|
TENORMIN (ATENOLOL) 25MG/1TAB
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
25001507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
TENORMIN (ATENOLOL) 50MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
25001508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
TENORMIN (ATENOLOL) 50MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
25001508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
TENOTMYLENTHNGRELEAS ABDUHALU
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
45000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
TENOTMYLENTHNGRELEAS ABDUHALU
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
45000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$681.60 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.10
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem Medicaid |
$244.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Humana KY Medicaid |
$244.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$246.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.10
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$869.11 |
| Rate for Payer: Aetna Commercial |
$791.75
|
| Rate for Payer: Anthem Medicaid |
$297.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$869.11
|
| Rate for Payer: Healthspan PPO |
$717.16
|
| Rate for Payer: Humana Medicaid |
$297.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.90
|
| Rate for Payer: Molina Healthcare Passport |
$297.94
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.00
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.92
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN(P
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
761P0760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$869.11 |
| Rate for Payer: Aetna Commercial |
$791.75
|
| Rate for Payer: Anthem Medicaid |
$297.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$869.11
|
| Rate for Payer: Healthspan PPO |
$717.16
|
| Rate for Payer: Humana Medicaid |
$297.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.90
|
| Rate for Payer: Molina Healthcare Passport |
$297.94
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.00
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.92
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TENDON REPAIR OR REATTACHMENT
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 24359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 28234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, 1 LEG
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 27391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 28232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 28010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.95 |
| Max. Negotiated Rate |
$2,702.40 |
| Rate for Payer: Aetna Commercial |
$2,167.55
|
| Rate for Payer: Anthem Medicaid |
$968.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,195.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cigna Commercial |
$2,336.45
|
| Rate for Payer: First Health Commercial |
$2,674.25
|
| Rate for Payer: Humana Commercial |
$2,392.75
|
| Rate for Payer: Humana KY Medicaid |
$968.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$977.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,308.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,077.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$987.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,477.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$563.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.65
|
| Rate for Payer: PHCS Commercial |
$2,702.40
|
| Rate for Payer: United Healthcare All Payer |
$2,477.20
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.72 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.84
|
| Rate for Payer: Anthem Medicaid |
$143.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,815.00
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cigna Commercial |
$344.32
|
| Rate for Payer: Healthspan PPO |
$304.75
|
| Rate for Payer: Humana Medicaid |
$143.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.59
|
| Rate for Payer: Molina Healthcare Passport |
$143.72
|
| Rate for Payer: Multiplan PHCS |
$1,689.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,970.50
|
| Rate for Payer: UHCCP Medicaid |
$165.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.16
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.95 |
| Max. Negotiated Rate |
$2,702.40 |
| Rate for Payer: Aetna Commercial |
$2,167.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,195.70
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cigna Commercial |
$2,336.45
|
| Rate for Payer: First Health Commercial |
$2,674.25
|
| Rate for Payer: Humana Commercial |
$2,392.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,308.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,077.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$844.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,477.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$563.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.65
|
| Rate for Payer: PHCS Commercial |
$2,702.40
|
| Rate for Payer: United Healthcare All Payer |
$2,477.20
|
|
|
TENOTOMY PERCUTAN, SING TEND(P
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
761P2678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.72 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.84
|
| Rate for Payer: Anthem Medicaid |
$143.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.32
|
| Rate for Payer: Healthspan PPO |
$304.75
|
| Rate for Payer: Humana Medicaid |
$143.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.59
|
| Rate for Payer: Molina Healthcare Passport |
$143.72
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$165.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.16
|
|
|
TENOTOMY PERCUTAN, SING TEND(T
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
761T2678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$2,289.60 |
| Rate for Payer: Aetna Commercial |
$1,836.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cigna Commercial |
$1,979.55
|
| Rate for Payer: First Health Commercial |
$2,265.75
|
| Rate for Payer: Humana Commercial |
$2,027.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,955.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,760.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$715.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,098.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,788.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$477.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$739.35
|
| Rate for Payer: PHCS Commercial |
$2,289.60
|
| Rate for Payer: United Healthcare All Payer |
$2,098.80
|
|
|
TENOTOMY PERCUTAN, SING TEND(T
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
761T2678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$2,289.60 |
| Rate for Payer: Aetna Commercial |
$1,836.45
|
| Rate for Payer: Anthem Medicaid |
$820.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,860.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cigna Commercial |
$1,979.55
|
| Rate for Payer: First Health Commercial |
$2,265.75
|
| Rate for Payer: Humana Commercial |
$2,027.25
|
| Rate for Payer: Humana KY Medicaid |
$820.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$828.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,955.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,760.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$836.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,098.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,788.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$477.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$739.35
|
| Rate for Payer: PHCS Commercial |
$2,289.60
|
| Rate for Payer: United Healthcare All Payer |
$2,098.80
|
|
|
TEPEZZA 10 MG (500mg VIAL)
|
Facility
|
OP
|
$92,746.03
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
25004115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$89,036.19 |
| Rate for Payer: Aetna Commercial |
$71,414.44
|
| Rate for Payer: Anthem Medicaid |
$31,895.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$328.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,341.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$459.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$442.80
|
| Rate for Payer: Cash Price |
$46,373.02
|
| Rate for Payer: Cash Price |
$46,373.02
|
| Rate for Payer: Cigna Commercial |
$76,979.20
|
| Rate for Payer: First Health Commercial |
$88,108.73
|
| Rate for Payer: Humana Commercial |
$78,834.13
|
| Rate for Payer: Humana KY Medicaid |
$31,895.36
|
| Rate for Payer: Humana Medicare Advantage |
$328.00
|
| Rate for Payer: Kentucky WC Medicaid |
$32,219.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76,051.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,446.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,535.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,616.51
|
| Rate for Payer: Ohio Health Group HMO |
$69,559.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,056.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,751.27
|
| Rate for Payer: PHCS Commercial |
$89,036.19
|
| Rate for Payer: United Healthcare All Payer |
$81,616.51
|
|
|
TEPEZZA 10 MG (500mg VIAL)
|
Facility
|
IP
|
$92,746.03
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
25004115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,056.98 |
| Max. Negotiated Rate |
$89,036.19 |
| Rate for Payer: Aetna Commercial |
$71,414.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,341.90
|
| Rate for Payer: Cash Price |
$46,373.02
|
| Rate for Payer: Cigna Commercial |
$76,979.20
|
| Rate for Payer: First Health Commercial |
$88,108.73
|
| Rate for Payer: Humana Commercial |
$78,834.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76,051.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,446.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,823.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,616.51
|
| Rate for Payer: Ohio Health Group HMO |
$69,559.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,056.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,751.27
|
| Rate for Payer: PHCS Commercial |
$89,036.19
|
| Rate for Payer: United Healthcare All Payer |
$81,616.51
|
|
|
TERAZOL 3 (0.8%) VAG CREAM
|
Facility
|
IP
|
$62.34
|
|
|
Service Code
|
NDC 51672130200
|
| Hospital Charge Code |
25001509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna Commercial |
$48.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.63
|
| Rate for Payer: Cash Price |
$31.17
|
| Rate for Payer: Cigna Commercial |
$51.74
|
| Rate for Payer: First Health Commercial |
$59.22
|
| Rate for Payer: Humana Commercial |
$52.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.86
|
| Rate for Payer: Ohio Health Group HMO |
$46.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.33
|
| Rate for Payer: PHCS Commercial |
$59.85
|
| Rate for Payer: United Healthcare All Payer |
$54.86
|
|
|
TERAZOL 3 (0.8%) VAG CREAM
|
Facility
|
OP
|
$62.34
|
|
|
Service Code
|
NDC 51672130200
|
| Hospital Charge Code |
25001509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna Commercial |
$48.00
|
| Rate for Payer: Anthem Medicaid |
$21.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.63
|
| Rate for Payer: Cash Price |
$31.17
|
| Rate for Payer: Cigna Commercial |
$51.74
|
| Rate for Payer: First Health Commercial |
$59.22
|
| Rate for Payer: Humana Commercial |
$52.99
|
| Rate for Payer: Humana KY Medicaid |
$21.44
|
| Rate for Payer: Kentucky WC Medicaid |
$21.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.86
|
| Rate for Payer: Ohio Health Group HMO |
$46.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.33
|
| Rate for Payer: PHCS Commercial |
$59.85
|
| Rate for Payer: United Healthcare All Payer |
$54.86
|
|
|
TERAZOL 3 (TERCONAZOL 80MG/1EA
|
Facility
|
IP
|
$65.21
|
|
|
Service Code
|
NDC 713055273
|
| Hospital Charge Code |
25001510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$50.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.86
|
| Rate for Payer: Cash Price |
$32.60
|
| Rate for Payer: Cigna Commercial |
$54.12
|
| Rate for Payer: First Health Commercial |
$61.95
|
| Rate for Payer: Humana Commercial |
$55.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.38
|
| Rate for Payer: Ohio Health Group HMO |
$48.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.22
|
| Rate for Payer: PHCS Commercial |
$62.60
|
| Rate for Payer: United Healthcare All Payer |
$57.38
|
|
