|
OT WHIRLPOOL-EXTREMITY
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
43000007
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$51.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$51.24
|
| Rate for Payer: Kentucky WC Medicaid |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OUTSIDE PR AFT DEL CARE ONLY
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
72000021
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Kentucky WC Medicaid |
$147.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OUTSIDE PR AFT DEL CARE ONLY
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
72000021
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OUTSIDE PR AFT DEL CARE ONLY
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
72000021
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$210.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.05
|
| Rate for Payer: Anthem Medicaid |
$65.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$212.72
|
| Rate for Payer: Healthspan PPO |
$167.32
|
| Rate for Payer: Humana Medicaid |
$65.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.10
|
| Rate for Payer: Molina Healthcare Passport |
$65.78
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$96.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.44
|
|
|
OUTSIDE PR AFT DEL CARE ONLY(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
720P0021
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$210.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.05
|
| Rate for Payer: Anthem Medicaid |
$65.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$212.72
|
| Rate for Payer: Healthspan PPO |
$167.32
|
| Rate for Payer: Humana Medicaid |
$65.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$237.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.10
|
| Rate for Payer: Molina Healthcare Passport |
$65.78
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$96.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.44
|
|
|
OVAL RESURF PAT 32MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 32MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 35MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 35MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 38MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 38MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 41MM
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVAL RESURF PAT 41MM
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
OVA & PARASITES W/ID
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
30001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$8.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.90
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$8.90
|
| Rate for Payer: Humana Medicare Advantage |
$8.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
OVA & PARASITES W/ID
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
30001316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.40
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58925
|
| Hospital Charge Code |
76102262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OVARIAN CYSTECTOMY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58925
|
| Hospital Charge Code |
76102262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OVARIAN CYSTECTOMY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58925
|
| Hospital Charge Code |
76102262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,108.15
|
| Rate for Payer: Anthem Medicaid |
$397.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,069.56
|
| Rate for Payer: Healthspan PPO |
$1,072.97
|
| Rate for Payer: Humana Medicaid |
$397.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.23
|
| Rate for Payer: Molina Healthcare Passport |
$397.28
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.25
|
|
|
OVARIAN CYSTECTOMY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58925
|
| Hospital Charge Code |
761P2262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,108.15
|
| Rate for Payer: Anthem Medicaid |
$397.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,069.56
|
| Rate for Payer: Healthspan PPO |
$1,072.97
|
| Rate for Payer: Humana Medicaid |
$397.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$405.23
|
| Rate for Payer: Molina Healthcare Passport |
$397.28
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$401.25
|
|
|
OVERNIGHT SP02 MONITORING
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
46000018
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem Medicaid |
$94.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Humana KY Medicaid |
$94.23
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$95.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
OVERNIGHT SP02 MONITORING
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
46000018
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
OXcarbazepine XR 150 MG Tablet
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
NDC 17772012101
|
| Hospital Charge Code |
25004003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.99 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Anthem Medicaid |
$8.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.30
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: First Health Commercial |
$24.73
|
| Rate for Payer: Humana Commercial |
$22.13
|
| Rate for Payer: Humana KY Medicaid |
$8.95
|
| Rate for Payer: Kentucky WC Medicaid |
$9.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.91
|
| Rate for Payer: Ohio Health Group HMO |
$19.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.07
|
| Rate for Payer: PHCS Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Payer |
$22.91
|
|
|
OXcarbazepine XR 150 MG Tablet
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
NDC 17772012101
|
| Hospital Charge Code |
25004003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.99 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.30
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cigna Commercial |
$21.60
|
| Rate for Payer: First Health Commercial |
$24.73
|
| Rate for Payer: Humana Commercial |
$22.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.91
|
| Rate for Payer: Ohio Health Group HMO |
$19.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.07
|
| Rate for Payer: PHCS Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Payer |
$22.91
|
|
|
OXcarbazepine XR 300 MG Tablet
|
Facility
|
OP
|
$29.54
|
|
|
Service Code
|
NDC 17772012201
|
| Hospital Charge Code |
25004004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$28.36 |
| Rate for Payer: Aetna Commercial |
$22.75
|
| Rate for Payer: Anthem Medicaid |
$10.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.04
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cigna Commercial |
$24.52
|
| Rate for Payer: First Health Commercial |
$28.06
|
| Rate for Payer: Humana Commercial |
$25.11
|
| Rate for Payer: Humana KY Medicaid |
$10.16
|
| Rate for Payer: Kentucky WC Medicaid |
$10.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.00
|
| Rate for Payer: Ohio Health Group HMO |
$22.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.16
|
| Rate for Payer: PHCS Commercial |
$28.36
|
| Rate for Payer: United Healthcare All Payer |
$26.00
|
|
|
OXcarbazepine XR 300 MG Tablet
|
Facility
|
IP
|
$29.54
|
|
|
Service Code
|
NDC 17772012201
|
| Hospital Charge Code |
25004004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$28.36 |
| Rate for Payer: Aetna Commercial |
$22.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.04
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cigna Commercial |
$24.52
|
| Rate for Payer: First Health Commercial |
$28.06
|
| Rate for Payer: Humana Commercial |
$25.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.00
|
| Rate for Payer: Ohio Health Group HMO |
$22.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.16
|
| Rate for Payer: PHCS Commercial |
$28.36
|
| Rate for Payer: United Healthcare All Payer |
$26.00
|
|
