|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$17,619.84
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$11,956.32 |
| Max. Negotiated Rate |
$17,619.84 |
| Rate for Payer: Anthem Medicaid |
$11,956.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,585.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,619.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,990.56
|
| Rate for Payer: Humana KY Medicaid |
$11,956.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,585.60
|
| Rate for Payer: Kentucky WC Medicaid |
$12,075.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,102.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,195.45
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$10,631.33
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,214.12 |
| Max. Negotiated Rate |
$10,631.33 |
| Rate for Payer: Anthem Medicaid |
$7,214.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,593.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,631.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,251.64
|
| Rate for Payer: Humana KY Medicaid |
$7,214.12
|
| Rate for Payer: Humana Medicare Advantage |
$7,593.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,286.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,112.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,358.40
|
|
|
TRAVATN(TRAVOPROST)2.5ML OPTH
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
25001581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.67
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cigna Commercial |
$9.23
|
| Rate for Payer: First Health Commercial |
$10.56
|
| Rate for Payer: Humana Commercial |
$9.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.79
|
| Rate for Payer: Ohio Health Group HMO |
$8.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Payer |
$9.79
|
|
|
TRAVATN(TRAVOPROST)2.5ML OPTH
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
25001581
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Anthem Medicaid |
$3.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.67
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cigna Commercial |
$9.23
|
| Rate for Payer: First Health Commercial |
$10.56
|
| Rate for Payer: Humana Commercial |
$9.45
|
| Rate for Payer: Humana KY Medicaid |
$3.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.79
|
| Rate for Payer: Ohio Health Group HMO |
$8.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Payer |
$9.79
|
|
|
TRAZIMERA 10mg (150mg SDV)
|
Facility
|
OP
|
$6,600.50
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
25004103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$6,336.48 |
| Rate for Payer: Aetna Commercial |
$5,082.38
|
| Rate for Payer: Anthem Medicaid |
$2,269.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,148.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.10
|
| Rate for Payer: Cash Price |
$3,300.25
|
| Rate for Payer: Cash Price |
$3,300.25
|
| Rate for Payer: Cigna Commercial |
$5,478.42
|
| Rate for Payer: First Health Commercial |
$6,270.48
|
| Rate for Payer: Humana Commercial |
$5,610.42
|
| Rate for Payer: Humana KY Medicaid |
$2,269.91
|
| Rate for Payer: Humana Medicare Advantage |
$16.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,293.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,412.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,315.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,808.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.16
|
| Rate for Payer: PHCS Commercial |
$6,336.48
|
| Rate for Payer: United Healthcare All Payer |
$5,808.44
|
|
|
TRAZIMERA 10mg (150mg SDV)
|
Facility
|
IP
|
$6,600.50
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
25004103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$858.06 |
| Max. Negotiated Rate |
$6,336.48 |
| Rate for Payer: Aetna Commercial |
$5,082.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,148.39
|
| Rate for Payer: Cash Price |
$3,300.25
|
| Rate for Payer: Cigna Commercial |
$5,478.42
|
| Rate for Payer: First Health Commercial |
$6,270.48
|
| Rate for Payer: Humana Commercial |
$5,610.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,412.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,980.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,808.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.16
|
| Rate for Payer: PHCS Commercial |
$6,336.48
|
| Rate for Payer: United Healthcare All Payer |
$5,808.44
|
|
|
TRAZIMERA 10mg(from 420mg MDV)
|
Facility
|
OP
|
$440.03
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
25004104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$422.43 |
| Rate for Payer: Aetna Commercial |
$338.82
|
| Rate for Payer: Anthem Medicaid |
$151.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.10
|
| Rate for Payer: Cash Price |
$220.01
|
| Rate for Payer: Cash Price |
$220.01
|
| Rate for Payer: Cigna Commercial |
$365.22
|
| Rate for Payer: First Health Commercial |
$418.03
|
| Rate for Payer: Humana Commercial |
$374.03
|
| Rate for Payer: Humana KY Medicaid |
$151.33
|
| Rate for Payer: Humana Medicare Advantage |
$16.37
|
| Rate for Payer: Kentucky WC Medicaid |
$152.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.23
|
| Rate for Payer: Ohio Health Group HMO |
$330.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.41
|
| Rate for Payer: PHCS Commercial |
$422.43
|
| Rate for Payer: United Healthcare All Payer |
$387.23
|
|
|
TRAZIMERA 10mg(from 420mg MDV)
|
Facility
|
IP
|
$440.03
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
25004104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.43 |
| Rate for Payer: Aetna Commercial |
$338.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.22
|
| Rate for Payer: Cash Price |
$220.01
|
| Rate for Payer: Cigna Commercial |
$365.22
|
| Rate for Payer: First Health Commercial |
$418.03
|
| Rate for Payer: Humana Commercial |
$374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.23
|
| Rate for Payer: Ohio Health Group HMO |
$330.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.41
|
| Rate for Payer: PHCS Commercial |
$422.43
|
| Rate for Payer: United Healthcare All Payer |
$387.23
|
|
|
TREADMILL STRESS TEST
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200004
|
|
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
|
|
|
TREADMILL STRESS TEST
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200004
|
|
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
|
|
|
TREANDA 25MG VIAL
|
Facility
|
IP
|
$4,049.08
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
25002562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$526.38 |
| Max. Negotiated Rate |
$3,887.12 |
| Rate for Payer: Aetna Commercial |
$3,117.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,158.28
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cigna Commercial |
$3,360.74
|
| Rate for Payer: First Health Commercial |
$3,846.63
|
| Rate for Payer: Humana Commercial |
$3,441.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,320.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,988.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,563.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.21
|
| Rate for Payer: PHCS Commercial |
$3,887.12
|
| Rate for Payer: United Healthcare All Payer |
$3,563.19
|
|
|
TREANDA 25MG VIAL
|
Facility
|
OP
|
$4,049.08
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
25002562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$3,887.12 |
| Rate for Payer: Aetna Commercial |
$3,117.79
|
| Rate for Payer: Anthem Medicaid |
$1,392.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,158.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.41
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cigna Commercial |
$3,360.74
|
| Rate for Payer: First Health Commercial |
$3,846.63
|
| Rate for Payer: Humana Commercial |
$3,441.72
|
| Rate for Payer: Humana KY Medicaid |
$1,392.48
|
| Rate for Payer: Humana Medicare Advantage |
$9.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,320.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,988.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,420.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,563.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.21
|
| Rate for Payer: PHCS Commercial |
$3,887.12
|
| Rate for Payer: United Healthcare All Payer |
$3,563.19
|
|
|
TREASURE 12 GW 180CM
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE 12 GW 180CM
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE 12 GW 300CM
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE 12 GW 300CM
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE FLOPPY GW 190CM
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE FLOPPY GW 190CM
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE FLOPPY GW 300CM
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREASURE FLOPPY GW 300CM
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
76102741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.65 |
| Max. Negotiated Rate |
$760.52 |
| Rate for Payer: Aetna Commercial |
$704.25
|
| Rate for Payer: Anthem Medicaid |
$235.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$519.00
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$760.52
|
| Rate for Payer: Healthspan PPO |
$637.90
|
| Rate for Payer: Humana Medicaid |
$235.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$605.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$240.36
|
| Rate for Payer: Molina Healthcare Passport |
$235.65
|
| Rate for Payer: Multiplan PHCS |
$311.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.30
|
| Rate for Payer: UHCCP Medicaid |
$181.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.01
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
761P2599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$913.26 |
| Rate for Payer: Aetna Commercial |
$834.96
|
| Rate for Payer: Anthem Medicaid |
$458.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$913.26
|
| Rate for Payer: Healthspan PPO |
$756.29
|
| Rate for Payer: Humana Medicaid |
$458.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.05
|
| Rate for Payer: Molina Healthcare Passport |
$458.87
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.46
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
76102716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.24 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna Commercial |
$393.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$164.38
|
| Rate for Payer: Anthem Medicaid |
$150.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.00
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$476.30
|
| Rate for Payer: Healthspan PPO |
$384.28
|
| Rate for Payer: Humana Medicaid |
$150.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.24
|
| Rate for Payer: Molina Healthcare Passport |
$150.24
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$172.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.74
|
|
