|
CANNULA 7.0
|
Facility
|
IP
|
$463.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.22 |
| Max. Negotiated Rate |
$444.68 |
| Rate for Payer: Aetna Commercial |
$356.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$361.30
|
| Rate for Payer: Cash Price |
$231.61
|
| Rate for Payer: Cigna Commercial |
$384.46
|
| Rate for Payer: First Health Commercial |
$440.05
|
| Rate for Payer: Humana Commercial |
$393.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.62
|
| Rate for Payer: Ohio Health Group HMO |
$347.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.60
|
| Rate for Payer: PHCS Commercial |
$444.68
|
| Rate for Payer: United Healthcare All Payer |
$407.62
|
|
|
CANNULA 7.0
|
Facility
|
OP
|
$463.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.22 |
| Max. Negotiated Rate |
$444.68 |
| Rate for Payer: Aetna Commercial |
$356.67
|
| Rate for Payer: Anthem Medicaid |
$159.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$361.30
|
| Rate for Payer: Cash Price |
$231.61
|
| Rate for Payer: Cigna Commercial |
$384.46
|
| Rate for Payer: First Health Commercial |
$440.05
|
| Rate for Payer: Humana Commercial |
$393.73
|
| Rate for Payer: Humana KY Medicaid |
$159.30
|
| Rate for Payer: Kentucky WC Medicaid |
$160.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.62
|
| Rate for Payer: Ohio Health Group HMO |
$347.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.60
|
| Rate for Payer: PHCS Commercial |
$444.68
|
| Rate for Payer: United Healthcare All Payer |
$407.62
|
|
|
CANNULATED REVISION DOWEL10*32
|
Facility
|
OP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem Medicaid |
$2,403.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Humana KY Medicaid |
$2,403.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,427.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
CANNULATED REVISION DOWEL10*32
|
Facility
|
IP
|
$6,988.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.49 |
| Max. Negotiated Rate |
$6,708.84 |
| Rate for Payer: Aetna Commercial |
$5,381.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,450.94
|
| Rate for Payer: Cash Price |
$3,494.19
|
| Rate for Payer: Cigna Commercial |
$5,800.36
|
| Rate for Payer: First Health Commercial |
$6,638.96
|
| Rate for Payer: Humana Commercial |
$5,940.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,730.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,157.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,149.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,241.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,397.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$908.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.40
|
| Rate for Payer: PHCS Commercial |
$6,708.84
|
| Rate for Payer: United Healthcare All Payer |
$6,149.77
|
|
|
CANNULATED SCREW 6.5*120*20MM
|
Facility
|
IP
|
$1,981.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.59 |
| Max. Negotiated Rate |
$1,902.21 |
| Rate for Payer: Aetna Commercial |
$1,525.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.55
|
| Rate for Payer: Cash Price |
$990.74
|
| Rate for Payer: Cigna Commercial |
$1,644.62
|
| Rate for Payer: First Health Commercial |
$1,882.40
|
| Rate for Payer: Humana Commercial |
$1,684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,486.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.26
|
| Rate for Payer: PHCS Commercial |
$1,902.21
|
| Rate for Payer: United Healthcare All Payer |
$1,743.69
|
|
|
CANNULATED SCREW 6.5*120*20MM
|
Facility
|
OP
|
$1,981.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.59 |
| Max. Negotiated Rate |
$1,902.21 |
| Rate for Payer: Aetna Commercial |
$1,525.73
|
| Rate for Payer: Anthem Medicaid |
$681.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.55
|
| Rate for Payer: Cash Price |
$990.74
|
| Rate for Payer: Cigna Commercial |
$1,644.62
|
| Rate for Payer: First Health Commercial |
$1,882.40
|
| Rate for Payer: Humana Commercial |
$1,684.25
|
| Rate for Payer: Humana KY Medicaid |
$681.43
|
| Rate for Payer: Kentucky WC Medicaid |
$688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,486.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.26
|
| Rate for Payer: PHCS Commercial |
$1,902.21
|
| Rate for Payer: United Healthcare All Payer |
$1,743.69
|
|
|
CANNULA TWIST-IN 6MM*7CM
|
Facility
|
OP
|
$446.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$343.61
|
| Rate for Payer: Anthem Medicaid |
$153.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.08
|
| Rate for Payer: Cash Price |
$223.12
|
| Rate for Payer: Cigna Commercial |
$370.39
|
| Rate for Payer: First Health Commercial |
$423.94
|
| Rate for Payer: Humana Commercial |
$379.31
|
| Rate for Payer: Humana KY Medicaid |
$153.47
|
| Rate for Payer: Kentucky WC Medicaid |
$155.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.70
|
| Rate for Payer: Ohio Health Group HMO |
$334.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.34
|
| Rate for Payer: PHCS Commercial |
$428.40
|
| Rate for Payer: United Healthcare All Payer |
$392.70
|
|
|
CANNULA TWIST-IN 6MM*7CM
|
Facility
|
IP
|
$446.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$343.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.08
|
| Rate for Payer: Cash Price |
$223.12
|
| Rate for Payer: Cigna Commercial |
$370.39
|
| Rate for Payer: First Health Commercial |
$423.94
|
| Rate for Payer: Humana Commercial |
$379.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.70
|
| Rate for Payer: Ohio Health Group HMO |
$334.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.34
|
| Rate for Payer: PHCS Commercial |
$428.40
|
| Rate for Payer: United Healthcare All Payer |
$392.70
|
|
|
CANN W/DEPLOY EXP TIP 8.25*7C
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
CANN W/DEPLOY EXP TIP 8.25*7C
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
CANTHOTOMY
|
Facility
|
OP
|
$2,772.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
76102388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,162.16
|
| Rate for Payer: Aetna Commercial |
$2,134.44
|
| Rate for Payer: Anthem Medicaid |
$953.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$2,300.76
|
| Rate for Payer: First Health Commercial |
$2,633.40
|
| Rate for Payer: Humana Commercial |
$2,356.20
|
| Rate for Payer: Humana KY Medicaid |
$953.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$962.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,273.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,045.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$972.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,439.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,079.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.32
|
| Rate for Payer: PHCS Commercial |
$2,661.12
|
| Rate for Payer: United Healthcare All Payer |
$2,439.36
|
|
|
CANTHOTOMY
|
Facility
|
IP
|
$2,772.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
76102388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$2,661.12 |
| Rate for Payer: Aetna Commercial |
$2,134.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,162.16
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$2,300.76
|
| Rate for Payer: First Health Commercial |
$2,633.40
|
| Rate for Payer: Humana Commercial |
$2,356.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,273.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,045.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$831.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,439.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,079.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.32
|
| Rate for Payer: PHCS Commercial |
$2,661.12
|
| Rate for Payer: United Healthcare All Payer |
$2,439.36
|
|
|
CANTHOTOMY
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
45000303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$2,774.40 |
| Rate for Payer: Aetna Commercial |
$2,225.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.20
|
| Rate for Payer: Cash Price |
$1,445.00
|
| Rate for Payer: Cigna Commercial |
$2,398.70
|
| Rate for Payer: First Health Commercial |
$2,745.50
|
| Rate for Payer: Humana Commercial |
$2,456.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,369.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,132.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,543.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,167.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$895.90
|
| Rate for Payer: PHCS Commercial |
$2,774.40
|
| Rate for Payer: United Healthcare All Payer |
$2,543.20
|
|
|
CANTHOTOMY
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
45000303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$2,225.30
|
| Rate for Payer: Anthem Medicaid |
$993.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$1,445.00
|
| Rate for Payer: Cash Price |
$1,445.00
|
| Rate for Payer: Cigna Commercial |
$2,398.70
|
| Rate for Payer: First Health Commercial |
$2,745.50
|
| Rate for Payer: Humana Commercial |
$2,456.50
|
| Rate for Payer: Humana KY Medicaid |
$993.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,003.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,369.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,132.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,013.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,543.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,167.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$895.90
|
| Rate for Payer: PHCS Commercial |
$2,774.40
|
| Rate for Payer: United Healthcare All Payer |
$2,543.20
|
|
|
CAPMIST DM TABLET
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 29978060190
|
| Hospital Charge Code |
25000370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
CAPMIST DM TABLET
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 29978060190
|
| Hospital Charge Code |
25000370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
CAPOTEN (CAPTOPRIL 12.5MG/1TAB
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 60687030421
|
| Hospital Charge Code |
25000371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Humana Commercial |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.28
|
| Rate for Payer: Ohio Health Group HMO |
$7.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.92
|
| Rate for Payer: PHCS Commercial |
$9.03
|
| Rate for Payer: United Healthcare All Payer |
$8.28
|
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.34
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.81
|
| Rate for Payer: First Health Commercial |
$8.94
|
|
|
CAPOTEN (CAPTOPRIL 12.5MG/1TAB
|
Facility
|
OP
|
$9.41
|
|
|
Service Code
|
NDC 60687030421
|
| Hospital Charge Code |
25000371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna Commercial |
$7.25
|
| Rate for Payer: Anthem Medicaid |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.34
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.81
|
| Rate for Payer: First Health Commercial |
$8.94
|
| Rate for Payer: Humana Commercial |
$8.00
|
| Rate for Payer: Humana KY Medicaid |
$3.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.28
|
| Rate for Payer: Ohio Health Group HMO |
$7.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.92
|
| Rate for Payer: PHCS Commercial |
$9.03
|
| Rate for Payer: United Healthcare All Payer |
$8.28
|
|
|
CAPOTEN (CAPTOPRIL) 25MG/1TAB
|
Facility
|
IP
|
$9.54
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
25000372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna Commercial |
$7.92
|
| Rate for Payer: First Health Commercial |
$9.06
|
| Rate for Payer: Humana Commercial |
$8.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.16
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
CAPOTEN (CAPTOPRIL) 25MG/1TAB
|
Facility
|
OP
|
$9.54
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
25000372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.44
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna Commercial |
$7.92
|
| Rate for Payer: First Health Commercial |
$9.06
|
| Rate for Payer: Humana Commercial |
$8.11
|
| Rate for Payer: Humana KY Medicaid |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.16
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
76100431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$859.20 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.45
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
76100431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$1,108.31 |
| Rate for Payer: Aetna Commercial |
$1,012.33
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$895.00
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$1,108.31
|
| Rate for Payer: Healthspan PPO |
$916.95
|
| Rate for Payer: Humana Medicaid |
$463.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.84
|
| Rate for Payer: Molina Healthcare Passport |
$463.57
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.50
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.21
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
76100431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$307.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$742.85
|
| Rate for Payer: First Health Commercial |
$850.25
|
| Rate for Payer: Humana Commercial |
$760.75
|
| Rate for Payer: Humana KY Medicaid |
$307.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$310.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$660.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$787.60
|
| Rate for Payer: Ohio Health Group HMO |
$671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.45
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
CAPSULAR CONTRACTURE RELEASE(P
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
761P0431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$1,108.31 |
| Rate for Payer: Aetna Commercial |
$1,012.33
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$895.00
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cash Price |
$447.50
|
| Rate for Payer: Cigna Commercial |
$1,108.31
|
| Rate for Payer: Healthspan PPO |
$916.95
|
| Rate for Payer: Humana Medicaid |
$463.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.84
|
| Rate for Payer: Molina Healthcare Passport |
$463.57
|
| Rate for Payer: Multiplan PHCS |
$537.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.50
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.21
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
