|
APP UNIPLANE EXT FIXATION SYS
|
Facility
|
OP
|
$9,818.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,276.34 |
| Max. Negotiated Rate |
$9,425.28 |
| Rate for Payer: Aetna Commercial |
$7,559.86
|
| Rate for Payer: Anthem Medicaid |
$3,376.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,658.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cigna Commercial |
$8,148.94
|
| Rate for Payer: First Health Commercial |
$9,327.10
|
| Rate for Payer: Humana Commercial |
$8,345.30
|
| Rate for Payer: Humana KY Medicaid |
$3,376.41
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,410.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,050.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,245.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,444.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,639.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,963.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.58
|
| Rate for Payer: PHCS Commercial |
$9,425.28
|
| Rate for Payer: United Healthcare All Payer |
$8,639.84
|
|
|
APP UNIPLANE EXT FIXATION SY(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
761T0351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
APP UNIPLANE EXT FIXATION SY(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
761T0351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
APRESOLINE [20 MG] 20MG/1ML VL
|
Facility
|
OP
|
$121.32
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
25001872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$116.47 |
| Rate for Payer: Aetna Commercial |
$93.42
|
| Rate for Payer: Anthem Medicaid |
$41.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.63
|
| Rate for Payer: Cash Price |
$60.66
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: First Health Commercial |
$115.25
|
| Rate for Payer: Humana Commercial |
$103.12
|
| Rate for Payer: Humana KY Medicaid |
$41.72
|
| Rate for Payer: Kentucky WC Medicaid |
$42.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.76
|
| Rate for Payer: Ohio Health Group HMO |
$90.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.61
|
| Rate for Payer: PHCS Commercial |
$116.47
|
| Rate for Payer: United Healthcare All Payer |
$106.76
|
|
|
APRESOLINE [20 MG] 20MG/1ML VL
|
Facility
|
IP
|
$121.32
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
25001872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$116.47 |
| Rate for Payer: Aetna Commercial |
$93.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.63
|
| Rate for Payer: Cash Price |
$60.66
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: First Health Commercial |
$115.25
|
| Rate for Payer: Humana Commercial |
$103.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.76
|
| Rate for Payer: Ohio Health Group HMO |
$90.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.61
|
| Rate for Payer: PHCS Commercial |
$116.47
|
| Rate for Payer: United Healthcare All Payer |
$106.76
|
|
|
APRESOLINE(HYDRALAZI 10MG/1TAB
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 51079007420
|
| Hospital Charge Code |
25000242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
APRESOLINE(HYDRALAZI 10MG/1TAB
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 51079007420
|
| Hospital Charge Code |
25000242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
APRESOLINE(HYDRALAZI 25MG/1TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
25000243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
APRESOLINE(HYDRALAZI 25MG/1TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
25000243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
APRETUDE 1mg (600mg SDV)
|
Facility
|
IP
|
$21,402.42
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
25004467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,782.31 |
| Max. Negotiated Rate |
$20,546.32 |
| Rate for Payer: Aetna Commercial |
$16,479.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,693.89
|
| Rate for Payer: Cash Price |
$10,701.21
|
| Rate for Payer: Cigna Commercial |
$17,764.01
|
| Rate for Payer: First Health Commercial |
$20,332.30
|
| Rate for Payer: Humana Commercial |
$18,192.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,549.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,794.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,420.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,834.13
|
| Rate for Payer: Ohio Health Group HMO |
$16,051.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.75
|
| Rate for Payer: PHCS Commercial |
$20,546.32
|
| Rate for Payer: United Healthcare All Payer |
$18,834.13
|
|
|
APRETUDE 1mg (600mg SDV)
|
Facility
|
OP
|
$21,402.42
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
25004467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,782.31 |
| Max. Negotiated Rate |
$20,546.32 |
| Rate for Payer: Aetna Commercial |
$16,479.86
|
| Rate for Payer: Anthem Medicaid |
$7,360.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,693.89
|
| Rate for Payer: Cash Price |
$10,701.21
|
| Rate for Payer: Cigna Commercial |
$17,764.01
|
| Rate for Payer: First Health Commercial |
$20,332.30
|
| Rate for Payer: Humana Commercial |
$18,192.06
|
| Rate for Payer: Humana KY Medicaid |
$7,360.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,435.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,549.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,794.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,420.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,507.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,834.13
|
| Rate for Payer: Ohio Health Group HMO |
$16,051.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,280.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,782.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.75
|
| Rate for Payer: PHCS Commercial |
$20,546.32
|
| Rate for Payer: United Healthcare All Payer |
$18,834.13
|
|
|
APRISO 0.375GM CAPSULE
|
Facility
|
OP
|
$12.25
|
|
|
Service Code
|
NDC 65649010302
|
| Hospital Charge Code |
25000244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Anthem Medicaid |
$4.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.56
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$10.17
|
| Rate for Payer: First Health Commercial |
$11.64
|
| Rate for Payer: Humana Commercial |
$10.41
|
| Rate for Payer: Humana KY Medicaid |
$4.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.04
|
| Rate for Payer: Aetna Commercial |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.78
|
| Rate for Payer: Ohio Health Group HMO |
$9.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.80
|
| Rate for Payer: PHCS Commercial |
$11.76
|
| Rate for Payer: United Healthcare All Payer |
$10.78
|
|
|
APRISO 0.375GM CAPSULE
|
Facility
|
IP
|
$12.25
|
|
|
Service Code
|
NDC 65649010302
|
| Hospital Charge Code |
25000244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Aetna Commercial |
$9.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.56
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$10.17
|
| Rate for Payer: First Health Commercial |
$11.64
|
| Rate for Payer: Humana Commercial |
$10.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.78
|
| Rate for Payer: Ohio Health Group HMO |
$9.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.80
|
| Rate for Payer: PHCS Commercial |
$11.76
|
| Rate for Payer: United Healthcare All Payer |
$10.78
|
|
|
AP SHOULDER LT 1 VIEW
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
32000074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
AP SHOULDER LT 1 VIEW
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
32000074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
AP SHOULDER LT 1 VIEW
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
32000074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Anthem Medicaid |
$19.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$36.96
|
| Rate for Payer: Healthspan PPO |
$33.18
|
| Rate for Payer: Humana Medicaid |
$19.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.71
|
| Rate for Payer: Molina Healthcare Passport |
$19.32
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.51
|
|
|
AP SHOULDER LT 1 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
320P0074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$35.41
|
| Rate for Payer: Anthem Medicaid |
$19.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$36.96
|
| Rate for Payer: Healthspan PPO |
$33.18
|
| Rate for Payer: Humana Medicaid |
$19.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.71
|
| Rate for Payer: Molina Healthcare Passport |
$19.32
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.51
|
|
|
AP SHOULDER LT 1 VIEW(T
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
320T0074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
AP SHOULDER LT 1 VIEW(T
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
320T0074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
AP SKSB T/A/L<1001ST 25SCM LC
|
Professional
|
Both
|
$3,646.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$3,646.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.75
|
| Rate for Payer: Anthem Medicaid |
$70.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,646.00
|
| Rate for Payer: Cash Price |
$1,823.00
|
| Rate for Payer: Cash Price |
$1,823.00
|
| Rate for Payer: Cigna Commercial |
$148.63
|
| Rate for Payer: Healthspan PPO |
$129.96
|
| Rate for Payer: Humana Medicaid |
$70.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.64
|
| Rate for Payer: Molina Healthcare Passport |
$70.24
|
| Rate for Payer: Multiplan PHCS |
$2,187.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,552.20
|
| Rate for Payer: UHCCP Medicaid |
$45.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.94
|
|
|
AP SKSB T/A/L<1001ST 25SCM LC
|
Facility
|
OP
|
$3,646.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.98 |
| Max. Negotiated Rate |
$3,500.16 |
| Rate for Payer: Aetna Commercial |
$2,807.42
|
| Rate for Payer: Anthem Medicaid |
$1,253.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,823.00
|
| Rate for Payer: Cash Price |
$1,823.00
|
| Rate for Payer: Cigna Commercial |
$3,026.18
|
| Rate for Payer: First Health Commercial |
$3,463.70
|
| Rate for Payer: Humana Commercial |
$3,099.10
|
| Rate for Payer: Humana KY Medicaid |
$1,253.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,266.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,279.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,208.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,734.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.26
|
| Rate for Payer: PHCS Commercial |
$3,500.16
|
| Rate for Payer: United Healthcare All Payer |
$3,208.48
|
|
|
AP SKSB T/A/L<1001ST 25SCM LC
|
Facility
|
IP
|
$3,646.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.98 |
| Max. Negotiated Rate |
$3,500.16 |
| Rate for Payer: Aetna Commercial |
$2,807.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.88
|
| Rate for Payer: Cash Price |
$1,823.00
|
| Rate for Payer: Cigna Commercial |
$3,026.18
|
| Rate for Payer: First Health Commercial |
$3,463.70
|
| Rate for Payer: Humana Commercial |
$3,099.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,208.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,734.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.26
|
| Rate for Payer: PHCS Commercial |
$3,500.16
|
| Rate for Payer: United Healthcare All Payer |
$3,208.48
|
|
|
AP SKSB T/A/L<1001ST 25SCM L(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
761P0190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.75
|
| Rate for Payer: Anthem Medicaid |
$70.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$148.63
|
| Rate for Payer: Healthspan PPO |
$129.96
|
| Rate for Payer: Humana Medicaid |
$70.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$109.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.64
|
| Rate for Payer: Molina Healthcare Passport |
$70.24
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$45.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.94
|
|
|
AP SKSB T/A/L<1001ST 25SCM L(T
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
761T0190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.23 |
| Max. Negotiated Rate |
$3,044.16 |
| Rate for Payer: Aetna Commercial |
$2,441.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.38
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: Cigna Commercial |
$2,631.93
|
| Rate for Payer: First Health Commercial |
$3,012.45
|
| Rate for Payer: Humana Commercial |
$2,695.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.01
|
| Rate for Payer: PHCS Commercial |
$3,044.16
|
| Rate for Payer: United Healthcare All Payer |
$2,790.48
|
|
|
AP SKSB T/A/L<1001ST 25SCM L(T
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
761T0190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.23 |
| Max. Negotiated Rate |
$3,044.16 |
| Rate for Payer: Aetna Commercial |
$2,441.67
|
| Rate for Payer: Anthem Medicaid |
$1,090.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: Cash Price |
$1,585.50
|
| Rate for Payer: Cigna Commercial |
$2,631.93
|
| Rate for Payer: First Health Commercial |
$3,012.45
|
| Rate for Payer: Humana Commercial |
$2,695.35
|
| Rate for Payer: Humana KY Medicaid |
$1,090.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.01
|
| Rate for Payer: PHCS Commercial |
$3,044.16
|
| Rate for Payer: United Healthcare All Payer |
$2,790.48
|
|
