|
ANCHOR SUTURE PUSHLOCK 2.9*12.
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
ANCHOR SUTURE PUSHLOCK 2.9*12.
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
ANDEXXA 10mg (200mg SDV)
|
Facility
|
IP
|
$13,625.00
|
|
|
Service Code
|
HCPCS J7169
|
| Hospital Charge Code |
25004433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,771.25 |
| Max. Negotiated Rate |
$13,080.00 |
| Rate for Payer: Aetna Commercial |
$10,491.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,627.50
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cigna Commercial |
$11,308.75
|
| Rate for Payer: First Health Commercial |
$12,943.75
|
| Rate for Payer: Humana Commercial |
$11,581.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,172.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,055.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,087.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,990.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,223.75
|
| Rate for Payer: PHCS Commercial |
$13,080.00
|
| Rate for Payer: United Healthcare All Payer |
$11,990.00
|
|
|
ANDEXXA 10mg (200mg SDV)
|
Facility
|
OP
|
$13,625.00
|
|
|
Service Code
|
HCPCS J7169
|
| Hospital Charge Code |
25004433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$13,080.00 |
| Rate for Payer: Aetna Commercial |
$10,491.25
|
| Rate for Payer: Anthem Medicaid |
$4,685.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$132.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,627.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$185.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$178.68
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cigna Commercial |
$11,308.75
|
| Rate for Payer: First Health Commercial |
$12,943.75
|
| Rate for Payer: Humana Commercial |
$11,581.25
|
| Rate for Payer: Humana KY Medicaid |
$4,685.64
|
| Rate for Payer: Humana Medicare Advantage |
$132.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,172.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,055.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,779.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,990.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,223.75
|
| Rate for Payer: PHCS Commercial |
$13,080.00
|
| Rate for Payer: United Healthcare All Payer |
$11,990.00
|
|
|
ANE COSM UNLIST 90 M PX
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANE COSM UNLIST 90 M PX
|
Professional
|
Both
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
|
|
ANE COSM UNLIST 90 M PX
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANECREAM 4% CREAM (30GM)
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 24357070130
|
| Hospital Charge Code |
25002835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.27
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
ANECREAM 4% CREAM (30GM)
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 24357070130
|
| Hospital Charge Code |
25002835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem Medicaid |
$0.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Humana KY Medicaid |
$0.30
|
| Rate for Payer: Kentucky WC Medicaid |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.27
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
ANECTINE 20MG/1ML(200MG/10 ML
|
Facility
|
IP
|
$126.37
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
25001869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$121.32 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.57
|
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Cigna Commercial |
$104.89
|
| Rate for Payer: First Health Commercial |
$120.05
|
| Rate for Payer: Humana Commercial |
$107.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.21
|
| Rate for Payer: Ohio Health Group HMO |
$94.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.17
|
| Rate for Payer: PHCS Commercial |
$121.32
|
| Rate for Payer: United Healthcare All Payer |
$111.21
|
|
|
ANECTINE 20MG/1ML(200MG/10 ML
|
Facility
|
OP
|
$126.37
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
25001869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$121.32 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: Anthem Medicaid |
$43.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.57
|
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Cigna Commercial |
$104.89
|
| Rate for Payer: First Health Commercial |
$120.05
|
| Rate for Payer: Humana Commercial |
$107.41
|
| Rate for Payer: Humana KY Medicaid |
$43.46
|
| Rate for Payer: Kentucky WC Medicaid |
$43.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.21
|
| Rate for Payer: Ohio Health Group HMO |
$94.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.17
|
| Rate for Payer: PHCS Commercial |
$121.32
|
| Rate for Payer: United Healthcare All Payer |
$111.21
|
|
|
ANES Albumin 25% (12.5gm/50mL)
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25004140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem Medicaid |
$112.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Humana KY Medicaid |
$112.25
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$113.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.18
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ANES Albumin 25% (12.5gm/50mL)
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25004140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.18
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ANES Albumin 5% (12.5gm/250mL)
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25004141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem Medicaid |
$123.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Humana KY Medicaid |
$123.46
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ANES Albumin 5% (12.5gm/250mL)
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25004141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ANES/ANALG CS DELIVER ADD-ON
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 1968
|
| Hospital Charge Code |
37000170
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| 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: Humana KY Medicaid |
$2.75
|
| 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 |
$2.40
|
| 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
|
|
|
ANES/ANALG CS DELIVER ADD-ON
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 1968
|
| Hospital Charge Code |
37000170
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: United Healthcare All Payer |
$7.04
|
| 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
|
|
|
ANES/ANALG CS DELIVER ADD-ON
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01968
|
| Hospital Charge Code |
37000170
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Anthem Medicaid |
$25.00
|
| 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: Humana Medicaid |
$25.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.50
|
| Rate for Payer: Molina Healthcare Passport |
$25.00
|
| 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 |
$25.25
|
|
|
ANES ARTH/ENDO ULNA/WRI/HND
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01830
|
| Hospital Charge Code |
37000153
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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
|
|
|
ANES ARTH/ENDO ULNA/WRI/HND
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 1830
|
| Hospital Charge Code |
37000153
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| 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: Humana KY Medicaid |
$2.75
|
| 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 |
$2.40
|
| 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
|
|
|
ANES ARTH/ENDO ULNA/WRI/HND
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 1830
|
| Hospital Charge Code |
37000153
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
ANES ART SHLDR/AXIL BYPSS GRFT
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 01654
|
| Hospital Charge Code |
37000136
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| 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
|
|
|
ANES ART SHLDR/AXIL BYPSS GRFT
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 1654
|
| Hospital Charge Code |
37000136
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| 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: Humana KY Medicaid |
$2.75
|
| 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 |
$2.40
|
| 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
|
|
|
ANES ART SHLDR/AXIL BYPSS GRFT
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 1654
|
| Hospital Charge Code |
37000136
|
|
Hospital Revenue Code
|
370
|
| 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
|
|
|
ANES COS BLEPUPPER & LOWER OR
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
37000186
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.55
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
