|
CLTX TRIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
761P0942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$379.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.26
|
| Rate for Payer: Anthem Medicaid |
$185.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: Healthspan PPO |
$378.36
|
| Rate for Payer: Humana Medicaid |
$185.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.68
|
| Rate for Payer: Molina Healthcare Passport |
$185.96
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$200.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.82
|
|
|
[C]MARINOL (DRONAB 2.5MG/1CAP
|
Facility
|
OP
|
$62.06
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
25002708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Anthem Medicaid |
$21.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.41
|
| Rate for Payer: Cash Price |
$31.03
|
| Rate for Payer: Cigna Commercial |
$51.51
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: Humana Commercial |
$52.75
|
| Rate for Payer: Humana KY Medicaid |
$21.34
|
| Rate for Payer: Kentucky WC Medicaid |
$21.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.61
|
| Rate for Payer: Ohio Health Group HMO |
$46.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.24
|
| Rate for Payer: PHCS Commercial |
$59.58
|
| Rate for Payer: United Healthcare All Payer |
$54.61
|
|
|
[C]MARINOL (DRONAB 2.5MG/1CAP
|
Facility
|
IP
|
$62.06
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
25002708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.41
|
| Rate for Payer: Cash Price |
$31.03
|
| Rate for Payer: Cigna Commercial |
$51.51
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: Humana Commercial |
$52.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.61
|
| Rate for Payer: Ohio Health Group HMO |
$46.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.24
|
| Rate for Payer: PHCS Commercial |
$59.58
|
| Rate for Payer: United Healthcare All Payer |
$54.61
|
|
|
[C]METHADONE 5 MG TA 5MG/1TAB
|
Facility
|
IP
|
$60.31
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
25000075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$57.90 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.04
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.06
|
| Rate for Payer: First Health Commercial |
$57.29
|
| Rate for Payer: Humana Commercial |
$51.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.07
|
| Rate for Payer: Ohio Health Group HMO |
$45.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$57.90
|
| Rate for Payer: United Healthcare All Payer |
$53.07
|
|
|
[C]METHADONE 5 MG TA 5MG/1TAB
|
Facility
|
OP
|
$60.31
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
25000075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$57.90 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Anthem Medicaid |
$20.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.04
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.06
|
| Rate for Payer: First Health Commercial |
$57.29
|
| Rate for Payer: Humana Commercial |
$51.26
|
| Rate for Payer: Humana KY Medicaid |
$20.74
|
| Rate for Payer: Kentucky WC Medicaid |
$20.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.07
|
| Rate for Payer: Ohio Health Group HMO |
$45.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$57.90
|
| Rate for Payer: United Healthcare All Payer |
$53.07
|
|
|
CMNT HUMST0 W/RMVABL HD.12X210
|
Facility
|
OP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem Medicaid |
$7,250.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Humana KY Medicaid |
$7,250.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,324.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,395.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CMNT HUMST0 W/RMVABL HD.12X210
|
Facility
|
IP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CMNT HUMSTM W/RMOVBL HD 14X210
|
Facility
|
IP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CMNT HUMSTM W/RMOVBL HD 14X210
|
Facility
|
OP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem Medicaid |
$7,250.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Humana KY Medicaid |
$7,250.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,324.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,395.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
[C]MORPHINE(GEN) 10MG/1ML
|
Facility
|
IP
|
$76.93
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
[C]MORPHINE(GEN) 10MG/1ML
|
Facility
|
OP
|
$76.93
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
[C]MORPHINE(GEN) 2MG/1ML
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem Medicaid |
$26.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Humana KY Medicaid |
$26.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27.05
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.14
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(GEN) 2MG/1ML
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.91
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
|
|
[C]MORPHINE(GEN) 4MG/1ML
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.02
|
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Cigna Commercial |
$63.87
|
| Rate for Payer: First Health Commercial |
$73.10
|
| Rate for Payer: Humana Commercial |
$65.41
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.72
|
| Rate for Payer: Ohio Health Group HMO |
$57.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.87
|
| Rate for Payer: United Healthcare All Payer |
$67.72
|
|
|
[C]MORPHINE(GEN) 4MG/1ML
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.02
|
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Cigna Commercial |
$63.87
|
| Rate for Payer: First Health Commercial |
$73.10
|
| Rate for Payer: Humana Commercial |
$65.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.72
|
| Rate for Payer: Ohio Health Group HMO |
$57.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.87
|
| Rate for Payer: United Healthcare All Payer |
$67.72
|
|
|
[C]MORPHINE SULFATE(R 10MG/1EA
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 574711212
|
| Hospital Charge Code |
25000108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| 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 |
$22.35
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| 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: Molina Healthcare Medicaid |
$22.80
|
| 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
|
|
|
[C]MORPHINE SULFATE(R 10MG/1EA
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 574711212
|
| Hospital Charge Code |
25000108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| 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
|
|
|
CMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
OP
|
$11,519.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.57 |
| Max. Negotiated Rate |
$11,059.01 |
| Rate for Payer: Aetna Commercial |
$8,870.25
|
| Rate for Payer: Anthem Medicaid |
$3,961.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,985.44
|
| Rate for Payer: Cash Price |
$5,759.90
|
| Rate for Payer: Cigna Commercial |
$9,561.43
|
| Rate for Payer: First Health Commercial |
$10,943.81
|
| Rate for Payer: Humana Commercial |
$9,791.83
|
| Rate for Payer: Humana KY Medicaid |
$3,961.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,001.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,446.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,501.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,455.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,041.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,137.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,639.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,571.14
|
| Rate for Payer: PHCS Commercial |
$11,059.01
|
| Rate for Payer: United Healthcare All Payer |
$10,137.42
|
|
|
CMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
IP
|
$11,519.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.57 |
| Max. Negotiated Rate |
$11,059.01 |
| Rate for Payer: Aetna Commercial |
$8,870.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,985.44
|
| Rate for Payer: Cash Price |
$5,759.90
|
| Rate for Payer: Cigna Commercial |
$9,561.43
|
| Rate for Payer: First Health Commercial |
$10,943.81
|
| Rate for Payer: Humana Commercial |
$9,791.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,446.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,501.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,455.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,137.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,639.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,571.14
|
| Rate for Payer: PHCS Commercial |
$11,059.01
|
| Rate for Payer: United Healthcare All Payer |
$10,137.42
|
|
|
CMPR RVS SHLDR GLEN BASPLT MIN
|
Facility
|
IP
|
$10,019.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.56 |
| Max. Negotiated Rate |
$9,618.91 |
| Rate for Payer: Aetna Commercial |
$7,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,815.37
|
| Rate for Payer: Cash Price |
$5,009.85
|
| Rate for Payer: Cigna Commercial |
$8,316.35
|
| Rate for Payer: First Health Commercial |
$9,518.72
|
| Rate for Payer: Humana Commercial |
$8,516.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,216.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,394.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,005.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,817.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,514.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,003.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,302.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.11
|
| Rate for Payer: PHCS Commercial |
$9,618.91
|
| Rate for Payer: United Healthcare All Payer |
$8,817.34
|
|
|
CMPR RVS SHLDR GLEN BASPLT MIN
|
Facility
|
OP
|
$10,019.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.56 |
| Max. Negotiated Rate |
$9,618.91 |
| Rate for Payer: Aetna Commercial |
$7,715.17
|
| Rate for Payer: Anthem Medicaid |
$3,445.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,815.37
|
| Rate for Payer: Cash Price |
$5,009.85
|
| Rate for Payer: Cigna Commercial |
$8,316.35
|
| Rate for Payer: First Health Commercial |
$9,518.72
|
| Rate for Payer: Humana Commercial |
$8,516.74
|
| Rate for Payer: Humana KY Medicaid |
$3,445.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,480.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,216.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,394.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,005.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,514.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,817.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,514.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,003.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,302.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.11
|
| Rate for Payer: PHCS Commercial |
$9,618.91
|
| Rate for Payer: United Healthcare All Payer |
$8,817.34
|
|
|
CMPR RVS SHLDR GLENSPR 36M STD
|
Facility
|
IP
|
$9,432.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.17 |
| Max. Negotiated Rate |
$9,054.77 |
| Rate for Payer: Aetna Commercial |
$7,262.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,357.00
|
| Rate for Payer: Cash Price |
$4,716.02
|
| Rate for Payer: Cigna Commercial |
$7,828.60
|
| Rate for Payer: First Health Commercial |
$8,960.45
|
| Rate for Payer: Humana Commercial |
$8,017.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,734.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,960.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,829.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,300.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,074.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.94
|
| Rate for Payer: PHCS Commercial |
$9,054.77
|
| Rate for Payer: United Healthcare All Payer |
$8,300.20
|
|
|
CMPR RVS SHLDR GLENSPR 36M STD
|
Facility
|
OP
|
$9,432.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.17 |
| Max. Negotiated Rate |
$9,054.77 |
| Rate for Payer: Aetna Commercial |
$7,262.68
|
| Rate for Payer: Anthem Medicaid |
$3,243.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,357.00
|
| Rate for Payer: Cash Price |
$4,716.02
|
| Rate for Payer: Cigna Commercial |
$7,828.60
|
| Rate for Payer: First Health Commercial |
$8,960.45
|
| Rate for Payer: Humana Commercial |
$8,017.24
|
| Rate for Payer: Humana KY Medicaid |
$3,243.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,276.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,734.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,960.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,829.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,308.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,300.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,074.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,886.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,923.94
|
| Rate for Payer: PHCS Commercial |
$9,054.77
|
| Rate for Payer: United Healthcare All Payer |
$8,300.20
|
|
|
CMPR RVS SHLDR GLENSPR 41M STD
|
Facility
|
OP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem Medicaid |
$3,124.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Humana KY Medicaid |
$3,124.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
CMPR RVS SHLDR GLENSPR 41M STD
|
Facility
|
IP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
