|
[C]TYLENOL #4 (ACETAMIN. 1TAB
|
Facility
|
OP
|
$60.58
|
|
|
Service Code
|
NDC 406048501
|
| Hospital Charge Code |
25000085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$58.16 |
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: Anthem Medicaid |
$20.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.25
|
| Rate for Payer: Cash Price |
$30.29
|
| Rate for Payer: Cigna Commercial |
$50.28
|
| Rate for Payer: First Health Commercial |
$57.55
|
| Rate for Payer: Humana Commercial |
$51.49
|
| Rate for Payer: Humana KY Medicaid |
$20.83
|
| Rate for Payer: Kentucky WC Medicaid |
$21.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.31
|
| Rate for Payer: Ohio Health Group HMO |
$45.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.80
|
| Rate for Payer: PHCS Commercial |
$58.16
|
| Rate for Payer: United Healthcare All Payer |
$53.31
|
|
|
[C]TYLENOL #4 (ACETAMIN. 1TAB
|
Facility
|
IP
|
$60.58
|
|
|
Service Code
|
NDC 406048501
|
| Hospital Charge Code |
25000085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$58.16 |
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.25
|
| Rate for Payer: Cash Price |
$30.29
|
| Rate for Payer: Cigna Commercial |
$50.28
|
| Rate for Payer: First Health Commercial |
$57.55
|
| Rate for Payer: Humana Commercial |
$51.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.31
|
| Rate for Payer: Ohio Health Group HMO |
$45.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.80
|
| Rate for Payer: PHCS Commercial |
$58.16
|
| Rate for Payer: United Healthcare All Payer |
$53.31
|
|
|
[C]TYLNOL #3 (ACETAMIN. 1 TAB
|
Facility
|
OP
|
$60.56
|
|
|
Service Code
|
NDC 406048462
|
| Hospital Charge Code |
25000084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Anthem Medicaid |
$20.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.24
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cigna Commercial |
$50.26
|
| Rate for Payer: First Health Commercial |
$57.53
|
| Rate for Payer: Humana Commercial |
$51.48
|
| Rate for Payer: Humana KY Medicaid |
$20.83
|
| Rate for Payer: Kentucky WC Medicaid |
$21.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.29
|
| Rate for Payer: Ohio Health Group HMO |
$45.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.79
|
| Rate for Payer: PHCS Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Payer |
$53.29
|
|
|
[C]TYLNOL #3 (ACETAMIN. 1 TAB
|
Facility
|
IP
|
$60.56
|
|
|
Service Code
|
NDC 406048462
|
| Hospital Charge Code |
25000084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$58.14 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.24
|
| Rate for Payer: Cash Price |
$30.28
|
| Rate for Payer: Cigna Commercial |
$50.26
|
| Rate for Payer: First Health Commercial |
$57.53
|
| Rate for Payer: Humana Commercial |
$51.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.29
|
| Rate for Payer: Ohio Health Group HMO |
$45.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.79
|
| Rate for Payer: PHCS Commercial |
$58.14
|
| Rate for Payer: United Healthcare All Payer |
$53.29
|
|
|
CUBICIN (GEN) 1MG (350MG)SDV
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25004086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
CUBICIN (GEN) 1MG (350MG)SDV
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25004086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$70.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$70.50
|
| Rate for Payer: Kentucky WC Medicaid |
$71.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
CUBICIN (GEN) 1MG (500MG)SDV
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.80 |
| 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 |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
CUBICIN (GEN) 1MG (500MG)SDV
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| 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: 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: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
CUBICIN (GENERIC) 1MG (500MG)
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| 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: 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: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
CUBICIN (GENERIC) 1MG (500MG)
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.80 |
| 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 |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
CUBICIN RF 500MG (AIC) VIAL
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CUBICIN RF 500MG (AIC) VIAL
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
25001974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Ambetter Exchange |
$6.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.96
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$9.22
|
| Rate for Payer: Healthspan PPO |
$6.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.63
|
| Rate for Payer: Multiplan PHCS |
$63.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.62
|
| Rate for Payer: UHCCP Medicaid |
$36.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.63
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
CULT PATH ORGANISM SCREEN MRSA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| 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 |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
CULTURE ACID FAST
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
30001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
CULTURE ACID FAST
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
30001284
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$10.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| 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 |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
CULTURE BLOOD
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
30001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| 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 |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
CULTURE BLOOD
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
30001247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
CULTURE; ENVIROMENTAL
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
30001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| 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 |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
CULTURE; ENVIROMENTAL
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
30001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| 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 |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.32
|
| Rate for Payer: PHCS Commercial |
$26.88
|
| Rate for Payer: United Healthcare All Payer |
$24.64
|
|
|
CULTURE GENITAL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
CULTURE GENITAL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
30001251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| 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 |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.87
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
CULTURE LEGIONELLA
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.83 |
| 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 |
$5.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.83
|
| Rate for Payer: PHCS Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Payer |
$6.16
|
|
|
CULTURE LEGIONELLA
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.10 |
| 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 |
$5.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.83
|
| Rate for Payer: PHCS Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Payer |
$6.16
|
|
