|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
45000036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
45000036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.02
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$424.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$60.01
|
| Rate for Payer: Healthspan PPO |
$52.12
|
| Rate for Payer: Humana Medicaid |
$14.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$15.29
|
| Rate for Payer: Molina Healthcare Passport |
$14.99
|
| Rate for Payer: Multiplan PHCS |
$254.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.80
|
| Rate for Payer: UHCCP Medicaid |
$16.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.14
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$407.04 |
| Rate for Payer: Aetna Commercial |
$326.48
|
| Rate for Payer: Anthem Medicaid |
$145.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.72
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$351.92
|
| Rate for Payer: First Health Commercial |
$402.80
|
| Rate for Payer: Humana Commercial |
$360.40
|
| Rate for Payer: Humana KY Medicaid |
$145.81
|
| Rate for Payer: Kentucky WC Medicaid |
$147.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$347.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$312.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$148.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$373.12
|
| Rate for Payer: Ohio Health Group HMO |
$318.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.44
|
| Rate for Payer: PHCS Commercial |
$407.04
|
| Rate for Payer: United Healthcare All Payer |
$373.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761T0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$407.04 |
| Rate for Payer: Aetna Commercial |
$326.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$330.72
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna Commercial |
$351.92
|
| Rate for Payer: First Health Commercial |
$402.80
|
| Rate for Payer: Humana Commercial |
$360.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$347.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$312.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$373.12
|
| Rate for Payer: Ohio Health Group HMO |
$318.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.44
|
| Rate for Payer: PHCS Commercial |
$407.04
|
| Rate for Payer: United Healthcare All Payer |
$373.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761T0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
AVX ULTRA
|
Facility
|
IP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
AVX ULTRA
|
Facility
|
OP
|
$4,387.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.38 |
| Max. Negotiated Rate |
$4,212.00 |
| Rate for Payer: Aetna Commercial |
$3,378.38
|
| Rate for Payer: Anthem Medicaid |
$1,508.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,422.25
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna Commercial |
$3,641.62
|
| Rate for Payer: First Health Commercial |
$4,168.12
|
| Rate for Payer: Humana Commercial |
$3,729.38
|
| Rate for Payer: Humana KY Medicaid |
$1,508.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,524.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,539.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.12
|
| Rate for Payer: PHCS Commercial |
$4,212.00
|
| Rate for Payer: United Healthcare All Payer |
$3,861.00
|
|
|
AVYCAZ 0.625gm (2.5gm SDV)
|
Facility
|
OP
|
$2,053.29
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
25001959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.45 |
| Max. Negotiated Rate |
$1,971.16 |
| Rate for Payer: Aetna Commercial |
$1,581.03
|
| Rate for Payer: Anthem Medicaid |
$706.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,601.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.86
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cigna Commercial |
$1,704.23
|
| Rate for Payer: First Health Commercial |
$1,950.63
|
| Rate for Payer: Humana Commercial |
$1,745.30
|
| Rate for Payer: Humana KY Medicaid |
$706.13
|
| Rate for Payer: Humana Medicare Advantage |
$95.45
|
| Rate for Payer: Kentucky WC Medicaid |
$713.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.52
|
| Rate for Payer: PHCS Commercial |
$1,971.16
|
| Rate for Payer: United Healthcare All Payer |
$1,806.90
|
|
|
AVYCAZ 0.625gm (2.5gm SDV)
|
Facility
|
IP
|
$2,053.29
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
25001959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.93 |
| Max. Negotiated Rate |
$1,971.16 |
| Rate for Payer: Aetna Commercial |
$1,581.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,601.57
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cigna Commercial |
$1,704.23
|
| Rate for Payer: First Health Commercial |
$1,950.63
|
| Rate for Payer: Humana Commercial |
$1,745.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.52
|
| Rate for Payer: PHCS Commercial |
$1,971.16
|
| Rate for Payer: United Healthcare All Payer |
$1,806.90
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| 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 |
$4,989.61
|
| 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 |
$5,987.53
|
| 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
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
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
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.95 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Anthem Medicaid |
$501.95
|
| 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 |
$1,161.30
|
| Rate for Payer: Healthspan PPO |
$997.64
|
| Rate for Payer: Humana Medicaid |
$501.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,109.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$511.99
|
| Rate for Payer: Molina Healthcare Passport |
$501.95
|
| 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 |
$506.97
|
|
|
AXIL LYMPHECTMY COMPLETE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
761P1607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.95 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Anthem Medicaid |
$501.95
|
| 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 |
$1,161.30
|
| Rate for Payer: Healthspan PPO |
$997.64
|
| Rate for Payer: Humana Medicaid |
$501.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,109.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$511.99
|
| Rate for Payer: Molina Healthcare Passport |
$501.95
|
| 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 |
$506.97
|
|
|
AXLE OSS
|
Facility
|
IP
|
$4,546.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$4,364.18 |
| Rate for Payer: Aetna Commercial |
$3,500.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.90
|
| Rate for Payer: Cash Price |
$2,273.01
|
| Rate for Payer: Cigna Commercial |
$3,773.20
|
| Rate for Payer: First Health Commercial |
$4,318.72
|
| Rate for Payer: Humana Commercial |
$3,864.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.27
|
| Rate for Payer: PHCS Commercial |
$4,364.18
|
| Rate for Payer: United Healthcare All Payer |
$4,000.50
|
|
|
AXLE OSS
|
Facility
|
OP
|
$4,546.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$4,364.18 |
| Rate for Payer: Aetna Commercial |
$3,500.44
|
| Rate for Payer: Anthem Medicaid |
$1,563.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.90
|
| Rate for Payer: Cash Price |
$2,273.01
|
| Rate for Payer: Cigna Commercial |
$3,773.20
|
| Rate for Payer: First Health Commercial |
$4,318.72
|
| Rate for Payer: Humana Commercial |
$3,864.12
|
| Rate for Payer: Humana KY Medicaid |
$1,563.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,579.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.27
|
| Rate for Payer: PHCS Commercial |
$4,364.18
|
| Rate for Payer: United Healthcare All Payer |
$4,000.50
|
|
|
AXLE PIN REPLACEMENT SM
|
Facility
|
IP
|
$4,146.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.98 |
| Max. Negotiated Rate |
$3,980.16 |
| Rate for Payer: Aetna Commercial |
$3,192.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.88
|
| Rate for Payer: Cash Price |
$2,073.00
|
| Rate for Payer: Cigna Commercial |
$3,441.18
|
| Rate for Payer: First Health Commercial |
$3,938.70
|
| Rate for Payer: Humana Commercial |
$3,524.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.26
|
| Rate for Payer: PHCS Commercial |
$3,980.16
|
| Rate for Payer: United Healthcare All Payer |
$3,648.48
|
|
|
AXLE PIN REPLACEMENT SM
|
Facility
|
OP
|
$4,146.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.98 |
| Max. Negotiated Rate |
$3,980.16 |
| Rate for Payer: Aetna Commercial |
$3,192.42
|
| Rate for Payer: Anthem Medicaid |
$1,425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.88
|
| Rate for Payer: Cash Price |
$2,073.00
|
| Rate for Payer: Cigna Commercial |
$3,441.18
|
| Rate for Payer: First Health Commercial |
$3,938.70
|
| Rate for Payer: Humana Commercial |
$3,524.10
|
| Rate for Payer: Humana KY Medicaid |
$1,425.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.26
|
| Rate for Payer: PHCS Commercial |
$3,980.16
|
| Rate for Payer: United Healthcare All Payer |
$3,648.48
|
|
|
AXLE RS OSS
|
Facility
|
IP
|
$4,546.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$4,364.18 |
| Rate for Payer: Aetna Commercial |
$3,500.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.90
|
| Rate for Payer: Cash Price |
$2,273.01
|
| Rate for Payer: Cigna Commercial |
$3,773.20
|
| Rate for Payer: First Health Commercial |
$4,318.72
|
| Rate for Payer: Humana Commercial |
$3,864.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.27
|
| Rate for Payer: PHCS Commercial |
$4,364.18
|
| Rate for Payer: United Healthcare All Payer |
$4,000.50
|
|
|
AXLE RS OSS
|
Facility
|
OP
|
$4,546.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$4,364.18 |
| Rate for Payer: Aetna Commercial |
$3,500.44
|
| Rate for Payer: Anthem Medicaid |
$1,563.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.90
|
| Rate for Payer: Cash Price |
$2,273.01
|
| Rate for Payer: Cigna Commercial |
$3,773.20
|
| Rate for Payer: First Health Commercial |
$4,318.72
|
| Rate for Payer: Humana Commercial |
$3,864.12
|
| Rate for Payer: Humana KY Medicaid |
$1,563.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,579.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.27
|
| Rate for Payer: PHCS Commercial |
$4,364.18
|
| Rate for Payer: United Healthcare All Payer |
$4,000.50
|
|
|
AXUMIN FLUCICLOVIN F18 1MCLX10
|
Facility
|
OP
|
$327.01
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
34000073
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.93 |
| Rate for Payer: Aetna Commercial |
$251.80
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.07
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.42
|
| Rate for Payer: First Health Commercial |
$310.66
|
| Rate for Payer: Humana Commercial |
$277.96
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.77
|
| Rate for Payer: Ohio Health Group HMO |
$245.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.93
|
| Rate for Payer: United Healthcare All Payer |
$287.77
|
|
|
AXUMIN FLUCICLOVIN F18 1MCLX10
|
Facility
|
IP
|
$327.01
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
34000073
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.93 |
| Rate for Payer: Aetna Commercial |
$251.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.07
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.42
|
| Rate for Payer: First Health Commercial |
$310.66
|
| Rate for Payer: Humana Commercial |
$277.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.77
|
| Rate for Payer: Ohio Health Group HMO |
$245.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.93
|
| Rate for Payer: United Healthcare All Payer |
$287.77
|
|
|
AYGESTIN 5MG TABLET
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 68462030450
|
| Hospital Charge Code |
25000299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
