|
MINI TREK II OTW 1.2*12
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TREK II OTW 1.2*15
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TREK II OTW 1.2*15
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TREK II OTW 1.2*8
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
|
|
MINI TREK II OTW 1.2*8
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
MINI TREK II OTW 2*12
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
MINI TREK II OTW 2*12
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
MINI TREK II OTW 2*15
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TREK II OTW 2*15
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TUMMY TUCK IN OFFICE
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200354
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
MINOCIN 1MG [100MGVIAL]
|
Facility
|
IP
|
$830.90
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
25002242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.02 |
| Max. Negotiated Rate |
$797.66 |
| Rate for Payer: Aetna Commercial |
$639.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.10
|
| Rate for Payer: Cash Price |
$415.45
|
| Rate for Payer: Cigna Commercial |
$689.65
|
| Rate for Payer: First Health Commercial |
$789.36
|
| Rate for Payer: Humana Commercial |
$706.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.19
|
| Rate for Payer: Ohio Health Group HMO |
$623.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.58
|
| Rate for Payer: PHCS Commercial |
$797.66
|
| Rate for Payer: United Healthcare All Payer |
$731.19
|
|
|
MINOCIN 1MG [100MGVIAL]
|
Facility
|
OP
|
$830.90
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
25002242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$797.66 |
| Rate for Payer: Aetna Commercial |
$639.79
|
| Rate for Payer: Anthem Medicaid |
$285.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.33
|
| Rate for Payer: Cash Price |
$415.45
|
| Rate for Payer: Cash Price |
$415.45
|
| Rate for Payer: Cigna Commercial |
$689.65
|
| Rate for Payer: First Health Commercial |
$789.36
|
| Rate for Payer: Humana Commercial |
$706.26
|
| Rate for Payer: Humana KY Medicaid |
$285.75
|
| Rate for Payer: Humana Medicare Advantage |
$2.46
|
| Rate for Payer: Kentucky WC Medicaid |
$288.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.19
|
| Rate for Payer: Ohio Health Group HMO |
$623.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.58
|
| Rate for Payer: PHCS Commercial |
$797.66
|
| Rate for Payer: United Healthcare All Payer |
$731.19
|
|
|
MINOCIN (MINOCYCLINE 50MG/1CAP
|
Facility
|
IP
|
$9.70
|
|
|
Service Code
|
NDC 50090301603
|
| Hospital Charge Code |
25000991
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cigna Commercial |
$8.05
|
| Rate for Payer: First Health Commercial |
$9.22
|
| Rate for Payer: Humana Commercial |
$8.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.54
|
| Rate for Payer: Ohio Health Group HMO |
$7.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$9.31
|
| Rate for Payer: United Healthcare All Payer |
$8.54
|
|
|
MINOCIN (MINOCYCLINE 50MG/1CAP
|
Facility
|
OP
|
$9.70
|
|
|
Service Code
|
NDC 50090301603
|
| Hospital Charge Code |
25000991
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$7.47
|
| Rate for Payer: Anthem Medicaid |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: Cigna Commercial |
$8.05
|
| Rate for Payer: First Health Commercial |
$9.22
|
| Rate for Payer: Humana Commercial |
$8.24
|
| Rate for Payer: Humana KY Medicaid |
$3.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.54
|
| Rate for Payer: Ohio Health Group HMO |
$7.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$9.31
|
| Rate for Payer: United Healthcare All Payer |
$8.54
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$17,067.68
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$11,581.64 |
| Max. Negotiated Rate |
$17,067.68 |
| Rate for Payer: Anthem Medicaid |
$11,581.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,191.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,067.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,458.12
|
| Rate for Payer: Humana KY Medicaid |
$11,581.64
|
| Rate for Payer: Humana Medicare Advantage |
$12,191.20
|
| Rate for Payer: Kentucky WC Medicaid |
$11,697.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,629.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,813.27
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$35,056.01
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$23,788.01 |
| Max. Negotiated Rate |
$35,056.01 |
| Rate for Payer: Anthem Medicaid |
$23,788.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,040.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,056.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,804.01
|
| Rate for Payer: Humana KY Medicaid |
$23,788.01
|
| Rate for Payer: Humana Medicare Advantage |
$25,040.01
|
| Rate for Payer: Kentucky WC Medicaid |
$24,025.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,048.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,263.77
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,418.81
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$8,427.05 |
| Max. Negotiated Rate |
$12,418.81 |
| Rate for Payer: Anthem Medicaid |
$8,427.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,870.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,418.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,975.28
|
| Rate for Payer: Humana KY Medicaid |
$8,427.05
|
| Rate for Payer: Humana Medicare Advantage |
$8,870.58
|
| Rate for Payer: Kentucky WC Medicaid |
$8,511.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,644.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,595.59
|
|
|
MINOR SKIN DISORDERS WITH MCC
|
Facility
|
IP
|
$18,551.02
|
|
|
Service Code
|
MSDRG 606
|
| Min. Negotiated Rate |
$12,588.19 |
| Max. Negotiated Rate |
$18,551.02 |
| Rate for Payer: Anthem Medicaid |
$12,588.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,250.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,551.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,888.49
|
| Rate for Payer: Humana KY Medicaid |
$12,588.19
|
| Rate for Payer: Humana Medicare Advantage |
$13,250.73
|
| Rate for Payer: Kentucky WC Medicaid |
$12,714.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,900.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,839.96
|
|
|
MINOR SKIN DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$10,452.34
|
|
|
Service Code
|
MSDRG 607
|
| Min. Negotiated Rate |
$7,092.66 |
| Max. Negotiated Rate |
$10,452.34 |
| Rate for Payer: Anthem Medicaid |
$7,092.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,465.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,452.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,079.05
|
| Rate for Payer: Humana KY Medicaid |
$7,092.66
|
| Rate for Payer: Humana Medicare Advantage |
$7,465.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,163.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,959.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.52
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC
|
Facility
|
IP
|
$18,022.24
|
|
|
Service Code
|
MSDRG 345
|
| Min. Negotiated Rate |
$12,229.38 |
| Max. Negotiated Rate |
$18,022.24 |
| Rate for Payer: Anthem Medicaid |
$12,229.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,873.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,022.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,378.59
|
| Rate for Payer: Humana KY Medicaid |
$12,229.38
|
| Rate for Payer: Humana Medicare Advantage |
$12,873.03
|
| Rate for Payer: Kentucky WC Medicaid |
$12,351.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,447.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,473.97
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC
|
Facility
|
IP
|
$32,057.75
|
|
|
Service Code
|
MSDRG 344
|
| Min. Negotiated Rate |
$21,753.47 |
| Max. Negotiated Rate |
$32,057.75 |
| Rate for Payer: Anthem Medicaid |
$21,753.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,898.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,057.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,912.83
|
| Rate for Payer: Humana KY Medicaid |
$21,753.47
|
| Rate for Payer: Humana Medicare Advantage |
$22,898.39
|
| Rate for Payer: Kentucky WC Medicaid |
$21,971.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,478.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,188.54
|
|
|
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,064.94
|
|
|
Service Code
|
MSDRG 346
|
| Min. Negotiated Rate |
$10,222.64 |
| Max. Negotiated Rate |
$15,064.94 |
| Rate for Payer: Anthem Medicaid |
$10,222.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,760.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,064.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,526.90
|
| Rate for Payer: Humana KY Medicaid |
$10,222.64
|
| Rate for Payer: Humana Medicare Advantage |
$10,760.67
|
| Rate for Payer: Kentucky WC Medicaid |
$10,324.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,912.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,427.09
|
|
|
MIOCHOL(ACETYLCHOLINE) OPH 2ML
|
Facility
|
OP
|
$556.64
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
25000992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$534.37 |
| Rate for Payer: Aetna Commercial |
$428.61
|
| Rate for Payer: Anthem Medicaid |
$191.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.18
|
| Rate for Payer: Cash Price |
$278.32
|
| Rate for Payer: Cigna Commercial |
$462.01
|
| Rate for Payer: First Health Commercial |
$528.81
|
| Rate for Payer: Humana Commercial |
$473.14
|
| Rate for Payer: Humana KY Medicaid |
$191.43
|
| Rate for Payer: Kentucky WC Medicaid |
$193.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.84
|
| Rate for Payer: Ohio Health Group HMO |
$417.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.56
|
| Rate for Payer: PHCS Commercial |
$534.37
|
| Rate for Payer: United Healthcare All Payer |
$489.84
|
|
|
MIOCHOL(ACETYLCHOLINE) OPH 2ML
|
Facility
|
IP
|
$556.64
|
|
|
Service Code
|
NDC 24208053920
|
| Hospital Charge Code |
25000992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$534.37 |
| Rate for Payer: Aetna Commercial |
$428.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$434.18
|
| Rate for Payer: Cash Price |
$278.32
|
| Rate for Payer: Cigna Commercial |
$462.01
|
| Rate for Payer: First Health Commercial |
$528.81
|
| Rate for Payer: Humana Commercial |
$473.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.84
|
| Rate for Payer: Ohio Health Group HMO |
$417.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.56
|
| Rate for Payer: PHCS Commercial |
$534.37
|
| Rate for Payer: United Healthcare All Payer |
$489.84
|
|
|
MIOSTAT (CARBACHOL) 0.01 1.5ML
|
Facility
|
OP
|
$200.68
|
|
|
Service Code
|
NDC 65002315
|
| Hospital Charge Code |
25000993
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$192.65 |
| Rate for Payer: Aetna Commercial |
$154.52
|
| Rate for Payer: Anthem Medicaid |
$69.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.53
|
| Rate for Payer: Cash Price |
$100.34
|
| Rate for Payer: Cigna Commercial |
$166.56
|
| Rate for Payer: First Health Commercial |
$190.65
|
| Rate for Payer: Humana Commercial |
$170.58
|
| Rate for Payer: Humana KY Medicaid |
$69.01
|
| Rate for Payer: Kentucky WC Medicaid |
$69.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.60
|
| Rate for Payer: Ohio Health Group HMO |
$150.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.21
|
| Rate for Payer: PHCS Commercial |
$192.65
|
| Rate for Payer: United Healthcare All Payer |
$176.60
|
|
