|
AORTIC EXT POWERFIT 25-25-75RL
|
Facility
|
OP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem Medicaid |
$4,643.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Humana KY Medicaid |
$4,643.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,690.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,736.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
AORTIC EXT POWERFIT 25-25-95RL
|
Facility
|
OP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem Medicaid |
$5,276.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Humana KY Medicaid |
$5,276.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,329.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,381.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
AORTIC EXT POWERFIT 25-25-95RL
|
Facility
|
IP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
AORTIC EXT POWERFIT 28-28-75RL
|
Facility
|
OP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem Medicaid |
$4,643.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Humana KY Medicaid |
$4,643.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,690.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,736.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
AORTIC EXT POWERFIT 28-28-75RL
|
Facility
|
IP
|
$13,501.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.23 |
| Max. Negotiated Rate |
$12,961.68 |
| Rate for Payer: Aetna Commercial |
$10,396.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,531.36
|
| Rate for Payer: Cash Price |
$6,750.88
|
| Rate for Payer: Cigna Commercial |
$11,206.45
|
| Rate for Payer: First Health Commercial |
$12,826.66
|
| Rate for Payer: Humana Commercial |
$11,476.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,071.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,964.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,050.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$10,126.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,185.54
|
| Rate for Payer: PHCS Commercial |
$12,961.68
|
| Rate for Payer: United Healthcare All Payer |
$11,881.54
|
|
|
AORTIC EXT POWERFIT 28-28-95RL
|
Facility
|
OP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem Medicaid |
$5,276.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Humana KY Medicaid |
$5,276.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,329.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,381.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
AORTIC EXT POWERFIT 28-28-95RL
|
Facility
|
IP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
AORTOGRA RAD SUPV INTERP THO(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
320P0283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$681.55 |
| Rate for Payer: Aetna Commercial |
$492.88
|
| Rate for Payer: Anthem Medicaid |
$361.36
|
| 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 |
$681.55
|
| Rate for Payer: Healthspan PPO |
$338.68
|
| Rate for Payer: Humana Medicaid |
$361.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.59
|
| Rate for Payer: Molina Healthcare Passport |
$361.36
|
| 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 |
$364.97
|
|
|
AORTOGRA RAD SUPV INTERP THOR
|
Facility
|
OP
|
$4,543.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$590.59 |
| Max. Negotiated Rate |
$4,361.28 |
| Rate for Payer: Aetna Commercial |
$3,498.11
|
| Rate for Payer: Anthem Medicaid |
$1,562.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,543.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,271.50
|
| Rate for Payer: Cash Price |
$2,271.50
|
| Rate for Payer: Cigna Commercial |
$3,770.69
|
| Rate for Payer: First Health Commercial |
$4,315.85
|
| Rate for Payer: Humana Commercial |
$3,861.55
|
| Rate for Payer: Humana KY Medicaid |
$1,562.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,725.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,593.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,997.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.33
|
| Rate for Payer: PHCS Commercial |
$4,361.28
|
| Rate for Payer: United Healthcare All Payer |
$3,997.84
|
|
|
AORTOGRA RAD SUPV INTERP THOR
|
Facility
|
IP
|
$4,543.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$590.59 |
| Max. Negotiated Rate |
$4,361.28 |
| Rate for Payer: Aetna Commercial |
$3,498.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,543.54
|
| Rate for Payer: Cash Price |
$2,271.50
|
| Rate for Payer: Cigna Commercial |
$3,770.69
|
| Rate for Payer: First Health Commercial |
$4,315.85
|
| Rate for Payer: Humana Commercial |
$3,861.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,725.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,997.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.33
|
| Rate for Payer: PHCS Commercial |
$4,361.28
|
| Rate for Payer: United Healthcare All Payer |
$3,997.84
|
|
|
AORTOGRA RAD SUPV INTERP THOR
|
Professional
|
Both
|
$4,543.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$4,543.00 |
| Rate for Payer: Aetna Commercial |
$492.88
|
| Rate for Payer: Anthem Medicaid |
$361.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,543.00
|
| Rate for Payer: Cash Price |
$2,271.50
|
| Rate for Payer: Cash Price |
$2,271.50
|
| Rate for Payer: Cigna Commercial |
$681.55
|
| Rate for Payer: Healthspan PPO |
$338.68
|
| Rate for Payer: Humana Medicaid |
$361.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.59
|
| Rate for Payer: Molina Healthcare Passport |
$361.36
|
| Rate for Payer: Multiplan PHCS |
$2,725.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,180.10
|
| Rate for Payer: UHCCP Medicaid |
$1,590.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.97
|
|
|
AORTOGRA RAD SUPV INTERP THO(T
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
320T0283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.59 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem Medicaid |
$1,493.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Humana KY Medicaid |
$1,493.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.33
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
AORTOGRA RAD SUPV INTERP THO(T
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
320T0283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.59 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.33
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
APIDRA EA 5U (U-100 VIAL) 10ML
|
Facility
|
IP
|
$46.43
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.22
|
| Rate for Payer: Cash Price |
$23.22
|
| Rate for Payer: Cigna Commercial |
$38.54
|
| Rate for Payer: First Health Commercial |
$44.11
|
| Rate for Payer: Humana Commercial |
$39.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.86
|
| Rate for Payer: Ohio Health Group HMO |
$34.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.39
|
| Rate for Payer: PHCS Commercial |
$44.57
|
| Rate for Payer: United Healthcare All Payer |
$40.86
|
|
|
APIDRA EA 5U (U-100 VIAL) 10ML
|
Facility
|
OP
|
$46.43
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Anthem Medicaid |
$15.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.22
|
| Rate for Payer: Cash Price |
$23.22
|
| Rate for Payer: Cigna Commercial |
$38.54
|
| Rate for Payer: First Health Commercial |
$44.11
|
| Rate for Payer: Humana Commercial |
$39.47
|
| Rate for Payer: Humana KY Medicaid |
$15.97
|
| Rate for Payer: Kentucky WC Medicaid |
$16.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.86
|
| Rate for Payer: Ohio Health Group HMO |
$34.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.39
|
| Rate for Payer: PHCS Commercial |
$44.57
|
| Rate for Payer: United Healthcare All Payer |
$40.86
|
|
|
AP KNEE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
AP KNEE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
AP KNEE
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.68
|
| Rate for Payer: Molina Healthcare Passport |
$21.25
|
| Rate for Payer: Multiplan PHCS |
$223.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.40
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
|
|
AP KNEE LT
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
32000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem Medicaid |
$190.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Humana KY Medicaid |
$190.18
|
| Rate for Payer: Kentucky WC Medicaid |
$192.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.43
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
AP KNEE LT
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
32000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.43
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
AP KNEE (P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
320P0099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$42.53
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.68
|
| Rate for Payer: Molina Healthcare Passport |
$21.25
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
|
|
AP KNEE (T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
320T0099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
AP KNEE (T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
320T0099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
APLISOL 5 TU/0.1ML SYR (0.1ML)
|
Facility
|
IP
|
$117.11
|
|
|
Service Code
|
NDC 49281075278
|
| Hospital Charge Code |
25002842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.43 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.35
|
| Rate for Payer: Cash Price |
$58.56
|
| Rate for Payer: Cigna Commercial |
$97.20
|
| Rate for Payer: First Health Commercial |
$111.25
|
| Rate for Payer: Humana Commercial |
$99.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.06
|
| Rate for Payer: Ohio Health Group HMO |
$87.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.30
|
| Rate for Payer: PHCS Commercial |
$112.43
|
| Rate for Payer: United Healthcare All Payer |
$103.06
|
|
|
APLISOL 5 TU/0.1ML SYR (0.1ML)
|
Facility
|
OP
|
$117.11
|
|
|
Service Code
|
NDC 49281075278
|
| Hospital Charge Code |
25002842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$112.43 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Anthem Medicaid |
$40.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.35
|
| Rate for Payer: Cash Price |
$58.56
|
| Rate for Payer: Cigna Commercial |
$97.20
|
| Rate for Payer: First Health Commercial |
$111.25
|
| Rate for Payer: Humana Commercial |
$99.54
|
| Rate for Payer: Humana KY Medicaid |
$40.27
|
| Rate for Payer: Kentucky WC Medicaid |
$40.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.06
|
| Rate for Payer: Ohio Health Group HMO |
$87.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.30
|
| Rate for Payer: PHCS Commercial |
$112.43
|
| Rate for Payer: United Healthcare All Payer |
$103.06
|
|
