|
STRONG IODINE SOLUTION (LUGOL)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 38779059805
|
| Hospital Charge Code |
25001442
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem Medicaid |
$0.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Humana KY Medicaid |
$0.00
|
| Rate for Payer: Kentucky WC Medicaid |
$0.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
STRUT CORTICAL FROZEN 20*200
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
STRUT CORTICAL FROZEN 20*200
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
STRUT CORTICL FREEZ DRIED 1CM*
|
Facility
|
OP
|
$3,430.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.19 |
| Max. Negotiated Rate |
$3,293.40 |
| Rate for Payer: Aetna Commercial |
$2,641.58
|
| Rate for Payer: Anthem Medicaid |
$1,179.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,675.88
|
| Rate for Payer: Cash Price |
$1,715.31
|
| Rate for Payer: Cigna Commercial |
$2,847.41
|
| Rate for Payer: First Health Commercial |
$3,259.09
|
| Rate for Payer: Humana Commercial |
$2,916.03
|
| Rate for Payer: Humana KY Medicaid |
$1,179.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,531.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,018.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,572.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,744.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,367.13
|
| Rate for Payer: PHCS Commercial |
$3,293.40
|
| Rate for Payer: United Healthcare All Payer |
$3,018.95
|
|
|
STRUT CORTICL FREEZ DRIED 1CM*
|
Facility
|
IP
|
$3,430.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.19 |
| Max. Negotiated Rate |
$3,293.40 |
| Rate for Payer: Aetna Commercial |
$2,641.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,675.88
|
| Rate for Payer: Cash Price |
$1,715.31
|
| Rate for Payer: Cigna Commercial |
$2,847.41
|
| Rate for Payer: First Health Commercial |
$3,259.09
|
| Rate for Payer: Humana Commercial |
$2,916.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,531.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,018.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,572.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,744.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,367.13
|
| Rate for Payer: PHCS Commercial |
$3,293.40
|
| Rate for Payer: United Healthcare All Payer |
$3,018.95
|
|
|
STRUT FEMORAL FROZEN 200*20
|
Facility
|
OP
|
$4,840.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,452.03 |
| Max. Negotiated Rate |
$4,646.50 |
| Rate for Payer: Aetna Commercial |
$3,726.88
|
| Rate for Payer: Anthem Medicaid |
$1,664.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,775.28
|
| Rate for Payer: Cash Price |
$2,420.05
|
| Rate for Payer: Cigna Commercial |
$4,017.28
|
| Rate for Payer: First Health Commercial |
$4,598.10
|
| Rate for Payer: Humana Commercial |
$4,114.09
|
| Rate for Payer: Humana KY Medicaid |
$1,664.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,259.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,630.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,872.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,210.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,339.67
|
| Rate for Payer: PHCS Commercial |
$4,646.50
|
| Rate for Payer: United Healthcare All Payer |
$4,259.29
|
|
|
STRUT FEMORAL FROZEN 200*20
|
Facility
|
IP
|
$4,840.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,452.03 |
| Max. Negotiated Rate |
$4,646.50 |
| Rate for Payer: Aetna Commercial |
$3,726.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,775.28
|
| Rate for Payer: Cash Price |
$2,420.05
|
| Rate for Payer: Cigna Commercial |
$4,017.28
|
| Rate for Payer: First Health Commercial |
$4,598.10
|
| Rate for Payer: Humana Commercial |
$4,114.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,259.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,630.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,872.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,210.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,339.67
|
| Rate for Payer: PHCS Commercial |
$4,646.50
|
| Rate for Payer: United Healthcare All Payer |
$4,259.29
|
|
|
STS PC HO SZ 11
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STS PC HO SZ 11
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
STYLET KIT 6093-58
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STYLET KIT 6093-58
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SUBCUTANEOUS INFUS EA ADDIT HR
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
26000018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$14.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$14.79
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$14.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SUBCUTANEOUS INFUS EA ADDIT HR
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
26000018
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SUBCUTANEOUS INFUS INIT 1HR
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 96369
|
| Hospital Charge Code |
26000017
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
SUBCUTANEOUS INFUS INIT 1HR
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 96369
|
| Hospital Charge Code |
26000017
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$71.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$71.19
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$71.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
SUBCUT REMOV SING/DUAL DEFIB G
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33241
|
| Hospital Charge Code |
76101267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
SUBCUT REMOV SING/DUAL DEFIB G
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33241
|
| Hospital Charge Code |
76101267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Ambetter Exchange |
$200.07
|
| Rate for Payer: Anthem Medicaid |
$155.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.08
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$378.33
|
| Rate for Payer: Healthspan PPO |
$381.72
|
| Rate for Payer: Humana Medicaid |
$155.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.64
|
| Rate for Payer: Molina Healthcare Passport |
$155.53
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.09
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.07
|
|
|
SUBCUT REMOV SING/DUAL DEFIB G
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33241
|
| Hospital Charge Code |
76101267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$3,362.64
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,035.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
SUBCUT REMOV SING/DUAL DEFIB G
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33241
|
| Hospital Charge Code |
761P1267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$388.24
|
| Rate for Payer: Ambetter Exchange |
$200.07
|
| Rate for Payer: Anthem Medicaid |
$155.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.08
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$378.33
|
| Rate for Payer: Healthspan PPO |
$381.72
|
| Rate for Payer: Humana Medicaid |
$155.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.64
|
| Rate for Payer: Molina Healthcare Passport |
$155.53
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.09
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.07
|
|
|
SUBLATIVE FULL FACE LASER TX
|
Professional
|
Both
|
$400.00
|
|
| Hospital Charge Code |
22200169
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
|
|
SUBLATIVE LIMIT FACE LSR TX
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200171
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
SUBLATIVE LIMIT FACE LSR TX
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
22200171
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
SUBLATIVE LIMIT FACE LSR TX
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
22200171
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
SUBLATIVE LMTD FACLSR-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200335
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
SUBLATIVE LOWREYELIDS LASTX
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200170
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
