|
MARCAIN+EPI 0.25%/1:200K50mLMD
|
Facility
|
IP
|
$119.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Humana Commercial |
$101.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.92
|
| Rate for Payer: Ohio Health Group HMO |
$89.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.96
|
| Rate for Payer: PHCS Commercial |
$114.46
|
| Rate for Payer: United Healthcare All Payer |
$104.92
|
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.00
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.96
|
| Rate for Payer: First Health Commercial |
$113.27
|
|
|
MARCAIN+EPI 0.25%/1:200K50mLMD
|
Facility
|
OP
|
$119.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Anthem Medicaid |
$41.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.00
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.96
|
| Rate for Payer: First Health Commercial |
$113.27
|
| Rate for Payer: Humana Commercial |
$101.35
|
| Rate for Payer: Humana KY Medicaid |
$41.00
|
| Rate for Payer: Kentucky WC Medicaid |
$41.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.92
|
| Rate for Payer: Ohio Health Group HMO |
$89.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.96
|
| Rate for Payer: PHCS Commercial |
$114.46
|
| Rate for Payer: United Healthcare All Payer |
$104.92
|
|
|
MARCAINE SPINAL (BUPIVACAI 2ML
|
Facility
|
OP
|
$78.59
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna Commercial |
$60.51
|
| Rate for Payer: Anthem Medicaid |
$27.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$65.23
|
| Rate for Payer: First Health Commercial |
$74.66
|
| Rate for Payer: Humana Commercial |
$66.80
|
| Rate for Payer: Humana KY Medicaid |
$27.03
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.16
|
| Rate for Payer: Ohio Health Group HMO |
$58.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.36
|
| Rate for Payer: PHCS Commercial |
$75.45
|
| Rate for Payer: United Healthcare All Payer |
$69.16
|
|
|
MARCAINE SPINAL (BUPIVACAI 2ML
|
Facility
|
IP
|
$78.59
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna Commercial |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$65.23
|
| Rate for Payer: First Health Commercial |
$74.66
|
| Rate for Payer: Humana Commercial |
$66.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.16
|
| Rate for Payer: Ohio Health Group HMO |
$58.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.36
|
| Rate for Payer: PHCS Commercial |
$75.45
|
| Rate for Payer: United Healthcare All Payer |
$69.16
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Professional
|
Both
|
$111.19
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$111.19 |
| Rate for Payer: Buckeye Medicare Advantage |
$111.19
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Multiplan PHCS |
$66.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.83
|
| Rate for Payer: UHCCP Medicaid |
$38.92
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$111.19
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$106.74 |
| Rate for Payer: Aetna Commercial |
$85.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.73
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cigna Commercial |
$92.29
|
| Rate for Payer: First Health Commercial |
$105.63
|
| Rate for Payer: Humana Commercial |
$94.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.85
|
| Rate for Payer: Ohio Health Group HMO |
$83.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.47
|
| Rate for Payer: PHCS Commercial |
$106.74
|
| Rate for Payer: United Healthcare All Payer |
$97.85
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$111.19
|
|
| Hospital Charge Code |
636T0090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$106.74 |
| Rate for Payer: Aetna Commercial |
$85.62
|
| Rate for Payer: Anthem Medicaid |
$38.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.73
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cigna Commercial |
$92.29
|
| Rate for Payer: First Health Commercial |
$105.63
|
| Rate for Payer: Humana Commercial |
$94.51
|
| Rate for Payer: Humana KY Medicaid |
$38.24
|
| Rate for Payer: Kentucky WC Medicaid |
$38.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.85
|
| Rate for Payer: Ohio Health Group HMO |
$83.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.47
|
| Rate for Payer: PHCS Commercial |
$106.74
|
| Rate for Payer: United Healthcare All Payer |
$97.85
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$111.19
|
|
| Hospital Charge Code |
636T0090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$106.74 |
| Rate for Payer: Aetna Commercial |
$85.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.73
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cigna Commercial |
$92.29
|
| Rate for Payer: First Health Commercial |
$105.63
|
| Rate for Payer: Humana Commercial |
$94.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.85
|
| Rate for Payer: Ohio Health Group HMO |
$83.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.47
|
| Rate for Payer: PHCS Commercial |
$106.74
|
| Rate for Payer: United Healthcare All Payer |
$97.85
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$111.19
|
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$106.74 |
| Rate for Payer: Aetna Commercial |
$85.62
|
| Rate for Payer: Anthem Medicaid |
$38.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.73
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cigna Commercial |
$92.29
|
| Rate for Payer: First Health Commercial |
$105.63
|
| Rate for Payer: Humana Commercial |
$94.51
|
| Rate for Payer: Humana KY Medicaid |
$38.24
|
| Rate for Payer: Kentucky WC Medicaid |
$38.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.85
|
| Rate for Payer: Ohio Health Group HMO |
$83.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.47
|
| Rate for Payer: PHCS Commercial |
$106.74
|
| Rate for Payer: United Healthcare All Payer |
$97.85
|
|
|
MARCAINE W/EPINEPH 0.5% 3 30ML
|
Facility
|
IP
|
$78.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna Commercial |
$60.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.43
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna Commercial |
$65.37
|
| Rate for Payer: First Health Commercial |
$74.82
|
| Rate for Payer: Humana Commercial |
$66.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.31
|
| Rate for Payer: Ohio Health Group HMO |
$59.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.42
|
| Rate for Payer: PHCS Commercial |
$75.61
|
| Rate for Payer: United Healthcare All Payer |
$69.31
|
|
|
MARCAINE W/EPINEPH 0.5% 3 30ML
|
Facility
|
OP
|
$78.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$75.61 |
| Rate for Payer: Aetna Commercial |
$60.65
|
| Rate for Payer: Anthem Medicaid |
$27.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.43
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cigna Commercial |
$65.37
|
| Rate for Payer: First Health Commercial |
$74.82
|
| Rate for Payer: Humana Commercial |
$66.95
|
| Rate for Payer: Humana KY Medicaid |
$27.09
|
| Rate for Payer: Kentucky WC Medicaid |
$27.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.31
|
| Rate for Payer: Ohio Health Group HMO |
$59.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.42
|
| Rate for Payer: PHCS Commercial |
$75.61
|
| Rate for Payer: United Healthcare All Payer |
$69.31
|
|
|
MARCON DECOMPRESSION SET
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
MARCON DECOMPRESSION SET
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
MARINOL 5 MG CAPSULE
|
Facility
|
IP
|
$63.10
|
|
|
Service Code
|
NDC 42858086806
|
| Hospital Charge Code |
25000942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.58 |
| Rate for Payer: Aetna Commercial |
$48.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.22
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: Cigna Commercial |
$52.37
|
| Rate for Payer: First Health Commercial |
$59.94
|
| Rate for Payer: Humana Commercial |
$53.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.53
|
| Rate for Payer: Ohio Health Group HMO |
$47.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.56
|
| Rate for Payer: PHCS Commercial |
$60.58
|
| Rate for Payer: United Healthcare All Payer |
$55.53
|
|
|
MARINOL 5 MG CAPSULE
|
Facility
|
OP
|
$63.10
|
|
|
Service Code
|
NDC 42858086806
|
| Hospital Charge Code |
25000942
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.58 |
| Rate for Payer: Aetna Commercial |
$48.59
|
| Rate for Payer: Anthem Medicaid |
$21.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.22
|
| Rate for Payer: Cash Price |
$31.55
|
| Rate for Payer: Cigna Commercial |
$52.37
|
| Rate for Payer: First Health Commercial |
$59.94
|
| Rate for Payer: Humana Commercial |
$53.64
|
| Rate for Payer: Humana KY Medicaid |
$21.70
|
| Rate for Payer: Kentucky WC Medicaid |
$21.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.53
|
| Rate for Payer: Ohio Health Group HMO |
$47.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.56
|
| Rate for Payer: PHCS Commercial |
$60.58
|
| Rate for Payer: United Healthcare All Payer |
$55.53
|
|
|
MARKING PIG 5F 100CM
|
Facility
|
OP
|
$1,566.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$1,504.12 |
| Rate for Payer: Aetna Commercial |
$1,206.43
|
| Rate for Payer: Anthem Medicaid |
$538.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.10
|
| Rate for Payer: Cash Price |
$783.39
|
| Rate for Payer: Cigna Commercial |
$1,300.44
|
| Rate for Payer: First Health Commercial |
$1,488.45
|
| Rate for Payer: Humana Commercial |
$1,331.77
|
| Rate for Payer: Humana KY Medicaid |
$538.82
|
| Rate for Payer: Kentucky WC Medicaid |
$544.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.70
|
| Rate for Payer: PHCS Commercial |
$1,504.12
|
| Rate for Payer: United Healthcare All Payer |
$1,378.78
|
|
|
MARKING PIG 5F 100CM
|
Facility
|
IP
|
$1,566.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$1,504.12 |
| Rate for Payer: Aetna Commercial |
$1,206.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.10
|
| Rate for Payer: Cash Price |
$783.39
|
| Rate for Payer: Cigna Commercial |
$1,300.44
|
| Rate for Payer: First Health Commercial |
$1,488.45
|
| Rate for Payer: Humana Commercial |
$1,331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.70
|
| Rate for Payer: PHCS Commercial |
$1,504.12
|
| Rate for Payer: United Healthcare All Payer |
$1,378.78
|
|
|
MARKING PIG 5F 65CM
|
Facility
|
OP
|
$1,566.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$1,504.12 |
| Rate for Payer: Aetna Commercial |
$1,206.43
|
| Rate for Payer: Anthem Medicaid |
$538.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.10
|
| Rate for Payer: Cash Price |
$783.39
|
| Rate for Payer: Cigna Commercial |
$1,300.44
|
| Rate for Payer: First Health Commercial |
$1,488.45
|
| Rate for Payer: Humana Commercial |
$1,331.77
|
| Rate for Payer: Humana KY Medicaid |
$538.82
|
| Rate for Payer: Kentucky WC Medicaid |
$544.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.70
|
| Rate for Payer: PHCS Commercial |
$1,504.12
|
| Rate for Payer: United Healthcare All Payer |
$1,378.78
|
|
|
MARKING PIG 5F 65CM
|
Facility
|
IP
|
$1,566.79
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.68 |
| Max. Negotiated Rate |
$1,504.12 |
| Rate for Payer: Aetna Commercial |
$1,206.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,222.10
|
| Rate for Payer: Cash Price |
$783.39
|
| Rate for Payer: Cigna Commercial |
$1,300.44
|
| Rate for Payer: First Health Commercial |
$1,488.45
|
| Rate for Payer: Humana Commercial |
$1,331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,156.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,175.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.70
|
| Rate for Payer: PHCS Commercial |
$1,504.12
|
| Rate for Payer: United Healthcare All Payer |
$1,378.78
|
|
|
MARKING PIGTAIL CATH 5FR
|
Facility
|
OP
|
$1,830.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.95 |
| Max. Negotiated Rate |
$1,757.16 |
| Rate for Payer: Aetna Commercial |
$1,409.39
|
| Rate for Payer: Anthem Medicaid |
$629.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.70
|
| Rate for Payer: Cash Price |
$915.19
|
| Rate for Payer: Cigna Commercial |
$1,519.22
|
| Rate for Payer: First Health Commercial |
$1,738.86
|
| Rate for Payer: Humana Commercial |
$1,555.82
|
| Rate for Payer: Humana KY Medicaid |
$629.47
|
| Rate for Payer: Kentucky WC Medicaid |
$635.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.42
|
| Rate for Payer: PHCS Commercial |
$1,757.16
|
| Rate for Payer: United Healthcare All Payer |
$1,610.73
|
|
|
MARKING PIGTAIL CATH 5FR
|
Facility
|
IP
|
$1,830.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.95 |
| Max. Negotiated Rate |
$1,757.16 |
| Rate for Payer: Aetna Commercial |
$1,409.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.70
|
| Rate for Payer: Cash Price |
$915.19
|
| Rate for Payer: Cigna Commercial |
$1,519.22
|
| Rate for Payer: First Health Commercial |
$1,738.86
|
| Rate for Payer: Humana Commercial |
$1,555.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.42
|
| Rate for Payer: PHCS Commercial |
$1,757.16
|
| Rate for Payer: United Healthcare All Payer |
$1,610.73
|
|
|
MARSUP BARTHOLIN CYST
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
MARSUP BARTHOLIN CYST
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
76102156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.05 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$276.56
|
| Rate for Payer: Anthem Medicaid |
$165.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$270.50
|
| Rate for Payer: Healthspan PPO |
$267.78
|
| Rate for Payer: Humana Medicaid |
$165.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.35
|
| Rate for Payer: Molina Healthcare Passport |
$165.05
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.70
|
|
