|
NON-LOCKING SCREWS 3.5*22MM
|
Facility
|
OP
|
$1,710.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.12 |
| Max. Negotiated Rate |
$1,641.98 |
| Rate for Payer: Aetna Commercial |
$1,317.01
|
| Rate for Payer: Anthem Medicaid |
$588.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.11
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cigna Commercial |
$1,419.63
|
| Rate for Payer: First Health Commercial |
$1,624.88
|
| Rate for Payer: Humana Commercial |
$1,453.84
|
| Rate for Payer: Humana KY Medicaid |
$588.21
|
| Rate for Payer: Kentucky WC Medicaid |
$594.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.18
|
| Rate for Payer: PHCS Commercial |
$1,641.98
|
| Rate for Payer: United Healthcare All Payer |
$1,505.15
|
|
|
NON-LOCKING SCREWS 3.5*22MM
|
Facility
|
IP
|
$1,710.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.12 |
| Max. Negotiated Rate |
$1,641.98 |
| Rate for Payer: Aetna Commercial |
$1,317.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.11
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cigna Commercial |
$1,419.63
|
| Rate for Payer: First Health Commercial |
$1,624.88
|
| Rate for Payer: Humana Commercial |
$1,453.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.18
|
| Rate for Payer: PHCS Commercial |
$1,641.98
|
| Rate for Payer: United Healthcare All Payer |
$1,505.15
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
48100010
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$911.70 |
| Max. Negotiated Rate |
$2,917.44 |
| Rate for Payer: Aetna Commercial |
$2,340.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,370.42
|
| Rate for Payer: Cash Price |
$1,519.50
|
| Rate for Payer: Cigna Commercial |
$2,522.37
|
| Rate for Payer: First Health Commercial |
$2,887.05
|
| Rate for Payer: Humana Commercial |
$2,583.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,674.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,279.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.91
|
| Rate for Payer: PHCS Commercial |
$2,917.44
|
| Rate for Payer: United Healthcare All Payer |
$2,674.32
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
OP
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,040.47 |
| Max. Negotiated Rate |
$3,329.50 |
| Rate for Payer: Aetna Commercial |
$2,670.54
|
| Rate for Payer: Anthem Medicaid |
$1,192.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.22
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$2,878.63
|
| Rate for Payer: First Health Commercial |
$3,294.82
|
| Rate for Payer: Humana Commercial |
$2,948.00
|
| Rate for Payer: Humana KY Medicaid |
$1,192.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,204.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,843.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,774.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,393.08
|
| Rate for Payer: PHCS Commercial |
$3,329.50
|
| Rate for Payer: United Healthcare All Payer |
$3,052.04
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
IP
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,040.47 |
| Max. Negotiated Rate |
$3,329.50 |
| Rate for Payer: Aetna Commercial |
$2,670.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.22
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$2,878.63
|
| Rate for Payer: First Health Commercial |
$3,294.82
|
| Rate for Payer: Humana Commercial |
$2,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,843.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,774.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,393.08
|
| Rate for Payer: PHCS Commercial |
$3,329.50
|
| Rate for Payer: United Healthcare All Payer |
$3,052.04
|
|
|
NON SEL CATH AORTA CATH
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
48100010
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$911.70 |
| Max. Negotiated Rate |
$2,917.44 |
| Rate for Payer: Aetna Commercial |
$2,340.03
|
| Rate for Payer: Anthem Medicaid |
$1,045.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,370.42
|
| Rate for Payer: Cash Price |
$1,519.50
|
| Rate for Payer: Cigna Commercial |
$2,522.37
|
| Rate for Payer: First Health Commercial |
$2,887.05
|
| Rate for Payer: Humana Commercial |
$2,583.15
|
| Rate for Payer: Humana KY Medicaid |
$1,045.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,066.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,674.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,279.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.91
|
| Rate for Payer: PHCS Commercial |
$2,917.44
|
| Rate for Payer: United Healthcare All Payer |
$2,674.32
|
|
|
NON SEL CATH AORTA CATH
|
Professional
|
Both
|
$3,468.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
76101438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$2,080.94 |
| Rate for Payer: Aetna Commercial |
$268.06
|
| Rate for Payer: Ambetter Exchange |
$131.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.60
|
| Rate for Payer: Anthem Medicaid |
$168.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$131.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$131.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.54
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cash Price |
$1,734.12
|
| Rate for Payer: Cigna Commercial |
$249.28
|
| Rate for Payer: Healthspan PPO |
$1,011.52
|
| Rate for Payer: Humana Medicaid |
$168.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$131.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.01
|
| Rate for Payer: Molina Healthcare Passport |
$168.64
|
| Rate for Payer: Multiplan PHCS |
$2,080.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.66
|
| Rate for Payer: UHCCP Medicaid |
$114.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$131.28
|
|
|
NON SEL CATH AORTA CATH(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761P1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.60 |
| Max. Negotiated Rate |
$1,011.52 |
| Rate for Payer: Aetna Commercial |
$268.06
|
| Rate for Payer: Ambetter Exchange |
$131.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.60
|
| Rate for Payer: Anthem Medicaid |
$168.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$131.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$131.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.54
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$249.28
|
| Rate for Payer: Healthspan PPO |
$1,011.52
|
| Rate for Payer: Humana Medicaid |
$168.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$207.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$131.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.01
|
| Rate for Payer: Molina Healthcare Passport |
$168.64
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.66
|
| Rate for Payer: UHCCP Medicaid |
$114.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$131.28
|
|
|
NON SEL CATH AORTA CATH(T
|
Facility
|
IP
|
$2,568.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761T1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$770.47 |
| Max. Negotiated Rate |
$2,465.50 |
| Rate for Payer: Aetna Commercial |
$1,977.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.22
|
| Rate for Payer: Cash Price |
$1,284.12
|
| Rate for Payer: Cigna Commercial |
$2,131.63
|
| Rate for Payer: First Health Commercial |
$2,439.82
|
| Rate for Payer: Humana Commercial |
$2,183.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,105.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,895.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$770.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,260.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,926.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,054.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,234.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,772.08
|
| Rate for Payer: PHCS Commercial |
$2,465.50
|
| Rate for Payer: United Healthcare All Payer |
$2,260.04
|
|
|
NON SEL CATH AORTA CATH(T
|
Facility
|
OP
|
$2,568.23
|
|
|
Service Code
|
HCPCS 36200
|
| Hospital Charge Code |
761T1438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$770.47 |
| Max. Negotiated Rate |
$2,465.50 |
| Rate for Payer: Aetna Commercial |
$1,977.54
|
| Rate for Payer: Anthem Medicaid |
$883.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,003.22
|
| Rate for Payer: Cash Price |
$1,284.12
|
| Rate for Payer: Cigna Commercial |
$2,131.63
|
| Rate for Payer: First Health Commercial |
$2,439.82
|
| Rate for Payer: Humana Commercial |
$2,183.00
|
| Rate for Payer: Humana KY Medicaid |
$883.21
|
| Rate for Payer: Kentucky WC Medicaid |
$892.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,105.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,895.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$770.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$900.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,260.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,926.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,054.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,234.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,772.08
|
| Rate for Payer: PHCS Commercial |
$2,465.50
|
| Rate for Payer: United Healthcare All Payer |
$2,260.04
|
|
|
NON-SURGICAL OFFICE CONSULT
|
Professional
|
Both
|
$25.00
|
|
| Hospital Charge Code |
22200117
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
|
|
NON-SURGICAL OFFICE CONSULT
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
22200117
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$8.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$8.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
NON-SURGICAL OFFICE CONSULT
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
22200117
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$755.82 |
| Rate for Payer: Anthem Medicaid |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$741.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$755.82
|
| Rate for Payer: Molina Healthcare Passport |
$741.00
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$748.41
|
|
|
NONVASCULAR SHUNT X-RAY
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NONVASCULAR SHUNT X-RAY
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Ambetter Exchange |
$73.12
|
| Rate for Payer: Anthem Medicaid |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.74
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$96.03
|
| Rate for Payer: Healthspan PPO |
$122.86
|
| Rate for Payer: Humana Medicaid |
$40.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.77
|
| Rate for Payer: Molina Healthcare Passport |
$40.95
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.06
|
| Rate for Payer: UHCCP Medicaid |
$241.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.12
|
|
|
NONVASCULAR SHUNT X-RAY
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NONVASCULAR SHUNT X-RAY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320P0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Ambetter Exchange |
$73.12
|
| Rate for Payer: Anthem Medicaid |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.74
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$96.03
|
| Rate for Payer: Healthspan PPO |
$122.86
|
| Rate for Payer: Humana Medicaid |
$40.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.77
|
| Rate for Payer: Molina Healthcare Passport |
$40.95
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.06
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.12
|
|
|
NONVASCULAR SHUNT X-RAY(T
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320T0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
NONVASCULAR SHUNT X-RAY(T
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320T0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
NORCO 10/325MG EQ TABLET
|
Facility
|
OP
|
$60.22
|
|
|
Service Code
|
NDC 406012501
|
| Hospital Charge Code |
25001094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Aetna Commercial |
$46.37
|
| Rate for Payer: Anthem Medicaid |
$20.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.97
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cigna Commercial |
$49.98
|
| Rate for Payer: First Health Commercial |
$57.21
|
| Rate for Payer: Humana Commercial |
$51.19
|
| Rate for Payer: Humana KY Medicaid |
$20.71
|
| Rate for Payer: Kentucky WC Medicaid |
$20.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.99
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.55
|
| Rate for Payer: PHCS Commercial |
$57.81
|
| Rate for Payer: United Healthcare All Payer |
$52.99
|
|
|
NORCO 10/325MG EQ TABLET
|
Facility
|
IP
|
$60.22
|
|
|
Service Code
|
NDC 406012501
|
| Hospital Charge Code |
25001094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Aetna Commercial |
$46.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.97
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cigna Commercial |
$49.98
|
| Rate for Payer: First Health Commercial |
$57.21
|
| Rate for Payer: Humana Commercial |
$51.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.99
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.55
|
| Rate for Payer: PHCS Commercial |
$57.81
|
| Rate for Payer: United Healthcare All Payer |
$52.99
|
|
|
NORCO 5/325MG EQ TABLET
|
Facility
|
IP
|
$60.10
|
|
|
Service Code
|
NDC 27808003501
|
| Hospital Charge Code |
25001095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.88
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.88
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.47
|
| Rate for Payer: PHCS Commercial |
$57.70
|
| Rate for Payer: United Healthcare All Payer |
$52.89
|
|
