ANTI-XA (UFH)
|
Facility
|
IP
|
$203.00
|
|
Service Code
|
HCPCS 85520
|
Hospital Charge Code |
30000610
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$26.39 |
Max. Negotiated Rate |
$194.88 |
Rate for Payer: Aetna Commercial |
$156.31
|
Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: Cigna Commercial |
$168.49
|
Rate for Payer: First Health Commercial |
$192.85
|
Rate for Payer: Humana Commercial |
$172.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$60.90
|
Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
Rate for Payer: Ohio Health Group HMO |
$152.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$40.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$26.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.93
|
Rate for Payer: PHCS Commercial |
$194.88
|
Rate for Payer: United Healthcare All Payer |
$178.64
|
|
ANTI-XA (UFH)
|
Facility
|
OP
|
$203.00
|
|
Service Code
|
HCPCS 85520
|
Hospital Charge Code |
30000610
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$13.09 |
Max. Negotiated Rate |
$194.88 |
Rate for Payer: Aetna Commercial |
$156.31
|
Rate for Payer: Anthem Medicaid |
$13.09
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$13.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$163.01
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.33
|
Rate for Payer: CareSource Just4Me Medicare |
$13.09
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: Cash Price |
$101.50
|
Rate for Payer: Cigna Commercial |
$168.49
|
Rate for Payer: First Health Commercial |
$192.85
|
Rate for Payer: Humana Commercial |
$172.55
|
Rate for Payer: Humana KY Medicaid |
$13.09
|
Rate for Payer: Humana Medicare Advantage |
$13.09
|
Rate for Payer: Kentucky WC Medicaid |
$13.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$166.46
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
Rate for Payer: Molina Healthcare Medicaid |
$13.35
|
Rate for Payer: Ohio Health Choice Commercial |
$178.64
|
Rate for Payer: Ohio Health Group HMO |
$152.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$40.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$26.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.93
|
Rate for Payer: PHCS Commercial |
$194.88
|
Rate for Payer: United Healthcare All Payer |
$178.64
|
|
ANTIZOL 15MG (1.5GM/1.5ML VL)
|
Facility
|
IP
|
$1,599.33
|
|
Service Code
|
HCPCS J1451
|
Hospital Charge Code |
25002065
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$207.91 |
Max. Negotiated Rate |
$1,535.36 |
Rate for Payer: Aetna Commercial |
$1,231.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.48
|
Rate for Payer: Cash Price |
$799.66
|
Rate for Payer: Cigna Commercial |
$1,327.44
|
Rate for Payer: First Health Commercial |
$1,519.36
|
Rate for Payer: Humana Commercial |
$1,359.43
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.31
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$479.80
|
Rate for Payer: Ohio Health Choice Commercial |
$1,407.41
|
Rate for Payer: Ohio Health Group HMO |
$1,199.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$319.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$207.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.79
|
Rate for Payer: PHCS Commercial |
$1,535.36
|
Rate for Payer: United Healthcare All Payer |
$1,407.41
|
|
ANTIZOL 15MG (1.5GM/1.5ML VL)
|
Facility
|
OP
|
$1,599.33
|
|
Service Code
|
HCPCS J1451
|
Hospital Charge Code |
25002065
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$6.06 |
Max. Negotiated Rate |
$1,535.36 |
Rate for Payer: Aetna Commercial |
$1,231.48
|
Rate for Payer: Anthem Medicaid |
$550.01
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6.06
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.48
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.48
|
Rate for Payer: CareSource Just4Me Medicare |
$8.18
|
Rate for Payer: Cash Price |
$799.66
|
Rate for Payer: Cash Price |
$799.66
|
Rate for Payer: Cigna Commercial |
$1,327.44
|
Rate for Payer: First Health Commercial |
$1,519.36
|
Rate for Payer: Humana Commercial |
$1,359.43
|
Rate for Payer: Humana KY Medicaid |
$550.01
|
Rate for Payer: Humana Medicare Advantage |
$6.06
|
Rate for Payer: Kentucky WC Medicaid |
$555.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.31
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7.27
|
Rate for Payer: Molina Healthcare Medicaid |
$561.04
|
Rate for Payer: Ohio Health Choice Commercial |
$1,407.41
|
Rate for Payer: Ohio Health Group HMO |
$1,199.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$319.87
|
Rate for Payer: Ohio Health Group PPO No Differential |
$207.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.79
|
Rate for Payer: PHCS Commercial |
$1,535.36
|
Rate for Payer: United Healthcare All Payer |
$1,407.41
|
|
ANTOMCAL SHLDR REM HD. 23MMX52
|
Facility
|
IP
|
$10,647.45
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,384.17 |
Max. Negotiated Rate |
$10,221.55 |
Rate for Payer: Aetna Commercial |
$8,198.54
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
Rate for Payer: Cash Price |
$5,323.73
|
Rate for Payer: Cigna Commercial |
$8,837.38
|
Rate for Payer: First Health Commercial |
$10,115.08
|
Rate for Payer: Humana Commercial |
$9,050.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
Rate for Payer: PHCS Commercial |
$10,221.55
|
Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
ANTOMCAL SHLDR REM HD. 23MMX52
|
Facility
|
OP
|
$10,647.45
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,384.17 |
Max. Negotiated Rate |
$10,221.55 |
Rate for Payer: Aetna Commercial |
$8,198.54
|
Rate for Payer: Anthem Medicaid |
$3,661.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
Rate for Payer: Cash Price |
$5,323.73
|
Rate for Payer: Cigna Commercial |
$8,837.38
|
Rate for Payer: First Health Commercial |
$10,115.08
|
Rate for Payer: Humana Commercial |
$9,050.33
|
Rate for Payer: Humana KY Medicaid |
$3,661.66
|
Rate for Payer: Kentucky WC Medicaid |
$3,698.92
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
Rate for Payer: Molina Healthcare Medicaid |
$3,735.13
|
Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
Rate for Payer: PHCS Commercial |
$10,221.55
|
Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
ANT & POST REPAIR
|
Facility
|
IP
|
$1,800.00
|
|
Service Code
|
HCPCS 57260
|
Hospital Charge Code |
76102182
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$234.00 |
Max. Negotiated Rate |
$1,728.00 |
Rate for Payer: Aetna Commercial |
$1,386.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,494.00
|
Rate for Payer: First Health Commercial |
$1,710.00
|
Rate for Payer: Humana Commercial |
$1,530.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
Rate for Payer: PHCS Commercial |
$1,728.00
|
Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
ANT & POST REPAIR
|
Professional
|
Both
|
$1,800.00
|
|
Service Code
|
HCPCS 57260
|
Hospital Charge Code |
76102182
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$500.41 |
Max. Negotiated Rate |
$1,800.00 |
Rate for Payer: Aetna Commercial |
$1,209.05
|
Rate for Payer: Anthem Medicaid |
$500.41
|
Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,126.53
|
Rate for Payer: Healthspan PPO |
$1,170.67
|
Rate for Payer: Humana Medicaid |
$500.41
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.42
|
Rate for Payer: Molina Healthcare Passport |
$500.41
|
Rate for Payer: Multiplan PHCS |
$1,080.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
Rate for Payer: UHCCP Medicaid |
$630.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$505.41
|
|
ANT & POST REPAIR
|
Facility
|
OP
|
$1,800.00
|
|
Service Code
|
HCPCS 57260
|
Hospital Charge Code |
76102182
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$234.00 |
Max. Negotiated Rate |
$6,021.69 |
Rate for Payer: Aetna Commercial |
$1,386.00
|
Rate for Payer: Anthem Medicaid |
$619.02
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,494.00
|
Rate for Payer: First Health Commercial |
$1,710.00
|
Rate for Payer: Humana Commercial |
$1,530.00
|
Rate for Payer: Humana KY Medicaid |
$619.02
|
Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
Rate for Payer: Kentucky WC Medicaid |
$625.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
Rate for Payer: PHCS Commercial |
$1,728.00
|
Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
ANT & POST REPAIR(P
|
Professional
|
Both
|
$1,800.00
|
|
Service Code
|
HCPCS 57260
|
Hospital Charge Code |
761P2182
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$500.41 |
Max. Negotiated Rate |
$1,800.00 |
Rate for Payer: Aetna Commercial |
$1,209.05
|
Rate for Payer: Anthem Medicaid |
$500.41
|
Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,126.53
|
Rate for Payer: Healthspan PPO |
$1,170.67
|
Rate for Payer: Humana Medicaid |
$500.41
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.42
|
Rate for Payer: Molina Healthcare Passport |
$500.41
|
Rate for Payer: Multiplan PHCS |
$1,080.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
Rate for Payer: UHCCP Medicaid |
$630.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$505.41
|
|
ANT & POST REPAIR W/ENTEROCELE
|
Professional
|
Both
|
$2,000.00
|
|
Service Code
|
HCPCS 57265
|
Hospital Charge Code |
76102183
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$519.90 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Aetna Commercial |
$1,358.55
|
Rate for Payer: Anthem Medicaid |
$519.90
|
Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,285.78
|
Rate for Payer: Healthspan PPO |
$1,315.42
|
Rate for Payer: Humana Medicaid |
$519.90
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,183.75
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.30
|
Rate for Payer: Molina Healthcare Passport |
$519.90
|
Rate for Payer: Multiplan PHCS |
$1,200.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
Rate for Payer: UHCCP Medicaid |
$700.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$525.10
|
|
ANT & POST REPAIR W/ENTEROCELE
|
Facility
|
OP
|
$2,000.00
|
|
Service Code
|
HCPCS 57265
|
Hospital Charge Code |
76102183
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$6,021.69 |
Rate for Payer: Aetna Commercial |
$1,540.00
|
Rate for Payer: Anthem Medicaid |
$687.80
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,660.00
|
Rate for Payer: First Health Commercial |
$1,900.00
|
Rate for Payer: Humana Commercial |
$1,700.00
|
Rate for Payer: Humana KY Medicaid |
$687.80
|
Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
Rate for Payer: Kentucky WC Medicaid |
$694.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
Rate for Payer: PHCS Commercial |
$1,920.00
|
Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
ANT & POST REPAIR W/ENTEROCELE
|
Facility
|
IP
|
$2,000.00
|
|
Service Code
|
HCPCS 57265
|
Hospital Charge Code |
76102183
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$1,920.00 |
Rate for Payer: Aetna Commercial |
$1,540.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,660.00
|
Rate for Payer: First Health Commercial |
$1,900.00
|
Rate for Payer: Humana Commercial |
$1,700.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
Rate for Payer: PHCS Commercial |
$1,920.00
|
Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
ANT & POST REPAIR W/ENTEROCELE
|
Professional
|
Both
|
$2,000.00
|
|
Service Code
|
HCPCS 57265
|
Hospital Charge Code |
761P2183
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$519.90 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Aetna Commercial |
$1,358.55
|
Rate for Payer: Anthem Medicaid |
$519.90
|
Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,285.78
|
Rate for Payer: Healthspan PPO |
$1,315.42
|
Rate for Payer: Humana Medicaid |
$519.90
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,183.75
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.30
|
Rate for Payer: Molina Healthcare Passport |
$519.90
|
Rate for Payer: Multiplan PHCS |
$1,200.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
Rate for Payer: UHCCP Medicaid |
$700.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$525.10
|
|
ANT RESISTANT BACT SCREEN
|
Facility
|
IP
|
$99.00
|
|
Service Code
|
HCPCS 87081
|
Hospital Charge Code |
30001268
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$12.87 |
Max. Negotiated Rate |
$95.04 |
Rate for Payer: Aetna Commercial |
$76.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
Rate for Payer: Cash Price |
$49.50
|
Rate for Payer: Cigna Commercial |
$82.17
|
Rate for Payer: First Health Commercial |
$94.05
|
Rate for Payer: Humana Commercial |
$84.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
Rate for Payer: Ohio Health Group HMO |
$74.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
Rate for Payer: PHCS Commercial |
$95.04
|
Rate for Payer: United Healthcare All Payer |
$87.12
|
|
ANT RESISTANT BACT SCREEN
|
Facility
|
OP
|
$99.00
|
|
Service Code
|
HCPCS 87081
|
Hospital Charge Code |
30001268
|
Hospital Revenue Code
|
306
|
Min. Negotiated Rate |
$6.63 |
Max. Negotiated Rate |
$95.04 |
Rate for Payer: Aetna Commercial |
$76.23
|
Rate for Payer: Anthem Medicaid |
$6.63
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
Rate for Payer: Cash Price |
$49.50
|
Rate for Payer: Cash Price |
$49.50
|
Rate for Payer: Cigna Commercial |
$82.17
|
Rate for Payer: First Health Commercial |
$94.05
|
Rate for Payer: Humana Commercial |
$84.15
|
Rate for Payer: Humana KY Medicaid |
$6.63
|
Rate for Payer: Humana Medicare Advantage |
$6.63
|
Rate for Payer: Kentucky WC Medicaid |
$6.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
Rate for Payer: Ohio Health Group HMO |
$74.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
Rate for Payer: PHCS Commercial |
$95.04
|
Rate for Payer: United Healthcare All Payer |
$87.12
|
|
ANUSOL-HC (COMBINATION) SU 1EA
|
Facility
|
IP
|
$27.92
|
|
Service Code
|
NDC 713050324
|
Hospital Charge Code |
25000238
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.63 |
Max. Negotiated Rate |
$26.80 |
Rate for Payer: Aetna Commercial |
$21.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21.78
|
Rate for Payer: Cash Price |
$13.96
|
Rate for Payer: Cigna Commercial |
$23.17
|
Rate for Payer: First Health Commercial |
$26.52
|
Rate for Payer: Humana Commercial |
$23.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22.89
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.38
|
Rate for Payer: Ohio Health Choice Commercial |
$24.57
|
Rate for Payer: Ohio Health Group HMO |
$20.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.58
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.66
|
Rate for Payer: PHCS Commercial |
$26.80
|
Rate for Payer: United Healthcare All Payer |
$24.57
|
|
ANUSOL-HC (COMBINATION) SU 1EA
|
Facility
|
OP
|
$27.92
|
|
Service Code
|
NDC 713050324
|
Hospital Charge Code |
25000238
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$3.63 |
Max. Negotiated Rate |
$26.80 |
Rate for Payer: Aetna Commercial |
$21.50
|
Rate for Payer: Anthem Medicaid |
$9.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21.78
|
Rate for Payer: Cash Price |
$13.96
|
Rate for Payer: Cigna Commercial |
$23.17
|
Rate for Payer: First Health Commercial |
$26.52
|
Rate for Payer: Humana Commercial |
$23.73
|
Rate for Payer: Humana KY Medicaid |
$9.60
|
Rate for Payer: Kentucky WC Medicaid |
$9.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22.89
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.38
|
Rate for Payer: Molina Healthcare Medicaid |
$9.79
|
Rate for Payer: Ohio Health Choice Commercial |
$24.57
|
Rate for Payer: Ohio Health Group HMO |
$20.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.58
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.63
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.66
|
Rate for Payer: PHCS Commercial |
$26.80
|
Rate for Payer: United Healthcare All Payer |
$24.57
|
|
ANUSOL-HC(HYDROCORT) 2.5% 1OZ
|
Facility
|
IP
|
$3.16
|
|
Service Code
|
NDC 64980032430
|
Hospital Charge Code |
25002840
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.41 |
Max. Negotiated Rate |
$3.03 |
Rate for Payer: Aetna Commercial |
$2.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2.46
|
Rate for Payer: Cash Price |
$1.58
|
Rate for Payer: Cigna Commercial |
$2.62
|
Rate for Payer: First Health Commercial |
$3.00
|
Rate for Payer: Humana Commercial |
$2.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
Rate for Payer: Ohio Health Choice Commercial |
$2.78
|
Rate for Payer: Ohio Health Group HMO |
$2.37
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.98
|
Rate for Payer: PHCS Commercial |
$3.03
|
Rate for Payer: United Healthcare All Payer |
$2.78
|
|
ANUSOL-HC(HYDROCORT) 2.5% 1OZ
|
Facility
|
OP
|
$3.16
|
|
Service Code
|
NDC 64980032430
|
Hospital Charge Code |
25002840
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.41 |
Max. Negotiated Rate |
$3.03 |
Rate for Payer: Anthem Medicaid |
$1.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2.46
|
Rate for Payer: Cash Price |
$1.58
|
Rate for Payer: Cigna Commercial |
$2.62
|
Rate for Payer: First Health Commercial |
$3.00
|
Rate for Payer: Humana Commercial |
$2.69
|
Rate for Payer: Humana KY Medicaid |
$1.09
|
Rate for Payer: Kentucky WC Medicaid |
$1.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
Rate for Payer: Molina Healthcare Medicaid |
$1.11
|
Rate for Payer: Ohio Health Choice Commercial |
$2.78
|
Rate for Payer: Ohio Health Group HMO |
$2.37
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.98
|
Rate for Payer: PHCS Commercial |
$3.03
|
Rate for Payer: United Healthcare All Payer |
$2.78
|
Rate for Payer: Aetna Commercial |
$2.43
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
IP
|
$750.00
|
|
Service Code
|
HCPCS 46999
|
Hospital Charge Code |
76101944
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$97.50 |
Max. Negotiated Rate |
$720.00 |
Rate for Payer: Aetna Commercial |
$577.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cigna Commercial |
$622.50
|
Rate for Payer: First Health Commercial |
$712.50
|
Rate for Payer: Humana Commercial |
$637.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
Rate for Payer: Ohio Health Group HMO |
$562.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
Rate for Payer: PHCS Commercial |
$720.00
|
Rate for Payer: United Healthcare All Payer |
$660.00
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
OP
|
$750.00
|
|
Service Code
|
HCPCS 46999
|
Hospital Charge Code |
76101944
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$97.50 |
Max. Negotiated Rate |
$1,106.49 |
Rate for Payer: Aetna Commercial |
$577.50
|
Rate for Payer: Anthem Medicaid |
$257.92
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cigna Commercial |
$622.50
|
Rate for Payer: First Health Commercial |
$712.50
|
Rate for Payer: Humana Commercial |
$637.50
|
Rate for Payer: Humana KY Medicaid |
$257.92
|
Rate for Payer: Humana Medicare Advantage |
$790.35
|
Rate for Payer: Kentucky WC Medicaid |
$260.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
Rate for Payer: Ohio Health Group HMO |
$562.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
Rate for Payer: PHCS Commercial |
$720.00
|
Rate for Payer: United Healthcare All Payer |
$660.00
|
|
ANUS SURGERY PROCEDURE
|
Professional
|
Both
|
$750.00
|
|
Service Code
|
HCPCS 46999
|
Hospital Charge Code |
76101944
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$750.00 |
Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Multiplan PHCS |
$450.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
Rate for Payer: UHCCP Medicaid |
$262.50
|
|
ANUS SURGERY PROCEDURE(P
|
Professional
|
Both
|
$750.00
|
|
Service Code
|
HCPCS 46999
|
Hospital Charge Code |
761P1944
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$0.60 |
Max. Negotiated Rate |
$750.00 |
Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Cash Price |
$375.00
|
Rate for Payer: Healthspan PPO |
$0.60
|
Rate for Payer: Multiplan PHCS |
$450.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
Rate for Payer: UHCCP Medicaid |
$262.50
|
|
AORTA BI FEMORAL BYPASS GRAF(P
|
Professional
|
Both
|
$4,100.00
|
|
Service Code
|
HCPCS 35646
|
Hospital Charge Code |
761P1410
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$1,435.00 |
Max. Negotiated Rate |
$4,100.00 |
Rate for Payer: Aetna Commercial |
$3,054.45
|
Rate for Payer: Anthem Medicaid |
$1,457.00
|
Rate for Payer: Buckeye Medicare Advantage |
$4,100.00
|
Rate for Payer: Cash Price |
$2,050.00
|
Rate for Payer: Cash Price |
$2,050.00
|
Rate for Payer: Cigna Commercial |
$2,919.02
|
Rate for Payer: Healthspan PPO |
$3,003.12
|
Rate for Payer: Humana Medicaid |
$1,457.00
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,363.80
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,486.14
|
Rate for Payer: Molina Healthcare Passport |
$1,457.00
|
Rate for Payer: Multiplan PHCS |
$2,460.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,870.00
|
Rate for Payer: UHCCP Medicaid |
$1,435.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$1,471.57
|
|