|
CAST SUP SHT ARM PED PLASTER
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS Q4011
|
| Hospital Charge Code |
27000141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.64
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
|
|
CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.06
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
CAST SUP SHT ARM SPLINT PLST
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4021
|
| Hospital Charge Code |
27000151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.23
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
|
|
CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
27000154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.52
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
CAST SUP SHT ARM SPLNT PED P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS Q4023
|
| Hospital Charge Code |
27000153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.63
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
27000174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.04
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
|
|
CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
27000175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$48.02 |
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.03
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
Cast sup sht leg splnt ped p
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4047
|
| Hospital Charge Code |
27000248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.00
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.23
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
|
|
CAST SUP SHT LEG SPLNT PLSTR
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4045
|
| Hospital Charge Code |
27000173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.45
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
|
|
CATAFLAM(DICLOFENAC 50MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 72819015110
|
| Hospital Charge Code |
25000394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAFLAM(DICLOFENAC 50MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 72819015110
|
| Hospital Charge Code |
25000394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAPRES (CLONIDINE)0.2MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
25000396
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAPRES (CLONIDINE)0.2MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 60687012401
|
| Hospital Charge Code |
25000396
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
|
|
CATAPRES (CLONIDINE) .1MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
25000395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAPRES (CLONIDINE) .1MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
25000395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAPRES-TTS-1 PATCH .1MG/1EA
|
Facility
|
IP
|
$34.13
|
|
|
Service Code
|
NDC 51862045301
|
| Hospital Charge Code |
25000397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna Commercial |
$26.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.62
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$32.42
|
| Rate for Payer: Humana Commercial |
$29.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.03
|
| Rate for Payer: Ohio Health Group HMO |
$25.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.58
|
| Rate for Payer: PHCS Commercial |
$32.76
|
| Rate for Payer: United Healthcare All Payer |
$30.03
|
|
|
CATAPRES-TTS-1 PATCH .1MG/1EA
|
Facility
|
OP
|
$34.13
|
|
|
Service Code
|
NDC 51862045301
|
| Hospital Charge Code |
25000397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna Commercial |
$26.28
|
| Rate for Payer: Anthem Medicaid |
$11.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.62
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cigna Commercial |
$28.33
|
| Rate for Payer: First Health Commercial |
$32.42
|
| Rate for Payer: Humana Commercial |
$29.01
|
| Rate for Payer: Humana KY Medicaid |
$11.74
|
| Rate for Payer: Kentucky WC Medicaid |
$11.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.03
|
| Rate for Payer: Ohio Health Group HMO |
$25.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.58
|
| Rate for Payer: PHCS Commercial |
$32.76
|
| Rate for Payer: United Healthcare All Payer |
$30.03
|
|
|
CATAPRES-TTS-2 PATCH .2MG/1EA
|
Facility
|
IP
|
$70.64
|
|
|
Service Code
|
NDC 51862045404
|
| Hospital Charge Code |
25000398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.10
|
| Rate for Payer: Cash Price |
$35.32
|
| Rate for Payer: Cigna Commercial |
$58.63
|
| Rate for Payer: First Health Commercial |
$67.11
|
| Rate for Payer: Humana Commercial |
$60.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.16
|
| Rate for Payer: Ohio Health Group HMO |
$52.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.90
|
| Rate for Payer: PHCS Commercial |
$67.81
|
| Rate for Payer: United Healthcare All Payer |
$62.16
|
|
|
CATAPRES-TTS-2 PATCH .2MG/1EA
|
Facility
|
OP
|
$70.64
|
|
|
Service Code
|
NDC 51862045404
|
| Hospital Charge Code |
25000398
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Anthem Medicaid |
$24.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.10
|
| Rate for Payer: Cash Price |
$35.32
|
| Rate for Payer: Cigna Commercial |
$58.63
|
| Rate for Payer: First Health Commercial |
$67.11
|
| Rate for Payer: Humana Commercial |
$60.04
|
| Rate for Payer: Humana KY Medicaid |
$24.29
|
| Rate for Payer: Kentucky WC Medicaid |
$24.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.16
|
| Rate for Payer: Ohio Health Group HMO |
$52.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.90
|
| Rate for Payer: PHCS Commercial |
$67.81
|
| Rate for Payer: United Healthcare All Payer |
$62.16
|
|
|
CATAPRES-TTS-3 PATCH .3MG/1EA
|
Facility
|
OP
|
$82.29
|
|
|
Service Code
|
NDC 51862045504
|
| Hospital Charge Code |
25000399
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna Commercial |
$63.36
|
| Rate for Payer: Anthem Medicaid |
$28.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.19
|
| Rate for Payer: Cash Price |
$41.15
|
| Rate for Payer: Cigna Commercial |
$68.30
|
| Rate for Payer: First Health Commercial |
$78.18
|
| Rate for Payer: Humana Commercial |
$69.95
|
| Rate for Payer: Humana KY Medicaid |
$28.30
|
| Rate for Payer: Kentucky WC Medicaid |
$28.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.42
|
| Rate for Payer: Ohio Health Group HMO |
$61.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.51
|
| Rate for Payer: PHCS Commercial |
$79.00
|
| Rate for Payer: United Healthcare All Payer |
$72.42
|
|
|
CATAPRES-TTS-3 PATCH .3MG/1EA
|
Facility
|
IP
|
$82.29
|
|
|
Service Code
|
NDC 51862045504
|
| Hospital Charge Code |
25000399
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Aetna Commercial |
$63.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.19
|
| Rate for Payer: Cash Price |
$41.15
|
| Rate for Payer: Cigna Commercial |
$68.30
|
| Rate for Payer: First Health Commercial |
$78.18
|
| Rate for Payer: Humana Commercial |
$69.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.42
|
| Rate for Payer: Ohio Health Group HMO |
$61.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.51
|
| Rate for Payer: PHCS Commercial |
$79.00
|
| Rate for Payer: United Healthcare All Payer |
$72.42
|
|
|
CAT DANDER IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CAT DANDER IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CATH 3FR VENOUS CENTRAL 8CM
|
Facility
|
IP
|
$464.12
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.34 |
| Max. Negotiated Rate |
$445.56 |
| Rate for Payer: Aetna Commercial |
$357.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.01
|
| Rate for Payer: Cash Price |
$232.06
|
| Rate for Payer: Cigna Commercial |
$385.22
|
| Rate for Payer: First Health Commercial |
$440.91
|
| Rate for Payer: Humana Commercial |
$394.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$380.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$342.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$408.43
|
| Rate for Payer: Ohio Health Group HMO |
$348.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.88
|
| Rate for Payer: PHCS Commercial |
$445.56
|
| Rate for Payer: United Healthcare All Payer |
$408.43
|
|
|
CATH 3FR VENOUS CENTRAL 8CM
|
Facility
|
OP
|
$464.12
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.34 |
| Max. Negotiated Rate |
$445.56 |
| Rate for Payer: Aetna Commercial |
$357.37
|
| Rate for Payer: Anthem Medicaid |
$159.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.01
|
| Rate for Payer: Cash Price |
$232.06
|
| Rate for Payer: Cigna Commercial |
$385.22
|
| Rate for Payer: First Health Commercial |
$440.91
|
| Rate for Payer: Humana Commercial |
$394.50
|
| Rate for Payer: Humana KY Medicaid |
$159.61
|
| Rate for Payer: Kentucky WC Medicaid |
$161.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$380.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$342.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$408.43
|
| Rate for Payer: Ohio Health Group HMO |
$348.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.88
|
| Rate for Payer: PHCS Commercial |
$445.56
|
| Rate for Payer: United Healthcare All Payer |
$408.43
|
|
