|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
OP
|
$3,192.53
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761T0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.03 |
| Max. Negotiated Rate |
$3,064.83 |
| Rate for Payer: Aetna Commercial |
$2,458.25
|
| Rate for Payer: Anthem Medicaid |
$1,097.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,596.27
|
| Rate for Payer: Cash Price |
$1,596.27
|
| Rate for Payer: Cigna Commercial |
$2,649.80
|
| Rate for Payer: First Health Commercial |
$3,032.90
|
| Rate for Payer: Humana Commercial |
$2,713.65
|
| Rate for Payer: Humana KY Medicaid |
$1,097.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,617.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,119.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$989.68
|
| Rate for Payer: PHCS Commercial |
$3,064.83
|
| Rate for Payer: United Healthcare All Payer |
$2,809.43
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761P0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$284.99
|
| Rate for Payer: Anthem Medicaid |
$136.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.00
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Healthspan PPO |
$258.14
|
| Rate for Payer: Humana Medicaid |
$136.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$239.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.54
|
| Rate for Payer: Molina Healthcare Passport |
$136.80
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.50
|
| Rate for Payer: UHCCP Medicaid |
$183.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.17
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Professional
|
Both
|
$3,717.53
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$3,717.53 |
| Rate for Payer: Aetna Commercial |
$284.99
|
| Rate for Payer: Anthem Medicaid |
$136.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,717.53
|
| Rate for Payer: Cash Price |
$1,858.77
|
| Rate for Payer: Cash Price |
$1,858.77
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Healthspan PPO |
$258.14
|
| Rate for Payer: Humana Medicaid |
$136.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$239.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.54
|
| Rate for Payer: Molina Healthcare Passport |
$136.80
|
| Rate for Payer: Multiplan PHCS |
$2,230.52
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,602.27
|
| Rate for Payer: UHCCP Medicaid |
$1,301.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.17
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
IP
|
$3,717.53
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.28 |
| Max. Negotiated Rate |
$3,568.83 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.67
|
| Rate for Payer: Cash Price |
$1,858.77
|
| Rate for Payer: Cigna Commercial |
$3,085.55
|
| Rate for Payer: First Health Commercial |
$3,531.65
|
| Rate for Payer: Humana Commercial |
$3,159.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.43
|
| Rate for Payer: PHCS Commercial |
$3,568.83
|
| Rate for Payer: United Healthcare All Payer |
$3,271.43
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
OP
|
$3,717.53
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.28 |
| Max. Negotiated Rate |
$3,568.83 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: Anthem Medicaid |
$1,278.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,858.77
|
| Rate for Payer: Cash Price |
$1,858.77
|
| Rate for Payer: Cigna Commercial |
$3,085.55
|
| Rate for Payer: First Health Commercial |
$3,531.65
|
| Rate for Payer: Humana Commercial |
$3,159.90
|
| Rate for Payer: Humana KY Medicaid |
$1,278.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.43
|
| Rate for Payer: PHCS Commercial |
$3,568.83
|
| Rate for Payer: United Healthcare All Payer |
$3,271.43
|
|
|
MAPLE TREE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
MAPLE TREE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
MARCAINE(BUPIVACAIN)0.25% 30ML
|
Facility
|
IP
|
$114.52
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$109.94 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.33
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: First Health Commercial |
$108.79
|
| Rate for Payer: Humana Commercial |
$97.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.78
|
| Rate for Payer: Ohio Health Group HMO |
$85.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.50
|
| Rate for Payer: PHCS Commercial |
$109.94
|
| Rate for Payer: United Healthcare All Payer |
$100.78
|
|
|
MARCAINE(BUPIVACAIN)0.25% 30ML
|
Facility
|
OP
|
$114.52
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$109.94 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: Anthem Medicaid |
$39.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: First Health Commercial |
$108.79
|
| Rate for Payer: Humana Commercial |
$97.34
|
| Rate for Payer: Humana KY Medicaid |
$39.38
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$39.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.78
|
| Rate for Payer: Ohio Health Group HMO |
$85.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.50
|
| Rate for Payer: PHCS Commercial |
$109.94
|
| Rate for Payer: United Healthcare All Payer |
$100.78
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$71.38
|
|
| Hospital Charge Code |
636T0091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$68.52 |
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Anthem Medicaid |
$24.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna Commercial |
$59.25
|
| Rate for Payer: First Health Commercial |
$67.81
|
| Rate for Payer: Humana Commercial |
$60.67
|
| Rate for Payer: Humana KY Medicaid |
$24.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.81
|
| Rate for Payer: Ohio Health Group HMO |
$53.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.13
|
| Rate for Payer: PHCS Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Payer |
$62.81
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$71.38
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$68.52 |
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna Commercial |
$59.25
|
| Rate for Payer: First Health Commercial |
$67.81
|
| Rate for Payer: Humana Commercial |
$60.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.81
|
| Rate for Payer: Ohio Health Group HMO |
$53.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.13
|
| Rate for Payer: PHCS Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Payer |
$62.81
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Anthem Medicaid |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: First Health Commercial |
$74.13
|
| Rate for Payer: Humana Commercial |
$66.33
|
| Rate for Payer: Humana KY Medicaid |
$26.83
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.67
|
| Rate for Payer: Ohio Health Group HMO |
$58.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.19
|
| Rate for Payer: PHCS Commercial |
$74.91
|
| Rate for Payer: United Healthcare All Payer |
$68.67
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Professional
|
Both
|
$71.38
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$71.38 |
| Rate for Payer: Buckeye Medicare Advantage |
$71.38
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Multiplan PHCS |
$42.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.97
|
| Rate for Payer: UHCCP Medicaid |
$24.98
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$71.38
|
|
| Hospital Charge Code |
636T0091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$68.52 |
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna Commercial |
$59.25
|
| Rate for Payer: First Health Commercial |
$67.81
|
| Rate for Payer: Humana Commercial |
$60.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.81
|
| Rate for Payer: Ohio Health Group HMO |
$53.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.13
|
| Rate for Payer: PHCS Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Payer |
$62.81
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$71.38
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$68.52 |
| Rate for Payer: Aetna Commercial |
$54.96
|
| Rate for Payer: Anthem Medicaid |
$24.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cigna Commercial |
$59.25
|
| Rate for Payer: First Health Commercial |
$67.81
|
| Rate for Payer: Humana Commercial |
$60.67
|
| Rate for Payer: Humana KY Medicaid |
$24.55
|
| Rate for Payer: Kentucky WC Medicaid |
$24.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.81
|
| Rate for Payer: Ohio Health Group HMO |
$53.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.13
|
| Rate for Payer: PHCS Commercial |
$68.52
|
| Rate for Payer: United Healthcare All Payer |
$62.81
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.86
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: First Health Commercial |
$74.13
|
| Rate for Payer: Humana Commercial |
$66.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.67
|
| Rate for Payer: Ohio Health Group HMO |
$58.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.19
|
| Rate for Payer: PHCS Commercial |
$74.91
|
| Rate for Payer: United Healthcare All Payer |
$68.67
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$79.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$76.46 |
| Rate for Payer: Aetna Commercial |
$61.33
|
| Rate for Payer: Anthem Medicaid |
$27.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cigna Commercial |
$66.11
|
| Rate for Payer: First Health Commercial |
$75.67
|
| Rate for Payer: Humana Commercial |
$67.70
|
| Rate for Payer: Humana KY Medicaid |
$27.39
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.09
|
| Rate for Payer: Ohio Health Group HMO |
$59.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.69
|
| Rate for Payer: PHCS Commercial |
$76.46
|
| Rate for Payer: United Healthcare All Payer |
$70.09
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Professional
|
Both
|
$73.06
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$73.06 |
| Rate for Payer: Buckeye Medicare Advantage |
$73.06
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Multiplan PHCS |
$43.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.14
|
| Rate for Payer: UHCCP Medicaid |
$25.57
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$73.06
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Anthem Medicaid |
$25.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.99
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cigna Commercial |
$60.64
|
| Rate for Payer: First Health Commercial |
$69.41
|
| Rate for Payer: Humana Commercial |
$62.10
|
| Rate for Payer: Humana KY Medicaid |
$25.13
|
| Rate for Payer: Kentucky WC Medicaid |
$25.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.29
|
| Rate for Payer: Ohio Health Group HMO |
$54.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.65
|
| Rate for Payer: PHCS Commercial |
$70.14
|
| Rate for Payer: United Healthcare All Payer |
$64.29
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$79.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$76.46 |
| Rate for Payer: Aetna Commercial |
$61.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.13
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cigna Commercial |
$66.11
|
| Rate for Payer: First Health Commercial |
$75.67
|
| Rate for Payer: Humana Commercial |
$67.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.09
|
| Rate for Payer: Ohio Health Group HMO |
$59.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.69
|
| Rate for Payer: PHCS Commercial |
$76.46
|
| Rate for Payer: United Healthcare All Payer |
$70.09
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$73.06
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.99
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cigna Commercial |
$60.64
|
| Rate for Payer: First Health Commercial |
$69.41
|
| Rate for Payer: Humana Commercial |
$62.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.29
|
| Rate for Payer: Ohio Health Group HMO |
$54.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.65
|
| Rate for Payer: PHCS Commercial |
$70.14
|
| Rate for Payer: United Healthcare All Payer |
$64.29
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$73.06
|
|
| Hospital Charge Code |
636T0092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Anthem Medicaid |
$25.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.99
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cigna Commercial |
$60.64
|
| Rate for Payer: First Health Commercial |
$69.41
|
| Rate for Payer: Humana Commercial |
$62.10
|
| Rate for Payer: Humana KY Medicaid |
$25.13
|
| Rate for Payer: Kentucky WC Medicaid |
$25.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.29
|
| Rate for Payer: Ohio Health Group HMO |
$54.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.65
|
| Rate for Payer: PHCS Commercial |
$70.14
|
| Rate for Payer: United Healthcare All Payer |
$64.29
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$73.06
|
|
| Hospital Charge Code |
636T0092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$56.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.99
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cigna Commercial |
$60.64
|
| Rate for Payer: First Health Commercial |
$69.41
|
| Rate for Payer: Humana Commercial |
$62.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.29
|
| Rate for Payer: Ohio Health Group HMO |
$54.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.65
|
| Rate for Payer: PHCS Commercial |
$70.14
|
| Rate for Payer: United Healthcare All Payer |
$64.29
|
|
|
MARCAINE/EPIEPHRINE 0.25% 10ML
|
Facility
|
IP
|
$80.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$77.24 |
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna Commercial |
$66.78
|
| Rate for Payer: First Health Commercial |
$76.44
|
| Rate for Payer: Humana Commercial |
$68.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.80
|
| Rate for Payer: Ohio Health Group HMO |
$60.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.94
|
| Rate for Payer: PHCS Commercial |
$77.24
|
| Rate for Payer: United Healthcare All Payer |
$70.80
|
|
|
MARCAINE/EPIEPHRINE 0.25% 10ML
|
Facility
|
OP
|
$80.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$77.24 |
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Anthem Medicaid |
$27.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna Commercial |
$66.78
|
| Rate for Payer: First Health Commercial |
$76.44
|
| Rate for Payer: Humana Commercial |
$68.39
|
| Rate for Payer: Humana KY Medicaid |
$27.67
|
| Rate for Payer: Kentucky WC Medicaid |
$27.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.80
|
| Rate for Payer: Ohio Health Group HMO |
$60.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.94
|
| Rate for Payer: PHCS Commercial |
$77.24
|
| Rate for Payer: United Healthcare All Payer |
$70.80
|
|
