|
TIGER RADIAL CATH 5FR 4.0
|
Facility
|
OP
|
$757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.48 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.28
|
| Rate for Payer: Anthem Medicaid |
$260.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.72
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Humana KY Medicaid |
$260.50
|
| Rate for Payer: Kentucky WC Medicaid |
$263.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.82
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
|
TIGHTROPE 2 ABS OPEN
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
TIGHTROPE 2 ABS OPEN
|
Facility
|
IP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
TIGHTROPE II BTB RECON IB
|
Facility
|
IP
|
$4,570.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$4,387.56 |
| Rate for Payer: Aetna Commercial |
$3,519.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.90
|
| Rate for Payer: Cash Price |
$2,285.19
|
| Rate for Payer: Cigna Commercial |
$3,793.42
|
| Rate for Payer: First Health Commercial |
$4,341.86
|
| Rate for Payer: Humana Commercial |
$3,884.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,747.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,372.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,021.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,427.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.82
|
| Rate for Payer: PHCS Commercial |
$4,387.56
|
| Rate for Payer: United Healthcare All Payer |
$4,021.93
|
|
|
TIGHTROPE II BTB RECON IB
|
Facility
|
OP
|
$4,570.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$4,387.56 |
| Rate for Payer: Aetna Commercial |
$3,519.19
|
| Rate for Payer: Anthem Medicaid |
$1,571.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,564.90
|
| Rate for Payer: Cash Price |
$2,285.19
|
| Rate for Payer: Cigna Commercial |
$3,793.42
|
| Rate for Payer: First Health Commercial |
$4,341.86
|
| Rate for Payer: Humana Commercial |
$3,884.82
|
| Rate for Payer: Humana KY Medicaid |
$1,571.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,587.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,747.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,372.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,603.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,021.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,427.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.82
|
| Rate for Payer: PHCS Commercial |
$4,387.56
|
| Rate for Payer: United Healthcare All Payer |
$4,021.93
|
|
|
TIKOSYN 125 MCG CAPSULE
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 59651011860
|
| Hospital Charge Code |
25003522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Anthem Medicaid |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$7.97
|
| Rate for Payer: First Health Commercial |
$9.12
|
| Rate for Payer: Humana Commercial |
$8.16
|
| Rate for Payer: Humana KY Medicaid |
$3.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.45
|
| Rate for Payer: Ohio Health Group HMO |
$7.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Payer |
$8.45
|
|
|
TIKOSYN 125 MCG CAPSULE
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 59651011860
|
| Hospital Charge Code |
25003522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$7.97
|
| Rate for Payer: First Health Commercial |
$9.12
|
| Rate for Payer: Humana Commercial |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.45
|
| Rate for Payer: Ohio Health Group HMO |
$7.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Payer |
$8.45
|
|
|
TIKOSYN 250MCG CAPSULE
|
Facility
|
OP
|
$28.08
|
|
|
Service Code
|
NDC 69581060
|
| Hospital Charge Code |
25001547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$21.62
|
| Rate for Payer: Anthem Medicaid |
$9.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.90
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna Commercial |
$23.31
|
| Rate for Payer: First Health Commercial |
$26.68
|
| Rate for Payer: Humana Commercial |
$23.87
|
| Rate for Payer: Humana KY Medicaid |
$9.66
|
| Rate for Payer: Kentucky WC Medicaid |
$9.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.71
|
| Rate for Payer: Ohio Health Group HMO |
$21.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.70
|
| Rate for Payer: PHCS Commercial |
$26.96
|
| Rate for Payer: United Healthcare All Payer |
$24.71
|
|
|
TIKOSYN 250MCG CAPSULE
|
Facility
|
IP
|
$28.08
|
|
|
Service Code
|
NDC 69581060
|
| Hospital Charge Code |
25001547
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$21.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.90
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cigna Commercial |
$23.31
|
| Rate for Payer: First Health Commercial |
$26.68
|
| Rate for Payer: Humana Commercial |
$23.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.71
|
| Rate for Payer: Ohio Health Group HMO |
$21.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.70
|
| Rate for Payer: PHCS Commercial |
$26.96
|
| Rate for Payer: United Healthcare All Payer |
$24.71
|
|
|
TIKOSYN 500MCG CAPSULE
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 16729049212
|
| Hospital Charge Code |
25001548
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$7.97
|
| Rate for Payer: First Health Commercial |
$9.12
|
| Rate for Payer: Humana Commercial |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.45
|
| Rate for Payer: Ohio Health Group HMO |
$7.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Payer |
$8.45
|
|
|
TIKOSYN 500MCG CAPSULE
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 16729049212
|
| Hospital Charge Code |
25001548
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Anthem Medicaid |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.49
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$7.97
|
| Rate for Payer: First Health Commercial |
$9.12
|
| Rate for Payer: Humana Commercial |
$8.16
|
| Rate for Payer: Humana KY Medicaid |
$3.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.45
|
| Rate for Payer: Ohio Health Group HMO |
$7.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.98
|
| Rate for Payer: PHCS Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Payer |
$8.45
|
|
|
TILT TABLE
|
Professional
|
Both
|
$1,981.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$1,981.00 |
| Rate for Payer: Aetna Commercial |
$276.78
|
| Rate for Payer: Anthem Medicaid |
$125.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,981.00
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cigna Commercial |
$257.91
|
| Rate for Payer: Healthspan PPO |
$260.18
|
| Rate for Payer: Humana Medicaid |
$125.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.08
|
| Rate for Payer: Molina Healthcare Passport |
$125.57
|
| Rate for Payer: Multiplan PHCS |
$1,188.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,386.70
|
| Rate for Payer: UHCCP Medicaid |
$693.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.83
|
|
|
TILT TABLE
|
Facility
|
OP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$257.53 |
| Max. Negotiated Rate |
$1,901.76 |
| Rate for Payer: Aetna Commercial |
$1,525.37
|
| Rate for Payer: Anthem Medicaid |
$681.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cigna Commercial |
$1,644.23
|
| Rate for Payer: First Health Commercial |
$1,881.95
|
| Rate for Payer: Humana Commercial |
$1,683.85
|
| Rate for Payer: Humana KY Medicaid |
$681.27
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$688.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.11
|
| Rate for Payer: PHCS Commercial |
$1,901.76
|
| Rate for Payer: United Healthcare All Payer |
$1,743.28
|
|
|
TILT TABLE
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000056
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.78 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem Medicaid |
$586.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Humana KY Medicaid |
$586.69
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$592.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.86
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TILT TABLE
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000056
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.78 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.86
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TILT TABLE
|
Facility
|
IP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
48000107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$257.53 |
| Max. Negotiated Rate |
$1,901.76 |
| Rate for Payer: Aetna Commercial |
$1,525.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.18
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cigna Commercial |
$1,644.23
|
| Rate for Payer: First Health Commercial |
$1,881.95
|
| Rate for Payer: Humana Commercial |
$1,683.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.11
|
| Rate for Payer: PHCS Commercial |
$1,901.76
|
| Rate for Payer: United Healthcare All Payer |
$1,743.28
|
|
|
TILT TABLE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480P0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$276.78 |
| Rate for Payer: Aetna Commercial |
$276.78
|
| Rate for Payer: Anthem Medicaid |
$125.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$257.91
|
| Rate for Payer: Healthspan PPO |
$260.18
|
| Rate for Payer: Humana Medicaid |
$125.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.08
|
| Rate for Payer: Molina Healthcare Passport |
$125.57
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.83
|
|
|
TILT TABLE(T
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480T0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.78 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem Medicaid |
$586.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Humana KY Medicaid |
$586.69
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$592.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.86
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TILT TABLE(T
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
HCPCS 93660
|
| Hospital Charge Code |
480T0107
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.78 |
| Max. Negotiated Rate |
$1,637.76 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,330.68
|
| Rate for Payer: Cash Price |
$853.00
|
| Rate for Payer: Cigna Commercial |
$1,415.98
|
| Rate for Payer: First Health Commercial |
$1,620.70
|
| Rate for Payer: Humana Commercial |
$1,450.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,501.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,279.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.86
|
| Rate for Payer: PHCS Commercial |
$1,637.76
|
| Rate for Payer: United Healthcare All Payer |
$1,501.28
|
|
|
TIMED SQ INJECTION MEDONC
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
94000004
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem Medicaid |
$38.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Humana KY Medicaid |
$38.17
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$38.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.41
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
TIMED SQ INJECTION MEDONC
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
94000004
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.58
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.41
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
TIMOLOL 5MG TABLET
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
25001549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
TIMOLOL 5MG TABLET
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
25001549
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
TIMOPTIC(TIMOLOL) 0.5% OP 5ML
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
25001550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna Commercial |
$0.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna Commercial |
$0.71
|
| Rate for Payer: First Health Commercial |
$0.81
|
| Rate for Payer: Humana Commercial |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.75
|
| Rate for Payer: Ohio Health Group HMO |
$0.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.26
|
| Rate for Payer: PHCS Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Payer |
$0.75
|
|
|
TIMOPTIC(TIMOLOL) 0.5% OP 5ML
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
25001550
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna Commercial |
$0.65
|
| Rate for Payer: Anthem Medicaid |
$0.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cigna Commercial |
$0.71
|
| Rate for Payer: First Health Commercial |
$0.81
|
| Rate for Payer: Humana Commercial |
$0.72
|
| Rate for Payer: Humana KY Medicaid |
$0.29
|
| Rate for Payer: Kentucky WC Medicaid |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.75
|
| Rate for Payer: Ohio Health Group HMO |
$0.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.26
|
| Rate for Payer: PHCS Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Payer |
$0.75
|
|
