|
CANN W/DEPLOY EXP TIP 8.25*7C
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
CANN W/DEPLOY EXP TIP 8.25*7C
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
CANTHOTOMY
|
Facility
|
OP
|
$2,772.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
76102388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.29 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$2,134.44
|
| Rate for Payer: Anthem Medicaid |
$953.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,162.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| 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 |
$2,155.61
|
| 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 |
$2,586.73
|
| 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 |
$2,217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,411.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,912.68
|
| 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 |
$831.60 |
| 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 |
$2,217.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,411.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,912.68
|
| Rate for Payer: PHCS Commercial |
$2,661.12
|
| Rate for Payer: United Healthcare All Payer |
$2,439.36
|
|
|
CANTHOTOMY
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
45000303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$993.87 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$2,225.30
|
| Rate for Payer: Anthem Medicaid |
$993.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| 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 |
$2,155.61
|
| 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 |
$2,586.73
|
| 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 |
$2,312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,994.10
|
| Rate for Payer: PHCS Commercial |
$2,774.40
|
| Rate for Payer: United Healthcare All Payer |
$2,543.20
|
|
|
CANTHOTOMY
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
HCPCS 67715
|
| Hospital Charge Code |
45000303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$867.00 |
| 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 |
$2,312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,994.10
|
| Rate for Payer: PHCS Commercial |
$2,774.40
|
| Rate for Payer: United Healthcare All Payer |
$2,543.20
|
|
|
CAPMIST DM TABLET
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 29978060190
|
| Hospital Charge Code |
25000370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
CAPMIST DM TABLET
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 29978060190
|
| Hospital Charge Code |
25000370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
CAPOTEN (CAPTOPRIL 12.5MG/1TAB
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 60687030421
|
| Hospital Charge Code |
25000371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$9.03 |
| 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
|
| 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 |
$7.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.03
|
| Rate for Payer: United Healthcare All Payer |
$8.28
|
|
|
CAPOTEN (CAPTOPRIL 12.5MG/1TAB
|
Facility
|
OP
|
$9.41
|
|
|
Service Code
|
NDC 60687030421
|
| Hospital Charge Code |
25000371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| 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 |
$7.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.03
|
| Rate for Payer: United Healthcare All Payer |
$8.28
|
|
|
CAPOTEN (CAPTOPRIL) 25MG/1TAB
|
Facility
|
OP
|
$9.54
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
25000372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| 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 |
$7.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.58
|
| Rate for Payer: PHCS Commercial |
$9.16
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
CAPOTEN (CAPTOPRIL) 25MG/1TAB
|
Facility
|
IP
|
$9.54
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
25000372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| 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 |
$7.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.58
|
| Rate for Payer: PHCS Commercial |
$9.16
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
CAPSAICIN 0.075% CREAM 57G
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 536111825
|
| Hospital Charge Code |
25004593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
CAPSAICIN 0.075% CREAM 57G
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 536111825
|
| Hospital Charge Code |
25004593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
76100431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.79 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$689.15
|
| Rate for Payer: Anthem Medicaid |
$307.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$698.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| Rate for Payer: PHCS Commercial |
$859.20
|
| Rate for Payer: United Healthcare All Payer |
$787.60
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
76100431
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.50 |
| 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 |
$716.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$778.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.55
|
| 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: Ambetter Exchange |
$659.71
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$659.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$659.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$791.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$659.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.71
|
| 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 |
$857.62
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$659.71
|
|
|
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: Ambetter Exchange |
$659.71
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$659.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$659.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$791.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$659.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.71
|
| 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 |
$857.62
|
| Rate for Payer: UHCCP Medicaid |
$313.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$659.71
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CAPSULE EGD
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
75000006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$1,816.32 |
| Rate for Payer: Aetna Commercial |
$1,456.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.76
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,570.36
|
| Rate for Payer: First Health Commercial |
$1,797.40
|
| Rate for Payer: Humana Commercial |
$1,608.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,664.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.48
|
| Rate for Payer: PHCS Commercial |
$1,816.32
|
| Rate for Payer: United Healthcare All Payer |
$1,664.96
|
|
|
CAPSULE EGD
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
75000006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$650.66 |
| Max. Negotiated Rate |
$1,816.32 |
| Rate for Payer: Aetna Commercial |
$1,456.84
|
| Rate for Payer: Anthem Medicaid |
$650.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,570.36
|
| Rate for Payer: First Health Commercial |
$1,797.40
|
| Rate for Payer: Humana Commercial |
$1,608.20
|
| Rate for Payer: Humana KY Medicaid |
$650.66
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$657.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,664.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.48
|
| Rate for Payer: PHCS Commercial |
$1,816.32
|
| Rate for Payer: United Healthcare All Payer |
$1,664.96
|
|
|
CAPSULE EGD
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
75000006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$249.71 |
| Max. Negotiated Rate |
$1,318.72 |
| Rate for Payer: Aetna Commercial |
$1,318.72
|
| Rate for Payer: Ambetter Exchange |
$622.30
|
| Rate for Payer: Anthem Medicaid |
$656.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$746.76
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cigna Commercial |
$1,219.64
|
| Rate for Payer: Healthspan PPO |
$1,079.15
|
| Rate for Payer: Humana Medicaid |
$656.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.54
|
| Rate for Payer: Molina Healthcare Passport |
$656.41
|
| Rate for Payer: Multiplan PHCS |
$1,135.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$808.99
|
| Rate for Payer: UHCCP Medicaid |
$662.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.30
|
|
|
CAPSULE EGD(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
750P0006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$1,318.72 |
| Rate for Payer: Aetna Commercial |
$1,318.72
|
| Rate for Payer: Ambetter Exchange |
$622.30
|
| Rate for Payer: Anthem Medicaid |
$656.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$746.76
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$1,219.64
|
| Rate for Payer: Healthspan PPO |
$1,079.15
|
| Rate for Payer: Humana Medicaid |
$656.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$249.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.54
|
| Rate for Payer: Molina Healthcare Passport |
$656.41
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$808.99
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.30
|
|
|
CAPSULE EGD(T
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
750T0006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$440.10 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.23
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
|
CAPSULE EGD(T
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
HCPCS 91110
|
| Hospital Charge Code |
750T0006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$504.50 |
| Max. Negotiated Rate |
$1,408.32 |
| Rate for Payer: Aetna Commercial |
$1,129.59
|
| Rate for Payer: Anthem Medicaid |
$504.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,144.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$1,217.61
|
| Rate for Payer: First Health Commercial |
$1,393.65
|
| Rate for Payer: Humana Commercial |
$1,246.95
|
| Rate for Payer: Humana KY Medicaid |
$504.50
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$509.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,082.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,100.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,276.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,012.23
|
| Rate for Payer: PHCS Commercial |
$1,408.32
|
| Rate for Payer: United Healthcare All Payer |
$1,290.96
|
|
