|
HCPCS 15780
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$915.73
|
| Rate for Payer: Anthem Medicaid |
$221.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,416.00
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cigna Commercial |
$1,128.70
|
| Rate for Payer: Healthspan PPO |
$917.52
|
| Rate for Payer: Humana Medicaid |
$221.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$225.58
|
| Rate for Payer: Molina Healthcare Passport |
$221.16
|
| Rate for Payer: Multiplan PHCS |
$2,649.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,091.20
|
| Rate for Payer: UHCCP Medicaid |
$1,545.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$223.37
|
|
|
DERMABRASION TOTAL FACE
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
HCPCS 15780
|
| Hospital Charge Code |
76100210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$574.08 |
| Max. Negotiated Rate |
$4,239.36 |
| Rate for Payer: Aetna Commercial |
$3,400.32
|
| Rate for Payer: Anthem Medicaid |
$1,518.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,444.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cigna Commercial |
$3,665.28
|
| Rate for Payer: First Health Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial |
$3,753.60
|
| Rate for Payer: Humana KY Medicaid |
$1,518.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,621.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,259.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,886.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,312.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$4,239.36
|
| Rate for Payer: United Healthcare All Payer |
$3,886.08
|
|
|
DERMABRASION TOTAL FACE (P
|
Professional
|
Both
|
$1,095.00
|
|
|
Service Code
|
HCPCS 15780
|
| Hospital Charge Code |
761P0210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$1,128.70 |
| Rate for Payer: Aetna Commercial |
$915.73
|
| Rate for Payer: Anthem Medicaid |
$221.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,095.00
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cash Price |
$547.50
|
| Rate for Payer: Cigna Commercial |
$1,128.70
|
| Rate for Payer: Healthspan PPO |
$917.52
|
| Rate for Payer: Humana Medicaid |
$221.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$225.58
|
| Rate for Payer: Molina Healthcare Passport |
$221.16
|
| Rate for Payer: Multiplan PHCS |
$657.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$766.50
|
| Rate for Payer: UHCCP Medicaid |
$383.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$223.37
|
|
|
DERMABRASION TOTAL FACE (T
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15780
|
| Hospital Charge Code |
761T0210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem Medicaid |
$1,142.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Humana KY Medicaid |
$1,142.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DERMABRASION TOTAL FACE (T
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
HCPCS 15780
|
| Hospital Charge Code |
761T0210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.73 |
| Max. Negotiated Rate |
$3,188.16 |
| Rate for Payer: Aetna Commercial |
$2,557.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.38
|
| Rate for Payer: Cash Price |
$1,660.50
|
| Rate for Payer: Cigna Commercial |
$2,756.43
|
| Rate for Payer: First Health Commercial |
$3,154.95
|
| Rate for Payer: Humana Commercial |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.51
|
| Rate for Payer: PHCS Commercial |
$3,188.16
|
| Rate for Payer: United Healthcare All Payer |
$2,922.48
|
|
|
DERMAGRAFT 2*3
|
Facility
|
IP
|
$4,167.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$541.71 |
| Max. Negotiated Rate |
$4,000.32 |
| Rate for Payer: Aetna Commercial |
$3,208.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,250.26
|
| Rate for Payer: Cash Price |
$2,083.50
|
| Rate for Payer: Cigna Commercial |
$3,458.61
|
| Rate for Payer: First Health Commercial |
$3,958.65
|
| Rate for Payer: Humana Commercial |
$3,541.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,416.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,075.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,666.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.77
|
| Rate for Payer: PHCS Commercial |
$4,000.32
|
| Rate for Payer: United Healthcare All Payer |
$3,666.96
|
|
|
DERMAGRAFT 2*3
|
Facility
|
OP
|
$4,167.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$541.71 |
| Max. Negotiated Rate |
$4,000.32 |
| Rate for Payer: Aetna Commercial |
$3,208.59
|
| Rate for Payer: Anthem Medicaid |
$1,433.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,250.26
|
| Rate for Payer: Cash Price |
$2,083.50
|
| Rate for Payer: Cigna Commercial |
$3,458.61
|
| Rate for Payer: First Health Commercial |
$3,958.65
|
| Rate for Payer: Humana Commercial |
$3,541.95
|
| Rate for Payer: Humana KY Medicaid |
$1,433.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,447.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,416.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,075.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,461.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,666.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.77
|
| Rate for Payer: PHCS Commercial |
$4,000.32
|
| Rate for Payer: United Healthcare All Payer |
$3,666.96
|
|
|
DERMAPHOR OINT 15APPL/15GM
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25003896
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
DERMAPHOR OINT 15APPL/15GM
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25003896
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
DERMA SMOOTHE FS OIL
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 68791010204
|
| Hospital Charge Code |
25000539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna Commercial |
$3.43
|
| Rate for Payer: First Health Commercial |
$3.92
|
| Rate for Payer: Humana Commercial |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.63
|
| Rate for Payer: Ohio Health Group HMO |
$3.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.28
|
| Rate for Payer: PHCS Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Payer |
$3.63
|
|
|
DERMA SMOOTHE FS OIL
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
NDC 68791010204
|
| Hospital Charge Code |
25000539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Anthem Medicaid |
$1.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna Commercial |
$3.43
|
| Rate for Payer: First Health Commercial |
$3.92
|
| Rate for Payer: Humana Commercial |
$3.51
|
| Rate for Payer: Humana KY Medicaid |
$1.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.63
|
| Rate for Payer: Ohio Health Group HMO |
$3.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.28
|
| Rate for Payer: PHCS Commercial |
$3.96
|
| Rate for Payer: United Healthcare All Payer |
$3.63
|
|
|
DERMATOPHAGOLDEPTERONYSINUSIGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
DERMATOPHAGOLDEPTERONYSINUSIGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000678
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
DERMATOPHAGOLDES FARINAE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
DERMATOPHAGOLDES FARINAE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000947
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
DERMOPLAST(BENZOCAINE) AER 2OZ
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 16864068003
|
| Hospital Charge Code |
25002985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
DERMOPLAST(BENZOCAINE) AER 2OZ
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 16864068003
|
| Hospital Charge Code |
25002985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
DESFERAL [500 MG] 500MG VIAL
|
Facility
|
IP
|
$119.95
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25002002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$115.15 |
| Rate for Payer: Aetna Commercial |
$92.36
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$99.56
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: First Health Commercial |
$113.95
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Humana Commercial |
$101.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$89.96
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.18
|
| Rate for Payer: PHCS Commercial |
$115.15
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: United Healthcare All Payer |
$105.56
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
|
|
DESFERAL [500 MG] 500MG VIAL
|
Facility
|
OP
|
$119.95
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25002002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$115.15 |
| Rate for Payer: Aetna Commercial |
$92.36
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem Medicaid |
$41.25
|
| Rate for Payer: Anthem Medicaid |
$24.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: Cigna Commercial |
$99.56
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: First Health Commercial |
$113.95
|
| Rate for Payer: Humana Commercial |
$101.96
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Humana KY Medicaid |
$41.25
|
| Rate for Payer: Humana KY Medicaid |
$24.27
|
| Rate for Payer: Kentucky WC Medicaid |
$24.52
|
| Rate for Payer: Kentucky WC Medicaid |
$41.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$89.96
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: PHCS Commercial |
$115.15
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
| Rate for Payer: United Healthcare All Payer |
$105.56
|
|
|
DESFERAL IM 500MG VIAL
|
Facility
|
IP
|
$70.58
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25002001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
|
|
DESFERAL IM 500MG VIAL
|
Facility
|
OP
|
$70.58
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25002001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Anthem Medicaid |
$24.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.05
|
| Rate for Payer: Cash Price |
$35.29
|
| Rate for Payer: Cigna Commercial |
$58.58
|
| Rate for Payer: First Health Commercial |
$67.05
|
| Rate for Payer: Humana Commercial |
$59.99
|
| Rate for Payer: Humana KY Medicaid |
$24.27
|
| Rate for Payer: Kentucky WC Medicaid |
$24.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.11
|
| Rate for Payer: Ohio Health Group HMO |
$52.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.88
|
| Rate for Payer: PHCS Commercial |
$67.76
|
| Rate for Payer: United Healthcare All Payer |
$62.11
|
|
|
DESIGN MLC DEVICE FOR IMRT
|
Facility
|
OP
|
$2,163.00
|
|
|
Service Code
|
HCPCS 77338
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$281.19 |
| Max. Negotiated Rate |
$2,076.48 |
| Rate for Payer: Aetna Commercial |
$1,665.51
|
| Rate for Payer: Anthem Medicaid |
$743.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,687.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$1,081.50
|
| Rate for Payer: Cash Price |
$1,081.50
|
| Rate for Payer: Cigna Commercial |
$1,795.29
|
| Rate for Payer: First Health Commercial |
$2,054.85
|
| Rate for Payer: Humana Commercial |
$1,838.55
|
| Rate for Payer: Humana KY Medicaid |
$743.86
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$751.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,622.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.53
|
| Rate for Payer: PHCS Commercial |
$2,076.48
|
| Rate for Payer: United Healthcare All Payer |
$1,903.44
|
|
|
DESIGN MLC DEVICE FOR IMRT
|
Professional
|
Both
|
$2,163.00
|
|
|
Service Code
|
HCPCS 77338
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$277.05 |
| Max. Negotiated Rate |
$2,163.00 |
| Rate for Payer: Aetna Commercial |
$728.87
|
| Rate for Payer: Anthem Medicaid |
$350.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,163.00
|
| Rate for Payer: Cash Price |
$1,081.50
|
| Rate for Payer: Cash Price |
$1,081.50
|
| Rate for Payer: Cigna Commercial |
$747.61
|
| Rate for Payer: Healthspan PPO |
$482.64
|
| Rate for Payer: Humana Medicaid |
$350.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$277.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.93
|
| Rate for Payer: Molina Healthcare Passport |
$350.91
|
| Rate for Payer: Multiplan PHCS |
$1,297.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,514.10
|
| Rate for Payer: UHCCP Medicaid |
$757.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.42
|
|
|
DESIGN MLC DEVICE FOR IMRT
|
Facility
|
IP
|
$2,163.00
|
|
|
Service Code
|
HCPCS 77338
|
| Hospital Charge Code |
33300018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$281.19 |
| Max. Negotiated Rate |
$2,076.48 |
| Rate for Payer: Aetna Commercial |
$1,665.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,687.14
|
| Rate for Payer: Cash Price |
$1,081.50
|
| Rate for Payer: Cigna Commercial |
$1,795.29
|
| Rate for Payer: First Health Commercial |
$2,054.85
|
| Rate for Payer: Humana Commercial |
$1,838.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,622.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.53
|
| Rate for Payer: PHCS Commercial |
$2,076.48
|
| Rate for Payer: United Healthcare All Payer |
$1,903.44
|
|
|
DESIGN MLC DEVICE FOR IMRT(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77338
|
| Hospital Charge Code |
333P0018
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$747.61 |
| Rate for Payer: Aetna Commercial |
$728.87
|
| Rate for Payer: Anthem Medicaid |
$350.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$747.61
|
| Rate for Payer: Healthspan PPO |
$482.64
|
| Rate for Payer: Humana Medicaid |
$350.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$277.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.93
|
| Rate for Payer: Molina Healthcare Passport |
$350.91
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.42
|
|
