|
ALCOHOL/SUBS INTERV >30 MIN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
51000141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$193.02 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
ALCOHOL/SUBS INTERV >30 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
51000141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$93.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.51
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
|
|
ALCOHOL/SUBS INTERV >30 MIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
51000141
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
ALDACTONE(SPIRONOLAC 25MG/1TAB
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
25000180
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ALDACTONE(SPIRONOLAC 25MG/1TAB
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 51079010320
|
| Hospital Charge Code |
25000180
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ALDOMET (METHYLDOPA 250MG/1TAB
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 378061101
|
| Hospital Charge Code |
25000182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALDOMET (METHYLDOPA 250MG/1TAB
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 378061101
|
| Hospital Charge Code |
25000182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALDOMET (METHYLDOPA 500MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 51079020120
|
| Hospital Charge Code |
25000183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ALDOMET (METHYLDOPA 500MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 51079020120
|
| Hospital Charge Code |
25000183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
AL I CATH 6F 100CM
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
AL I CATH 6F 100CM
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
ALIGN RADICAL STEM 10MM*0MM
|
Facility
|
OP
|
$9,935.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.65 |
| Max. Negotiated Rate |
$9,538.32 |
| Rate for Payer: Aetna Commercial |
$7,650.53
|
| Rate for Payer: Anthem Medicaid |
$3,416.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.88
|
| Rate for Payer: Cash Price |
$4,967.88
|
| Rate for Payer: Cigna Commercial |
$8,246.67
|
| Rate for Payer: First Health Commercial |
$9,438.96
|
| Rate for Payer: Humana Commercial |
$8,445.39
|
| Rate for Payer: Humana KY Medicaid |
$3,416.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,743.46
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.08
|
| Rate for Payer: PHCS Commercial |
$9,538.32
|
| Rate for Payer: United Healthcare All Payer |
$8,743.46
|
|
|
ALIGN RADICAL STEM 10MM*0MM
|
Facility
|
IP
|
$9,935.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.65 |
| Max. Negotiated Rate |
$9,538.32 |
| Rate for Payer: Aetna Commercial |
$7,650.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.88
|
| Rate for Payer: Cash Price |
$4,967.88
|
| Rate for Payer: Cigna Commercial |
$8,246.67
|
| Rate for Payer: First Health Commercial |
$9,438.96
|
| Rate for Payer: Humana Commercial |
$8,445.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,743.46
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.08
|
| Rate for Payer: PHCS Commercial |
$9,538.32
|
| Rate for Payer: United Healthcare All Payer |
$8,743.46
|
|
|
AL II CATH 6F 100CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
AL II CATH 6F 100CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
AL III CATH 6F 100CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
AL III CATH 6F 100CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
ALIMTA 10MG (100 MG VIAL)
|
Facility
|
IP
|
$163.50
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
25002672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.53
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cigna Commercial |
$135.70
|
| Rate for Payer: First Health Commercial |
$155.32
|
| Rate for Payer: Humana Commercial |
$138.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.88
|
| Rate for Payer: Ohio Health Group HMO |
$122.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.68
|
| Rate for Payer: PHCS Commercial |
$156.96
|
| Rate for Payer: United Healthcare All Payer |
$143.88
|
|
|
ALIMTA 10MG (100 MG VIAL)
|
Facility
|
OP
|
$163.50
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
25002672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$125.90
|
| Rate for Payer: Anthem Medicaid |
$56.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.90
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cigna Commercial |
$135.70
|
| Rate for Payer: First Health Commercial |
$155.32
|
| Rate for Payer: Humana Commercial |
$138.98
|
| Rate for Payer: Humana KY Medicaid |
$56.23
|
| Rate for Payer: Humana Medicare Advantage |
$4.37
|
| Rate for Payer: Kentucky WC Medicaid |
$56.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.88
|
| Rate for Payer: Ohio Health Group HMO |
$122.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.68
|
| Rate for Payer: PHCS Commercial |
$156.96
|
| Rate for Payer: United Healthcare All Payer |
$143.88
|
|
|
ALIMTA 10 MG/500MG VIAL
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
25002671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem Medicaid |
$281.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.90
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Humana KY Medicaid |
$281.14
|
| Rate for Payer: Humana Medicare Advantage |
$4.37
|
| Rate for Payer: Kentucky WC Medicaid |
$284.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
ALIMTA 10 MG/500MG VIAL
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
25002671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
ALKALINE PHOS ISOENZYME MAYO
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
30001779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.40
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
ALKALINE PHOS ISOENZYME MAYO
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
30001779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$14.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$14.78
|
| Rate for Payer: Humana Medicare Advantage |
$14.78
|
| Rate for Payer: Kentucky WC Medicaid |
$14.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.36
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
