|
CK ISOENZYMES
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$11.75
|
| Rate for Payer: Healthspan PPO |
$14.03
|
| Rate for Payer: Multiplan PHCS |
$92.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.80
|
| Rate for Payer: UHCCP Medicaid |
$53.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.03
|
|
|
CK ISOENZYMES
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
CK ISOENZYMES
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
30000294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$13.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Humana KY Medicaid |
$13.39
|
| Rate for Payer: Humana Medicare Advantage |
$13.39
|
| Rate for Payer: Kentucky WC Medicaid |
$13.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
[C]KLONOPIN (.5MG/1TAB)
|
Facility
|
OP
|
$60.03
|
|
|
Service Code
|
NDC 93083205
|
| Hospital Charge Code |
25000072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Anthem Medicaid |
$20.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.82
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.82
|
| Rate for Payer: First Health Commercial |
$57.03
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Humana KY Medicaid |
$20.64
|
| Rate for Payer: Kentucky WC Medicaid |
$20.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.22
|
| Rate for Payer: Aetna Commercial |
$46.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.61
|
| Rate for Payer: PHCS Commercial |
$57.63
|
| Rate for Payer: United Healthcare All Payer |
$52.83
|
|
|
[C]KLONOPIN (.5MG/1TAB)
|
Facility
|
IP
|
$60.03
|
|
|
Service Code
|
NDC 93083205
|
| Hospital Charge Code |
25000072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Aetna Commercial |
$46.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.82
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.82
|
| Rate for Payer: First Health Commercial |
$57.03
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.61
|
| Rate for Payer: PHCS Commercial |
$57.63
|
| Rate for Payer: United Healthcare All Payer |
$52.83
|
|
|
CLADOSPORIUM HERBARUM IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000648
|
|
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
|
|
|
CLADOSPORIUM HERBARUM IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000648
|
|
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
|
|
|
CLADRIBINE 1MG/ML(10MG/10ML)VL
|
Facility
|
OP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
25002585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem Medicaid |
$815.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.29
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Humana KY Medicaid |
$815.30
|
| Rate for Payer: Humana Medicare Advantage |
$15.77
|
| Rate for Payer: Kentucky WC Medicaid |
$823.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$831.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.93
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
CLADRIBINE 1MG/ML(10MG/10ML)VL
|
Facility
|
IP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
25002585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.20 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.93
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
CLAMS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000858
|
|
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
|
|
|
CLAMS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000858
|
|
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
|
|
|
CLARIA MRI SURESCAN CRT-D
|
Facility
|
OP
|
$92,651.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,044.66 |
| Max. Negotiated Rate |
$88,945.15 |
| Rate for Payer: Aetna Commercial |
$71,341.42
|
| Rate for Payer: Anthem Medicaid |
$31,862.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,267.94
|
| Rate for Payer: Cash Price |
$46,325.60
|
| Rate for Payer: Cigna Commercial |
$76,900.50
|
| Rate for Payer: First Health Commercial |
$88,018.64
|
| Rate for Payer: Humana Commercial |
$78,753.52
|
| Rate for Payer: Humana KY Medicaid |
$31,862.75
|
| Rate for Payer: Kentucky WC Medicaid |
$32,187.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,973.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,376.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,795.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,502.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,533.06
|
| Rate for Payer: Ohio Health Group HMO |
$69,488.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,530.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,044.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,721.87
|
| Rate for Payer: PHCS Commercial |
$88,945.15
|
| Rate for Payer: United Healthcare All Payer |
$81,533.06
|
|
|
CLARIA MRI SURESCAN CRT-D
|
Facility
|
IP
|
$92,651.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,044.66 |
| Max. Negotiated Rate |
$88,945.15 |
| Rate for Payer: Aetna Commercial |
$71,341.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72,267.94
|
| Rate for Payer: Cash Price |
$46,325.60
|
| Rate for Payer: Cigna Commercial |
$76,900.50
|
| Rate for Payer: First Health Commercial |
$88,018.64
|
| Rate for Payer: Humana Commercial |
$78,753.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75,973.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68,376.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$81,533.06
|
| Rate for Payer: Ohio Health Group HMO |
$69,488.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,530.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,044.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,721.87
|
| Rate for Payer: PHCS Commercial |
$88,945.15
|
| Rate for Payer: United Healthcare All Payer |
$81,533.06
|
|
|
CLARITIN 10MG TABLET
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 24385047152
|
| Hospital Charge Code |
25000424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CLARITIN 10MG TABLET
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 24385047152
|
| Hospital Charge Code |
25000424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CLASSC SHEATH HEMO INTRO 9.5FR
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASSC SHEATH HEMO INTRO 9.5FR
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASSIC SHEATH HEMO INTRO 7FR
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASSIC SHEATH HEMO INTRO 7FR
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASSIC SHEATH HEMO INTRO 9FR
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASSIC SHEATH HEMO INTRO 9FR
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASS SHEATH HEMO INTRO 10.5FR
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLASS SHEATH HEMO INTRO 10.5FR
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLAVICLE LT COMPLETE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
CLAVICLE LT COMPLETE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
