|
NDSC WRST WRLS TRNSVR CARP LIG
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 29848
|
| Hospital Charge Code |
76101088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
NDSC WRST WRLS TRNSVR CARP LIG
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 29848
|
| Hospital Charge Code |
761P1088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.88 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$712.60
|
| Rate for Payer: Anthem Medicaid |
$236.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$774.22
|
| Rate for Payer: Healthspan PPO |
$645.47
|
| Rate for Payer: Humana Medicaid |
$236.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$623.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$241.62
|
| Rate for Payer: Molina Healthcare Passport |
$236.88
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$239.25
|
|
|
NEBCIN POWDER 80MG(1.2GM VIAL)
|
Facility
|
IP
|
$155.50
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
25002392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$149.28 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.29
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.06
|
| Rate for Payer: First Health Commercial |
$147.72
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.84
|
| Rate for Payer: Ohio Health Group HMO |
$116.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.20
|
| Rate for Payer: PHCS Commercial |
$149.28
|
| Rate for Payer: United Healthcare All Payer |
$136.84
|
|
|
NEBCIN POWDER 80MG(1.2GM VIAL)
|
Facility
|
OP
|
$155.50
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
25002392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$149.28 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.29
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.06
|
| Rate for Payer: First Health Commercial |
$147.72
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Humana KY Medicaid |
$53.48
|
| Rate for Payer: Kentucky WC Medicaid |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.84
|
| Rate for Payer: Ohio Health Group HMO |
$116.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.20
|
| Rate for Payer: PHCS Commercial |
$149.28
|
| Rate for Payer: United Healthcare All Payer |
$136.84
|
|
|
NEBCIN (TOBRAMYCIN) I 80MG/2ML
|
Facility
|
OP
|
$77.98
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
25002391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna Commercial |
$60.04
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.82
|
| Rate for Payer: Cash Price |
$38.99
|
| Rate for Payer: Cigna Commercial |
$64.72
|
| Rate for Payer: First Health Commercial |
$74.08
|
| Rate for Payer: Humana Commercial |
$66.28
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Kentucky WC Medicaid |
$27.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.62
|
| Rate for Payer: Ohio Health Group HMO |
$58.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.17
|
| Rate for Payer: PHCS Commercial |
$74.86
|
| Rate for Payer: United Healthcare All Payer |
$68.62
|
|
|
NEBCIN (TOBRAMYCIN) I 80MG/2ML
|
Facility
|
IP
|
$77.98
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
25002391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna Commercial |
$60.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.82
|
| Rate for Payer: Cash Price |
$38.99
|
| Rate for Payer: Cigna Commercial |
$64.72
|
| Rate for Payer: First Health Commercial |
$74.08
|
| Rate for Payer: Humana Commercial |
$66.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.62
|
| Rate for Payer: Ohio Health Group HMO |
$58.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.17
|
| Rate for Payer: PHCS Commercial |
$74.86
|
| Rate for Payer: United Healthcare All Payer |
$68.62
|
|
|
NEBUPENT (PENTAMIDINE)300 MG
|
Facility
|
IP
|
$336.89
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
25003253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$323.41 |
| Rate for Payer: Aetna Commercial |
$259.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.77
|
| Rate for Payer: Cash Price |
$168.44
|
| Rate for Payer: Cigna Commercial |
$279.62
|
| Rate for Payer: First Health Commercial |
$320.05
|
| Rate for Payer: Humana Commercial |
$286.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.46
|
| Rate for Payer: Ohio Health Group HMO |
$252.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.44
|
| Rate for Payer: PHCS Commercial |
$323.41
|
| Rate for Payer: United Healthcare All Payer |
$296.46
|
|
|
NEBUPENT (PENTAMIDINE)300 MG
|
Facility
|
OP
|
$336.89
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
25003253
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$323.41 |
| Rate for Payer: Aetna Commercial |
$259.41
|
| Rate for Payer: Anthem Medicaid |
$115.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.77
|
| Rate for Payer: Cash Price |
$168.44
|
| Rate for Payer: Cigna Commercial |
$279.62
|
| Rate for Payer: First Health Commercial |
$320.05
|
| Rate for Payer: Humana Commercial |
$286.36
|
| Rate for Payer: Humana KY Medicaid |
$115.86
|
| Rate for Payer: Kentucky WC Medicaid |
$117.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.46
|
| Rate for Payer: Ohio Health Group HMO |
$252.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.44
|
| Rate for Payer: PHCS Commercial |
$323.41
|
| Rate for Payer: United Healthcare All Payer |
$296.46
|
|
|
NECK ANGLE HIP STEM 127 DEG
|
Facility
|
OP
|
$9,378.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.24 |
| Max. Negotiated Rate |
$9,003.61 |
| Rate for Payer: Aetna Commercial |
$7,221.65
|
| Rate for Payer: Anthem Medicaid |
$3,225.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,315.43
|
| Rate for Payer: Cash Price |
$4,689.38
|
| Rate for Payer: Cigna Commercial |
$7,784.37
|
| Rate for Payer: First Health Commercial |
$8,909.82
|
| Rate for Payer: Humana Commercial |
$7,971.95
|
| Rate for Payer: Humana KY Medicaid |
$3,225.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,690.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,921.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,813.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,290.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,253.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,034.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,907.42
|
| Rate for Payer: PHCS Commercial |
$9,003.61
|
| Rate for Payer: United Healthcare All Payer |
$8,253.31
|
|
|
NECK ANGLE HIP STEM 127 DEG
|
Facility
|
IP
|
$9,378.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.24 |
| Max. Negotiated Rate |
$9,003.61 |
| Rate for Payer: Aetna Commercial |
$7,221.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,315.43
|
| Rate for Payer: Cash Price |
$4,689.38
|
| Rate for Payer: Cigna Commercial |
$7,784.37
|
| Rate for Payer: First Health Commercial |
$8,909.82
|
| Rate for Payer: Humana Commercial |
$7,971.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,690.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,921.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,813.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,253.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,034.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,907.42
|
| Rate for Payer: PHCS Commercial |
$9,003.61
|
| Rate for Payer: United Healthcare All Payer |
$8,253.31
|
|
|
NECK-CESSITY
|
Professional
|
Both
|
$125.00
|
|
| Hospital Charge Code |
22200128
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
|
|
Neck FrntLsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200471
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$159.00
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
Neck Front Laser Hair Removal
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200210
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Neck Front LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200211
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$319.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
NECK REJUV MOD 30MM 16^ 130^ P
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 30MM 16^ 130^ P
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 34MM 16^ 130^ P
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 34MM 16^ 130^ P
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 38MM 16^ 130^ P
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 38MM 16^ 130^ P
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 42MM 16^ 130^ P
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK REJUV MOD 42MM 16^ 130^ P
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NECK STD MOD HEAD 36MM
|
Facility
|
OP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem Medicaid |
$2,702.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Humana KY Medicaid |
$2,702.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
NECK STD MOD HEAD 36MM
|
Facility
|
IP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
NEEDLE BIOPSY AXILLA US
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
