|
STRESS TEST(T
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
482T0002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STRESS TEST W/O INT/REPORT
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$1,263.36 |
| Rate for Payer: Aetna Commercial |
$1,013.32
|
| Rate for Payer: Anthem Medicaid |
$452.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$1,092.28
|
| Rate for Payer: First Health Commercial |
$1,250.20
|
| Rate for Payer: Humana Commercial |
$1,118.60
|
| Rate for Payer: Humana KY Medicaid |
$452.57
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$457.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,079.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$971.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$461.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,158.08
|
| Rate for Payer: Ohio Health Group HMO |
$987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.96
|
| Rate for Payer: PHCS Commercial |
$1,263.36
|
| Rate for Payer: United Healthcare All Payer |
$1,158.08
|
|
|
STRESS TEST W/O INT/REPORT
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$1,263.36 |
| Rate for Payer: Aetna Commercial |
$1,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.48
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$1,092.28
|
| Rate for Payer: First Health Commercial |
$1,250.20
|
| Rate for Payer: Humana Commercial |
$1,118.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,079.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$971.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,158.08
|
| Rate for Payer: Ohio Health Group HMO |
$987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.96
|
| Rate for Payer: PHCS Commercial |
$1,263.36
|
| Rate for Payer: United Healthcare All Payer |
$1,158.08
|
|
|
STRESS TEST W/O INT/REPORT
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Anthem Medicaid |
$45.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,316.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$100.88
|
| Rate for Payer: Healthspan PPO |
$89.08
|
| Rate for Payer: Humana Medicaid |
$45.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.75
|
| Rate for Payer: Molina Healthcare Passport |
$45.83
|
| Rate for Payer: Multiplan PHCS |
$789.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.20
|
| Rate for Payer: UHCCP Medicaid |
$460.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.29
|
|
|
STRESS TEST W/O INT/REPORT(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482P0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Anthem Medicaid |
$45.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$100.88
|
| Rate for Payer: Healthspan PPO |
$89.08
|
| Rate for Payer: Humana Medicaid |
$45.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.75
|
| Rate for Payer: Molina Healthcare Passport |
$45.83
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.29
|
|
|
STRESS TEST W/O INT/REPORT(T
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482T0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STRESS TEST W/O INT/REPORT(T
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482T0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STROMECTOL(IVERMECTIN) 3MG TAB
|
Facility
|
IP
|
$12.14
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
25001440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.47
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.53
|
| Rate for Payer: Humana Commercial |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.68
|
| Rate for Payer: Ohio Health Group HMO |
$9.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.76
|
| Rate for Payer: PHCS Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Payer |
$10.68
|
|
|
STROMECTOL(IVERMECTIN) 3MG TAB
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
25001440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Anthem Medicaid |
$4.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.47
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.53
|
| Rate for Payer: Humana Commercial |
$10.32
|
| Rate for Payer: Humana KY Medicaid |
$4.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.68
|
| Rate for Payer: Ohio Health Group HMO |
$9.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.76
|
| Rate for Payer: PHCS Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Payer |
$10.68
|
|
|
STRONG IODINE SOLUTION (LUGOL)
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 10481011108
|
| Hospital Charge Code |
25001442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
STRONG IODINE SOLUTION (LUGOL)
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 10481011108
|
| Hospital Charge Code |
25001442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
STRUT CORTICAL FROZEN 20*200
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
STRUT CORTICAL FROZEN 20*200
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
STRUT CORTICL FREEZ DRIED 1CM*
|
Facility
|
OP
|
$3,535.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.58 |
| Max. Negotiated Rate |
$3,393.84 |
| Rate for Payer: Aetna Commercial |
$2,722.14
|
| Rate for Payer: Anthem Medicaid |
$1,215.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.50
|
| Rate for Payer: Cash Price |
$1,767.62
|
| Rate for Payer: Cigna Commercial |
$2,934.26
|
| Rate for Payer: First Health Commercial |
$3,358.49
|
| Rate for Payer: Humana Commercial |
$3,004.96
|
| Rate for Payer: Humana KY Medicaid |
$1,215.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,228.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,609.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,240.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,111.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.93
|
| Rate for Payer: PHCS Commercial |
$3,393.84
|
| Rate for Payer: United Healthcare All Payer |
$3,111.02
|
|
|
STRUT CORTICL FREEZ DRIED 1CM*
|
Facility
|
IP
|
$3,535.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.58 |
| Max. Negotiated Rate |
$3,393.84 |
| Rate for Payer: Aetna Commercial |
$2,722.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.50
|
| Rate for Payer: Cash Price |
$1,767.62
|
| Rate for Payer: Cigna Commercial |
$2,934.26
|
| Rate for Payer: First Health Commercial |
$3,358.49
|
| Rate for Payer: Humana Commercial |
$3,004.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,609.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,111.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.93
|
| Rate for Payer: PHCS Commercial |
$3,393.84
|
| Rate for Payer: United Healthcare All Payer |
$3,111.02
|
|
|
STRUT FEMORAL FROZEN 200*20
|
Facility
|
OP
|
$4,850.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.60 |
| Max. Negotiated Rate |
$4,656.73 |
| Rate for Payer: Aetna Commercial |
$3,735.09
|
| Rate for Payer: Anthem Medicaid |
$1,668.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.59
|
| Rate for Payer: Cash Price |
$2,425.38
|
| Rate for Payer: Cigna Commercial |
$4,026.13
|
| Rate for Payer: First Health Commercial |
$4,608.22
|
| Rate for Payer: Humana Commercial |
$4,123.15
|
| Rate for Payer: Humana KY Medicaid |
$1,668.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,685.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,638.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.74
|
| Rate for Payer: PHCS Commercial |
$4,656.73
|
| Rate for Payer: United Healthcare All Payer |
$4,268.67
|
|
|
STRUT FEMORAL FROZEN 200*20
|
Facility
|
IP
|
$4,850.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.60 |
| Max. Negotiated Rate |
$4,656.73 |
| Rate for Payer: Aetna Commercial |
$3,735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.59
|
| Rate for Payer: Cash Price |
$2,425.38
|
| Rate for Payer: Cigna Commercial |
$4,026.13
|
| Rate for Payer: First Health Commercial |
$4,608.22
|
| Rate for Payer: Humana Commercial |
$4,123.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,638.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.74
|
| Rate for Payer: PHCS Commercial |
$4,656.73
|
| Rate for Payer: United Healthcare All Payer |
$4,268.67
|
|
|
STS PC HO SZ 11
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STS PC HO SZ 11
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
STYLET KIT 6093-58
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STYLET KIT 6093-58
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SUBCUTANEOUS INFUS EA ADDIT HR
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
26000018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$57.51 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Anthem Medicaid |
$14.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$34.03
|
| Rate for Payer: First Health Commercial |
$38.95
|
| Rate for Payer: Humana Commercial |
$34.85
|
| Rate for Payer: Humana KY Medicaid |
$14.10
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$14.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.08
|
| Rate for Payer: Ohio Health Group HMO |
$30.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.71
|
| Rate for Payer: PHCS Commercial |
$39.36
|
| Rate for Payer: United Healthcare All Payer |
$36.08
|
|
|
SUBCUTANEOUS INFUS EA ADDIT HR
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
26000018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$39.36 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.98
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cigna Commercial |
$34.03
|
| Rate for Payer: First Health Commercial |
$38.95
|
| Rate for Payer: Humana Commercial |
$34.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.08
|
| Rate for Payer: Ohio Health Group HMO |
$30.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.71
|
| Rate for Payer: PHCS Commercial |
$39.36
|
| Rate for Payer: United Healthcare All Payer |
$36.08
|
|
|
SUBCUTANEOUS INFUS INIT 1HR
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 96369
|
| Hospital Charge Code |
26000017
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$259.49 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Cash Price |
$97.00
|
| 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: Humana Medicare Advantage |
$185.35
|
| 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 |
$222.42
|
| 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
|
|
|
SUBCUTANEOUS INFUS INIT 1HR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 96369
|
| Hospital Charge Code |
26000017
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
