|
FLONASE (FLUTICASONE .05%/16GM
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
25000685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem Medicaid |
$0.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Humana KY Medicaid |
$0.27
|
| Rate for Payer: Kentucky WC Medicaid |
$0.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.24
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
FLONASE (FLUTICASONE .05%/16GM
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
25000685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.24
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
|
|
FLORINEF(FLUDROCORTI .1MG/1TAB
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
25000687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
FLORINEF(FLUDROCORTI .1MG/1TAB
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
25000687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
FLOSEAL HEMO SEALANT 10ML
|
Facility
|
OP
|
$3,404.39
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.21 |
| Rate for Payer: Aetna Commercial |
$2,621.38
|
| Rate for Payer: Anthem Medicaid |
$1,170.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.42
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$2,825.64
|
| Rate for Payer: First Health Commercial |
$3,234.17
|
| Rate for Payer: Humana Commercial |
$2,893.73
|
| Rate for Payer: Humana KY Medicaid |
$1,170.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.36
|
| Rate for Payer: PHCS Commercial |
$3,268.21
|
| Rate for Payer: United Healthcare All Payer |
$2,995.86
|
|
|
FLOSEAL HEMO SEALANT 10ML
|
Facility
|
IP
|
$3,404.39
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.21 |
| Rate for Payer: Aetna Commercial |
$2,621.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.42
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$2,825.64
|
| Rate for Payer: First Health Commercial |
$3,234.17
|
| Rate for Payer: Humana Commercial |
$2,893.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.36
|
| Rate for Payer: PHCS Commercial |
$3,268.21
|
| Rate for Payer: United Healthcare All Payer |
$2,995.86
|
|
|
FLOSEAL HEMOSTATIC MATRIX 5ML
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
|
|
FLOSEAL HEMOSTATIC MATRIX 5ML
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FLOVENT HFA 110 MCG INH 12 GM
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
25000688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| 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 |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
FLOVENT HFA 110 MCG INH 12 GM
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
25000688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| 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 |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
FLOVENT HFA 220 MCG INH 12 GM
|
Facility
|
IP
|
$7.35
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
25000689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$5.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.73
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna Commercial |
$6.10
|
| Rate for Payer: First Health Commercial |
$6.98
|
| Rate for Payer: Humana Commercial |
$6.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.47
|
| Rate for Payer: Ohio Health Group HMO |
$5.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.28
|
| Rate for Payer: PHCS Commercial |
$7.06
|
| Rate for Payer: United Healthcare All Payer |
$6.47
|
|
|
FLOVENT HFA 220 MCG INH 12 GM
|
Facility
|
OP
|
$7.35
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
25000689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$5.66
|
| Rate for Payer: Anthem Medicaid |
$2.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.73
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna Commercial |
$6.10
|
| Rate for Payer: First Health Commercial |
$6.98
|
| Rate for Payer: Humana Commercial |
$6.25
|
| Rate for Payer: Humana KY Medicaid |
$2.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.47
|
| Rate for Payer: Ohio Health Group HMO |
$5.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.28
|
| Rate for Payer: PHCS Commercial |
$7.06
|
| Rate for Payer: United Healthcare All Payer |
$6.47
|
|
|
FLOVENT HFA 44MCG INH 10.6GRAM
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
25000691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| 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 |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| 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 |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
|
|
FLOVENT HFA 44MCG INH 10.6GRAM
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
25000691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| 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 |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| 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 |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
FLOW CYTOMETRY 1ST MARKER WBC
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$189.12 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.07
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
FLOW CYTOMETRY 1ST MARKER WBC
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$151.69
|
| Rate for Payer: Anthem Medicaid |
$34.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$163.51
|
| Rate for Payer: First Health Commercial |
$187.15
|
| Rate for Payer: Humana Commercial |
$167.45
|
| Rate for Payer: Humana KY Medicaid |
$34.20
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$34.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.36
|
| Rate for Payer: Ohio Health Group HMO |
$147.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.07
|
| Rate for Payer: PHCS Commercial |
$189.12
|
| Rate for Payer: United Healthcare All Payer |
$173.36
|
|
|
FLOW DIRECTD BI-POLR PACING CA
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
FLOW DIRECTD BI-POLR PACING CA
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Professional
|
Both
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$1,813.00 |
| Rate for Payer: Aetna Commercial |
$455.59
|
| Rate for Payer: Anthem Medicaid |
$198.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,813.00
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$427.67
|
| Rate for Payer: Healthspan PPO |
$418.89
|
| Rate for Payer: Humana Medicaid |
$198.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.78
|
| Rate for Payer: Molina Healthcare Passport |
$198.80
|
| Rate for Payer: Multiplan PHCS |
$1,087.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,269.10
|
| Rate for Payer: UHCCP Medicaid |
$634.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.79
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
FLOW RESERVE MEASURE - INITI(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761P2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$455.59 |
| Rate for Payer: Aetna Commercial |
$455.59
|
| Rate for Payer: Anthem Medicaid |
$198.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$427.67
|
| Rate for Payer: Healthspan PPO |
$418.89
|
| Rate for Payer: Humana Medicaid |
$198.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.78
|
| Rate for Payer: Molina Healthcare Passport |
$198.80
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.79
|
|
|
FLOW RESERVE MEASURE - INITI(T
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761T2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
