|
AORTIC EXT POWERFIT 28-28-95RL
|
Facility
|
IP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
AORTIC EXT POWERFIT 28-28-95RL
|
Facility
|
OP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem Medicaid |
$5,451.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Humana KY Medicaid |
$5,451.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,506.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,560.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
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: Ambetter Exchange |
$154.96
|
| Rate for Payer: Anthem Medicaid |
$361.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$154.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.96
|
| 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 |
$201.45
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.96
|
|
|
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 |
$1,562.34 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,543.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,634.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,952.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,134.67
|
| 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 |
$1,362.90 |
| 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 |
$3,634.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,952.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,134.67
|
| 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 |
$2,725.80 |
| Rate for Payer: Aetna Commercial |
$492.88
|
| Rate for Payer: Ambetter Exchange |
$154.96
|
| Rate for Payer: Anthem Medicaid |
$361.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$154.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.96
|
| 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 |
$201.45
|
| Rate for Payer: UHCCP Medicaid |
$1,590.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.96
|
|
|
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 |
$1,302.90 |
| 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 |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| 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
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS 75600
|
| Hospital Charge Code |
320T0283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,493.56 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| 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
|
OP
|
$46.43
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.93 |
| 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 |
$37.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.04
|
| Rate for Payer: PHCS Commercial |
$44.57
|
| Rate for Payer: United Healthcare All Payer |
$40.86
|
|
|
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 |
$13.93 |
| 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 |
$37.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.04
|
| Rate for Payer: PHCS Commercial |
$44.57
|
| Rate for Payer: United Healthcare All Payer |
$40.86
|
|
|
AP KNEE
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem Medicaid |
$135.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Humana KY Medicaid |
$135.50
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$136.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
AP KNEE
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$342.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.86
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
AP KNEE
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
32000099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$236.40 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Ambetter Exchange |
$30.60
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.72
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.68
|
| Rate for Payer: Molina Healthcare Passport |
$21.25
|
| Rate for Payer: Multiplan PHCS |
$236.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.78
|
| Rate for Payer: UHCCP Medicaid |
$137.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.60
|
|
|
AP KNEE LT
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
32000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.90 |
| 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 |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
AP KNEE LT
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
32000990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.90 |
| 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 |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| 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: Ambetter Exchange |
$30.60
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| 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 |
$39.78
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.60
|
|
|
AP KNEE (T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
320T0099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
AP KNEE (T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
320T0099
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
APLISOL 5 TU/0.1ML SYR (0.1ML)
|
Facility
|
OP
|
$118.57
|
|
|
Service Code
|
NDC 49281075278
|
| Hospital Charge Code |
25002842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$91.30
|
| Rate for Payer: Anthem Medicaid |
$40.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.48
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cigna Commercial |
$98.41
|
| Rate for Payer: First Health Commercial |
$112.64
|
| Rate for Payer: Humana Commercial |
$100.78
|
| Rate for Payer: Humana KY Medicaid |
$40.78
|
| Rate for Payer: Kentucky WC Medicaid |
$41.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.34
|
| Rate for Payer: Ohio Health Group HMO |
$88.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.81
|
| Rate for Payer: PHCS Commercial |
$113.83
|
| Rate for Payer: United Healthcare All Payer |
$104.34
|
|
|
APLISOL 5 TU/0.1ML SYR (0.1ML)
|
Facility
|
IP
|
$118.57
|
|
|
Service Code
|
NDC 49281075278
|
| Hospital Charge Code |
25002842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$113.83 |
| Rate for Payer: Aetna Commercial |
$91.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.48
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cigna Commercial |
$98.41
|
| Rate for Payer: First Health Commercial |
$112.64
|
| Rate for Payer: Humana Commercial |
$100.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.34
|
| Rate for Payer: Ohio Health Group HMO |
$88.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.81
|
| Rate for Payer: PHCS Commercial |
$113.83
|
| Rate for Payer: United Healthcare All Payer |
$104.34
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
45000184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.40 |
| Max. Negotiated Rate |
$343.55 |
| Rate for Payer: Aetna Commercial |
$271.81
|
| Rate for Payer: Anthem Medicaid |
$121.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$292.99
|
| Rate for Payer: First Health Commercial |
$335.35
|
| Rate for Payer: Humana Commercial |
$300.05
|
| Rate for Payer: Humana KY Medicaid |
$121.40
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$122.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$289.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$260.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$310.64
|
| Rate for Payer: Ohio Health Group HMO |
$264.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.57
|
| Rate for Payer: PHCS Commercial |
$338.88
|
| Rate for Payer: United Healthcare All Payer |
$310.64
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
76101047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.80 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,049.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$832.14
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761P1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.39 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$89.57
|
| Rate for Payer: Ambetter Exchange |
$59.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.50
|
| Rate for Payer: Anthem Medicaid |
$41.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.66
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Healthspan PPO |
$108.76
|
| Rate for Payer: Humana Medicaid |
$41.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.22
|
| Rate for Payer: Molina Healthcare Passport |
$41.39
|
| Rate for Payer: Multiplan PHCS |
$276.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.64
|
| Rate for Payer: UHCCP Medicaid |
$51.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.72
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
45000184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.90 |
| Max. Negotiated Rate |
$338.88 |
| Rate for Payer: Aetna Commercial |
$271.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.34
|
| Rate for Payer: Cash Price |
$176.50
|
| Rate for Payer: Cigna Commercial |
$292.99
|
| Rate for Payer: First Health Commercial |
$335.35
|
| Rate for Payer: Humana Commercial |
$300.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$289.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$260.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$310.64
|
| Rate for Payer: Ohio Health Group HMO |
$264.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.57
|
| Rate for Payer: PHCS Commercial |
$338.88
|
| Rate for Payer: United Healthcare All Payer |
$310.64
|
|
|
APP CAST ELBOW TO FING LNG ARM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
761T1047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.39 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
