|
BLEPHAROPLASTY, UPPER EYELID(T
|
Facility
|
OP
|
$4,972.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
761T0215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$4,773.12 |
| Rate for Payer: Aetna Commercial |
$3,828.44
|
| Rate for Payer: Anthem Medicaid |
$1,709.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,486.00
|
| Rate for Payer: Cash Price |
$2,486.00
|
| Rate for Payer: Cigna Commercial |
$4,126.76
|
| Rate for Payer: First Health Commercial |
$4,723.40
|
| Rate for Payer: Humana Commercial |
$4,226.20
|
| Rate for Payer: Humana KY Medicaid |
$1,709.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,727.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,744.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,430.68
|
| Rate for Payer: PHCS Commercial |
$4,773.12
|
| Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|
|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
BLEPHAROPLASTY (UPPER&LOWER)
|
Professional
|
Both
|
$1,770.00
|
|
| Hospital Charge Code |
22200038
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$619.50 |
| Max. Negotiated Rate |
$1,239.00 |
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Multiplan PHCS |
$1,062.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,239.00
|
| Rate for Payer: UHCCP Medicaid |
$619.50
|
|
|
BLEPHAROPLASTY (UPPER&LOWER)
|
Facility
|
OP
|
$1,770.00
|
|
| Hospital Charge Code |
22200038
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.30
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
BLEPHAROPLASTY (UPPER&LOWER)
|
Facility
|
IP
|
$1,770.00
|
|
| Hospital Charge Code |
22200038
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.30
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
BLEPHAROPLASY(UP &LOW OR)-80
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
22200372
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$681.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$690.30
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$734.55
|
| Rate for Payer: First Health Commercial |
$840.75
|
| Rate for Payer: Humana Commercial |
$752.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$725.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$778.80
|
| Rate for Payer: Ohio Health Group HMO |
$663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.65
|
| Rate for Payer: PHCS Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Payer |
$778.80
|
|
|
BLEPHAROPLASY(UP &LOW OR)-80
|
Professional
|
Both
|
$885.00
|
|
| Hospital Charge Code |
22200372
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$309.75 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Multiplan PHCS |
$531.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.50
|
| Rate for Payer: UHCCP Medicaid |
$309.75
|
|
|
BLEPHAROPLASY(UP &LOW OR)-80
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
22200372
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$681.45
|
| Rate for Payer: Anthem Medicaid |
$304.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$690.30
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$734.55
|
| Rate for Payer: First Health Commercial |
$840.75
|
| Rate for Payer: Humana Commercial |
$752.25
|
| Rate for Payer: Humana KY Medicaid |
$304.35
|
| Rate for Payer: Kentucky WC Medicaid |
$307.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$725.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$778.80
|
| Rate for Payer: Ohio Health Group HMO |
$663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.65
|
| Rate for Payer: PHCS Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Payer |
$778.80
|
|
|
BLEPH (BOTH UPPER EYELIDS)
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
22200193
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
BLEPH (BOTH UPPER EYELIDS)
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
22200193
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
BLEPH (BOTH UPPER EYELIDS)
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200193
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
BLEPH (SINGLE UPPER EYELID)
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
22200694
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
BLEPH (SINGLE UPPER EYELID)
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200694
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
BLEPH (SINGLE UPPER EYELID)
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
22200694
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
BLOCADREN (TIMOLOL) 10MG/1TAB
|
Facility
|
OP
|
$9.36
|
|
|
Service Code
|
NDC 378022101
|
| Hospital Charge Code |
25000343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem Medicaid |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.77
|
| Rate for Payer: First Health Commercial |
$8.89
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Humana KY Medicaid |
$3.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.46
|
| Rate for Payer: PHCS Commercial |
$8.99
|
| Rate for Payer: United Healthcare All Payer |
$8.24
|
|
|
BLOCADREN (TIMOLOL) 10MG/1TAB
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
NDC 378022101
|
| Hospital Charge Code |
25000343
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.77
|
| Rate for Payer: First Health Commercial |
$8.89
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.46
|
| Rate for Payer: PHCS Commercial |
$8.99
|
| Rate for Payer: United Healthcare All Payer |
$8.24
|
|
|
BLOCK S&N FEMUR LEFT
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
BLOCK S&N FEMUR LEFT
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
BLOCK S&N FEMUR RIGHT
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
BLOCK S&N FEMUR RIGHT
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
BLOOD ADMINISTRATION
|
Professional
|
Both
|
$1,278.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
38000001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Aetna Commercial |
$54.57
|
| Rate for Payer: Ambetter Exchange |
$38.13
|
| Rate for Payer: Anthem Medicaid |
$27.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.76
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$57.98
|
| Rate for Payer: Healthspan PPO |
$43.64
|
| Rate for Payer: Humana Medicaid |
$27.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.00
|
| Rate for Payer: Molina Healthcare Passport |
$27.45
|
| Rate for Payer: Multiplan PHCS |
$766.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.57
|
| Rate for Payer: UHCCP Medicaid |
$447.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.13
|
|
|
BLOOD ADMINISTRATION
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
38000001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem Medicaid |
$439.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Humana KY Medicaid |
$439.50
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$443.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$448.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.82
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
BLOOD ADMINISTRATION
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
38000001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$1,226.88 |
| Rate for Payer: Aetna Commercial |
$984.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$996.84
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$1,060.74
|
| Rate for Payer: First Health Commercial |
$1,214.10
|
| Rate for Payer: Humana Commercial |
$1,086.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,047.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$881.82
|
| Rate for Payer: PHCS Commercial |
$1,226.88
|
| Rate for Payer: United Healthcare All Payer |
$1,124.64
|
|
|
BLOOD ADMINISTRATION(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
380P0001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$54.57
|
| Rate for Payer: Ambetter Exchange |
$38.13
|
| Rate for Payer: Anthem Medicaid |
$27.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.76
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$57.98
|
| Rate for Payer: Healthspan PPO |
$43.64
|
| Rate for Payer: Humana Medicaid |
$27.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.00
|
| Rate for Payer: Molina Healthcare Passport |
$27.45
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.57
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.13
|
|
|
BLOOD ADMINISTRATION(T
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
380T0001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$1,001.28 |
| Rate for Payer: Aetna Commercial |
$803.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$813.54
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cigna Commercial |
$865.69
|
| Rate for Payer: First Health Commercial |
$990.85
|
| Rate for Payer: Humana Commercial |
$886.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$855.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$917.84
|
| Rate for Payer: Ohio Health Group HMO |
$782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$719.67
|
| Rate for Payer: PHCS Commercial |
$1,001.28
|
| Rate for Payer: United Healthcare All Payer |
$917.84
|
|
