|
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: Ambetter Exchange |
$11.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$11.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.67
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.17
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.67
|
|
|
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 |
$28.81 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Ambetter Exchange |
$14.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$14.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$14.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.50
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.85
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.50
|
|
|
CATAFLAM(DICLOFENAC 50MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 72819015110
|
| Hospital Charge Code |
25000394
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| 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 |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| 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 |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| 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 |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| 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 |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
CATAPRES (CLONIDINE) .1MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 60687011301
|
| Hospital Charge Code |
25000395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
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 |
$10.24 |
| 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 |
$27.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.55
|
| Rate for Payer: PHCS Commercial |
$32.76
|
| Rate for Payer: United Healthcare All Payer |
$30.03
|
|
|
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 |
$10.24 |
| 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 |
$27.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.55
|
| Rate for Payer: PHCS Commercial |
$32.76
|
| Rate for Payer: United Healthcare All Payer |
$30.03
|
|
|
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 |
$21.19 |
| 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 |
$56.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.74
|
| Rate for Payer: PHCS Commercial |
$67.81
|
| Rate for Payer: United Healthcare All Payer |
$62.16
|
|
|
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 |
$21.19 |
| 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 |
$56.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.74
|
| Rate for Payer: PHCS Commercial |
$67.81
|
| Rate for Payer: United Healthcare All Payer |
$62.16
|
|
|
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 |
$24.69 |
| 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 |
$65.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.78
|
| Rate for Payer: PHCS Commercial |
$79.00
|
| Rate for Payer: United Healthcare All Payer |
$72.42
|
|
|
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 |
$24.69 |
| 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 |
$65.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.78
|
| Rate for Payer: PHCS Commercial |
$79.00
|
| Rate for Payer: United Healthcare All Payer |
$72.42
|
|
|
CAT DANDER IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CAT DANDER IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CATH 3FR VENOUS CENTRAL 8CM
|
Facility
|
IP
|
$467.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$449.22 |
| Rate for Payer: Aetna Commercial |
$360.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.99
|
| Rate for Payer: Cash Price |
$233.97
|
| Rate for Payer: Cigna Commercial |
$388.39
|
| Rate for Payer: First Health Commercial |
$444.54
|
| Rate for Payer: Humana Commercial |
$397.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.79
|
| Rate for Payer: Ohio Health Group HMO |
$350.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.88
|
| Rate for Payer: PHCS Commercial |
$449.22
|
| Rate for Payer: United Healthcare All Payer |
$411.79
|
|
|
CATH 3FR VENOUS CENTRAL 8CM
|
Facility
|
OP
|
$467.94
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$449.22 |
| Rate for Payer: Aetna Commercial |
$360.31
|
| Rate for Payer: Anthem Medicaid |
$160.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.99
|
| Rate for Payer: Cash Price |
$233.97
|
| Rate for Payer: Cigna Commercial |
$388.39
|
| Rate for Payer: First Health Commercial |
$444.54
|
| Rate for Payer: Humana Commercial |
$397.75
|
| Rate for Payer: Humana KY Medicaid |
$160.92
|
| Rate for Payer: Kentucky WC Medicaid |
$162.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.79
|
| Rate for Payer: Ohio Health Group HMO |
$350.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.88
|
| Rate for Payer: PHCS Commercial |
$449.22
|
| Rate for Payer: United Healthcare All Payer |
$411.79
|
|
|
CATH 4FR VENOUS CENTRAL 12CM
|
Facility
|
IP
|
$479.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$460.56 |
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.20
|
| Rate for Payer: Cash Price |
$239.88
|
| Rate for Payer: Cigna Commercial |
$398.19
|
| Rate for Payer: First Health Commercial |
$455.76
|
| Rate for Payer: Humana Commercial |
$407.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.18
|
| Rate for Payer: Ohio Health Group HMO |
$359.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.03
|
| Rate for Payer: PHCS Commercial |
$460.56
|
| Rate for Payer: United Healthcare All Payer |
$422.18
|
|
|
CATH 4FR VENOUS CENTRAL 12CM
|
Facility
|
OP
|
$479.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.93 |
| Max. Negotiated Rate |
$460.56 |
| Rate for Payer: Aetna Commercial |
$369.41
|
| Rate for Payer: Anthem Medicaid |
$164.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.20
|
| Rate for Payer: Cash Price |
$239.88
|
| Rate for Payer: Cigna Commercial |
$398.19
|
| Rate for Payer: First Health Commercial |
$455.76
|
| Rate for Payer: Humana Commercial |
$407.79
|
| Rate for Payer: Humana KY Medicaid |
$164.99
|
| Rate for Payer: Kentucky WC Medicaid |
$166.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.18
|
| Rate for Payer: Ohio Health Group HMO |
$359.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.03
|
| Rate for Payer: PHCS Commercial |
$460.56
|
| Rate for Payer: United Healthcare All Payer |
$422.18
|
|
|
CATH 5FR INFINITI IM 100CM
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$163.36 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Anthem Medicaid |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.73
|
| Rate for Payer: Cash Price |
$85.08
|
| Rate for Payer: Cigna Commercial |
$141.24
|
| Rate for Payer: First Health Commercial |
$161.66
|
| Rate for Payer: Humana Commercial |
$144.64
|
| Rate for Payer: Humana KY Medicaid |
$58.52
|
| Rate for Payer: Kentucky WC Medicaid |
$59.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.75
|
| Rate for Payer: Ohio Health Group HMO |
$127.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.42
|
| Rate for Payer: PHCS Commercial |
$163.36
|
| Rate for Payer: United Healthcare All Payer |
$149.75
|
|
|
CATH 5FR INFINITI IM 100CM
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$163.36 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.73
|
| Rate for Payer: Cash Price |
$85.08
|
| Rate for Payer: Cigna Commercial |
$141.24
|
| Rate for Payer: First Health Commercial |
$161.66
|
| Rate for Payer: Humana Commercial |
$144.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.75
|
| Rate for Payer: Ohio Health Group HMO |
$127.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.42
|
| Rate for Payer: PHCS Commercial |
$163.36
|
| Rate for Payer: United Healthcare All Payer |
$149.75
|
|
|
CATH 8FR SINGLE LUMEN GROSHONG
|
Facility
|
OP
|
$3,480.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,044.15 |
| Max. Negotiated Rate |
$3,341.28 |
| Rate for Payer: Aetna Commercial |
$2,679.99
|
| Rate for Payer: Anthem Medicaid |
$1,196.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,714.79
|
| Rate for Payer: Cash Price |
$1,740.25
|
| Rate for Payer: Cigna Commercial |
$2,888.82
|
| Rate for Payer: First Health Commercial |
$3,306.47
|
| Rate for Payer: Humana Commercial |
$2,958.43
|
| Rate for Payer: Humana KY Medicaid |
$1,196.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,568.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,220.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,062.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,784.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,401.55
|
| Rate for Payer: PHCS Commercial |
$3,341.28
|
| Rate for Payer: United Healthcare All Payer |
$3,062.84
|
|
|
CATH 8FR SINGLE LUMEN GROSHONG
|
Facility
|
IP
|
$3,480.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,044.15 |
| Max. Negotiated Rate |
$3,341.28 |
| Rate for Payer: Aetna Commercial |
$2,679.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,714.79
|
| Rate for Payer: Cash Price |
$1,740.25
|
| Rate for Payer: Cigna Commercial |
$2,888.82
|
| Rate for Payer: First Health Commercial |
$3,306.47
|
| Rate for Payer: Humana Commercial |
$2,958.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,568.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,062.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,784.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,401.55
|
| Rate for Payer: PHCS Commercial |
$3,341.28
|
| Rate for Payer: United Healthcare All Payer |
$3,062.84
|
|
|
CATH ABLT HALO 360+18MM
|
Facility
|
OP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem Medicaid |
$2,907.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Humana KY Medicaid |
$2,907.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,965.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
