|
AL I CATH 6F 100CM
|
Facility
|
IP
|
$163.69
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
ALIGN RADICAL STEM 10MM*0MM
|
Facility
|
IP
|
$10,135.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.72 |
| Max. Negotiated Rate |
$9,730.32 |
| Rate for Payer: Aetna Commercial |
$7,804.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,905.89
|
| Rate for Payer: Cash Price |
$5,067.88
|
| Rate for Payer: Cigna Commercial |
$8,412.67
|
| Rate for Payer: First Health Commercial |
$9,628.96
|
| Rate for Payer: Humana Commercial |
$8,615.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,919.46
|
| Rate for Payer: Ohio Health Group HMO |
$7,601.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,993.67
|
| Rate for Payer: PHCS Commercial |
$9,730.32
|
| Rate for Payer: United Healthcare All Payer |
$8,919.46
|
|
|
ALIGN RADICAL STEM 10MM*0MM
|
Facility
|
OP
|
$10,135.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.72 |
| Max. Negotiated Rate |
$9,730.32 |
| Rate for Payer: Aetna Commercial |
$7,804.53
|
| Rate for Payer: Anthem Medicaid |
$3,485.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,905.89
|
| Rate for Payer: Cash Price |
$5,067.88
|
| Rate for Payer: Cigna Commercial |
$8,412.67
|
| Rate for Payer: First Health Commercial |
$9,628.96
|
| Rate for Payer: Humana Commercial |
$8,615.39
|
| Rate for Payer: Humana KY Medicaid |
$3,485.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,521.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,311.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,480.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,555.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,919.46
|
| Rate for Payer: Ohio Health Group HMO |
$7,601.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,818.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,993.67
|
| Rate for Payer: PHCS Commercial |
$9,730.32
|
| Rate for Payer: United Healthcare All Payer |
$8,919.46
|
|
|
AL II CATH 6F 100CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
AL II CATH 6F 100CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
AL III CATH 6F 100CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
AL III CATH 6F 100CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
ALIMTA 10MG (100 MG VIAL)
|
Facility
|
IP
|
$163.50
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
25002672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$125.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.53
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cigna Commercial |
$135.71
|
| Rate for Payer: First Health Commercial |
$155.32
|
| Rate for Payer: Humana Commercial |
$138.97
|
| 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 |
$130.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.81
|
| 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 |
$3.73 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$125.89
|
| Rate for Payer: Anthem Medicaid |
$56.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.04
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cigna Commercial |
$135.71
|
| Rate for Payer: First Health Commercial |
$155.32
|
| Rate for Payer: Humana Commercial |
$138.97
|
| Rate for Payer: Humana KY Medicaid |
$56.23
|
| Rate for Payer: Humana Medicare Advantage |
$3.73
|
| 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 |
$4.48
|
| 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 |
$130.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.81
|
| 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 |
$3.73 |
| 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 |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.04
|
| 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 |
$3.73
|
| 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 |
$4.48
|
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| 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 |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
ALKALINE PHOS ISOENZYME MAYO
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
30001779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.63
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.36
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
ALKALINE PHOS ISOENZYME MAYO
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
30001779
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem Medicaid |
$14.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| 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 |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.36
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
30000471
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| 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 |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
ALKERAN (MELPHALAN) 2MG/1TAB
|
Facility
|
IP
|
$61.69
|
|
|
Service Code
|
NDC 52609000105
|
| Hospital Charge Code |
25003854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.51 |
| 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 |
$49.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.57
|
| 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 |
$18.51 |
| 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 |
$49.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.57
|
| Rate for Payer: PHCS Commercial |
$59.22
|
| Rate for Payer: United Healthcare All Payer |
$54.29
|
|
|
ALLANFOL TABLET
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 51991038490
|
| Hospital Charge Code |
25000189
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.72
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.37
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.43
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
ALLANFOL TABLET
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 51991038490
|
| Hospital Charge Code |
25000189
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.72
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.37
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.43
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
ALLBEE WITH C CAPSULE 1CAP
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
25000190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| 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 |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| 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 |
$1.27 |
| 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 |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ALLERGENIC EXTRACT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
94000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| 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 |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ALLERGENIC EXTRACT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
94000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.14 |
| 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 |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| 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 |
$42.63
|
| 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 |
$51.16
|
| 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 |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| 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 |
$45.60 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Ambetter Exchange |
$3.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.73
|
| Rate for Payer: Anthem Medicaid |
$7.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.79
|
| 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 |
$7.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.29
|
| Rate for Payer: Molina Healthcare Passport |
$7.15
|
| Rate for Payer: Multiplan PHCS |
$45.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.11
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.16
|
|
|
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 |
$20.08 |
| Rate for Payer: Aetna Commercial |
$4.47
|
| Rate for Payer: Ambetter Exchange |
$3.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$2.73
|
| Rate for Payer: Anthem Medicaid |
$7.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.79
|
| 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 |
$7.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.29
|
| Rate for Payer: Molina Healthcare Passport |
$7.15
|
| Rate for Payer: Multiplan PHCS |
$12.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.11
|
| Rate for Payer: UHCCP Medicaid |
$2.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.16
|
|
