|
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 |
$6.03 |
| 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 |
$6.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.14
|
| 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 |
$6.03
|
| 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 |
$7.24
|
| 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 |
$1,279.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.54
|
| Rate for Payer: PHCS Commercial |
$1,535.36
|
| Rate for Payer: United Healthcare All Payer |
$1,407.41
|
|
|
ANTOMCAL SHLDR REM HD. 23MMX52
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANTOMCAL SHLDR REM HD. 23MMX52
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
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 |
$1,209.05 |
| Rate for Payer: Aetna Commercial |
$1,209.05
|
| Rate for Payer: Ambetter Exchange |
$737.27
|
| Rate for Payer: Anthem Medicaid |
$500.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$884.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$737.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.27
|
| 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 |
$958.45
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.27
|
|
|
ANT & POST REPAIR
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57260
|
| Hospital Charge Code |
76102182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| 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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
ANT & POST REPAIR
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57260
|
| Hospital Charge Code |
76102182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| 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 |
$1,209.05 |
| Rate for Payer: Aetna Commercial |
$1,209.05
|
| Rate for Payer: Ambetter Exchange |
$737.27
|
| Rate for Payer: Anthem Medicaid |
$500.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$884.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$737.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.27
|
| 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 |
$958.45
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.27
|
|
|
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 |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| 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 |
$1,358.55 |
| Rate for Payer: Aetna Commercial |
$1,358.55
|
| Rate for Payer: Ambetter Exchange |
$825.08
|
| Rate for Payer: Anthem Medicaid |
$519.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$825.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$990.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$825.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.08
|
| 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 |
$1,072.60
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$825.08
|
|
|
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 |
$1,358.55 |
| Rate for Payer: Aetna Commercial |
$1,358.55
|
| Rate for Payer: Ambetter Exchange |
$825.08
|
| Rate for Payer: Anthem Medicaid |
$519.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$825.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$990.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$825.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.08
|
| 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 |
$1,072.60
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$825.08
|
|
|
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 |
$687.80 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| 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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ANT RESISTANT BACT SCREEN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$52.50
|
| 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: 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 |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| 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 |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
ANT RESISTANT BACT SCREEN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| 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 |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
ANUSOL-HC (COMBINATION) SU 1EA
|
Facility
|
IP
|
$27.92
|
|
|
Service Code
|
NDC 713050324
|
| Hospital Charge Code |
25000238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.38 |
| 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 |
$22.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.26
|
| 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 |
$8.38 |
| 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 |
$22.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.26
|
| 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 |
$0.95 |
| 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 |
$2.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.18
|
| 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 |
$0.95 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| 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 |
$2.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.18
|
| Rate for Payer: PHCS Commercial |
$3.03
|
| Rate for Payer: United Healthcare All Payer |
$2.78
|
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
76101944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| 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 |
$1,010.88
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 46999
|
| Hospital Charge Code |
76101944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
$525.00 |
| 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 |
$525.00 |
| 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 |
$3,054.45 |
| Rate for Payer: Aetna Commercial |
$3,054.45
|
| Rate for Payer: Ambetter Exchange |
$1,595.64
|
| Rate for Payer: Anthem Medicaid |
$1,457.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,595.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,595.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,914.77
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,595.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.64
|
| 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 |
$2,074.33
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,471.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,595.64
|
|
|
AORTA BI FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
AORTA BI FEMORAL BYPASS GRAFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.00 |
| Max. Negotiated Rate |
$3,054.45 |
| Rate for Payer: Aetna Commercial |
$3,054.45
|
| Rate for Payer: Ambetter Exchange |
$1,595.64
|
| Rate for Payer: Anthem Medicaid |
$1,457.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,595.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,595.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,914.77
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,595.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.64
|
| 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 |
$2,074.33
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,471.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,595.64
|
|
|
AORTA BI FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 35646
|
| Hospital Charge Code |
76101410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
