|
ALKERAN (MELPHALAN) 2MG/1TAB
|
Facility
|
IP
|
$61.69
|
|
|
Service Code
|
NDC 52609000105
|
| Hospital Charge Code |
25003854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.12
|
| Rate for Payer: Cash Price |
$30.84
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: First Health Commercial |
$58.61
|
| Rate for Payer: Humana Commercial |
$52.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.29
|
| Rate for Payer: Ohio Health Group HMO |
$46.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.12
|
| Rate for Payer: PHCS Commercial |
$59.22
|
| Rate for Payer: United Healthcare All Payer |
$54.29
|
|
|
ALKERAN (MELPHALAN) 2MG/1TAB
|
Facility
|
OP
|
$61.69
|
|
|
Service Code
|
NDC 52609000105
|
| Hospital Charge Code |
25003854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Anthem Medicaid |
$21.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.12
|
| Rate for Payer: Cash Price |
$30.84
|
| Rate for Payer: Cigna Commercial |
$51.20
|
| Rate for Payer: First Health Commercial |
$58.61
|
| Rate for Payer: Humana Commercial |
$52.44
|
| Rate for Payer: Humana KY Medicaid |
$21.22
|
| Rate for Payer: Kentucky WC Medicaid |
$21.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.29
|
| Rate for Payer: Ohio Health Group HMO |
$46.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.12
|
| Rate for Payer: PHCS Commercial |
$59.22
|
| Rate for Payer: United Healthcare All Payer |
$54.29
|
|
|
ALLANFOL TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 61269032610
|
| Hospital Charge Code |
25000189
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
ALLANFOL TABLET
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 61269032610
|
| Hospital Charge Code |
25000189
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
ALLBEE WITH C CAPSULE 1CAP
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
25000190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ALLBEE WITH C CAPSULE 1CAP
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
25000190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ALLERGENIC EXTRACT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
94000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ALLERGENIC EXTRACT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
94000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ALLERGENIC EXTRACT
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
94000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.73
|
| Rate for Payer: Anthem Medicaid |
$2.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$15.67
|
| Rate for Payer: Healthspan PPO |
$20.08
|
| Rate for Payer: Humana Medicaid |
$2.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.78
|
| Rate for Payer: Molina Healthcare Passport |
$2.73
|
| Rate for Payer: Multiplan PHCS |
$45.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.20
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.76
|
|
|
ALLERGENIC EXTRACT(P
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
940P0011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.73
|
| Rate for Payer: Anthem Medicaid |
$2.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$15.67
|
| Rate for Payer: Healthspan PPO |
$20.08
|
| Rate for Payer: Humana Medicaid |
$2.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.78
|
| Rate for Payer: Molina Healthcare Passport |
$2.73
|
| Rate for Payer: Multiplan PHCS |
$12.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.70
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.76
|
|
|
ALLERGENIC EXTRACT(T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
940T0011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$57.51 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ALLERGENIC EXTRACT(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
940T0011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ALLERGEN SPECIFIC IGG
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
30001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem Medicaid |
$7.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.82
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Humana KY Medicaid |
$7.82
|
| Rate for Payer: Humana Medicare Advantage |
$7.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.78
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
ALLERGEN SPECIFIC IGG
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
30001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.51
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Cigna Commercial |
$31.54
|
| Rate for Payer: First Health Commercial |
$36.10
|
| Rate for Payer: Humana Commercial |
$32.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.44
|
| Rate for Payer: Ohio Health Group HMO |
$28.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.78
|
| Rate for Payer: PHCS Commercial |
$36.48
|
| Rate for Payer: United Healthcare All Payer |
$33.44
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$20,752.62
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$14,082.14 |
| Max. Negotiated Rate |
$20,752.62 |
| Rate for Payer: Anthem Medicaid |
$14,082.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,823.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,752.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,011.46
|
| Rate for Payer: Humana KY Medicaid |
$14,082.14
|
| Rate for Payer: Humana Medicare Advantage |
$14,823.30
|
| Rate for Payer: Kentucky WC Medicaid |
$14,222.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,787.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,363.78
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$7,706.78
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$5,229.60 |
| Max. Negotiated Rate |
$7,706.78 |
| Rate for Payer: Anthem Medicaid |
$5,229.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,504.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,706.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,431.53
|
| Rate for Payer: Humana KY Medicaid |
$5,229.60
|
| Rate for Payer: Humana Medicare Advantage |
$5,504.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,281.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,605.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,334.19
|
|
|
ALLERGY INJ MULTIPLE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Anthem Medicaid |
$13.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$25.40
|
| Rate for Payer: Healthspan PPO |
$21.81
|
| Rate for Payer: Humana Medicaid |
$13.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.64
|
| Rate for Payer: Molina Healthcare Passport |
$13.37
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.50
|
|
|
ALLERGY INJ MULTIPLE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$57.51 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ALLERGY INJ MULTIPLE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ALLERGY INJ SINGLE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$13.49
|
| Rate for Payer: Anthem Medicaid |
$10.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$20.43
|
| Rate for Payer: Healthspan PPO |
$18.15
|
| Rate for Payer: Humana Medicaid |
$10.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.75
|
| Rate for Payer: Molina Healthcare Passport |
$10.54
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.65
|
|
|
ALLERGY INJ SINGLE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$57.51 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ALLERGY INJ SINGLE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
ALLERGY PATCH TESTS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ALLERGY PATCH TESTS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$5.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: Healthspan PPO |
$10.60
|
| Rate for Payer: Humana Medicaid |
$5.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5.45
|
| Rate for Payer: Molina Healthcare Passport |
$5.34
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.39
|
|
|
ALLERGY PATCH TESTS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1,265.78 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$904.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,265.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,220.58
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Humana Medicare Advantage |
$904.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,084.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
