|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
IP
|
$324.03
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
25001953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$311.07 |
| Rate for Payer: Aetna Commercial |
$249.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.74
|
| Rate for Payer: Cash Price |
$162.01
|
| Rate for Payer: Cigna Commercial |
$268.94
|
| Rate for Payer: First Health Commercial |
$307.83
|
| Rate for Payer: Humana Commercial |
$275.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.15
|
| Rate for Payer: Ohio Health Group HMO |
$243.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.58
|
| Rate for Payer: PHCS Commercial |
$311.07
|
| Rate for Payer: United Healthcare All Payer |
$285.15
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
OP
|
$64.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
63600023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Anthem Medicaid |
$22.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.55
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Cigna Commercial |
$53.79
|
| Rate for Payer: First Health Commercial |
$61.57
|
| Rate for Payer: Humana Commercial |
$55.09
|
| Rate for Payer: Humana KY Medicaid |
$22.29
|
| Rate for Payer: Kentucky WC Medicaid |
$22.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.03
|
| Rate for Payer: Ohio Health Group HMO |
$48.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.72
|
| Rate for Payer: PHCS Commercial |
$62.22
|
| Rate for Payer: United Healthcare All Payer |
$57.03
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Professional
|
Both
|
$64.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
63600023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Aetna Commercial |
$11.00
|
| Rate for Payer: Ambetter Exchange |
$6.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.27
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Healthspan PPO |
$7.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Multiplan PHCS |
$38.89
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.96
|
| Rate for Payer: UHCCP Medicaid |
$22.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.89
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
OP
|
$64.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636T0023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Anthem Medicaid |
$22.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.55
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Cigna Commercial |
$53.79
|
| Rate for Payer: First Health Commercial |
$61.57
|
| Rate for Payer: Humana Commercial |
$55.09
|
| Rate for Payer: Humana KY Medicaid |
$22.29
|
| Rate for Payer: Kentucky WC Medicaid |
$22.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.03
|
| Rate for Payer: Ohio Health Group HMO |
$48.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.72
|
| Rate for Payer: PHCS Commercial |
$62.22
|
| Rate for Payer: United Healthcare All Payer |
$57.03
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
IP
|
$64.81
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636T0023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.55
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Cigna Commercial |
$53.79
|
| Rate for Payer: First Health Commercial |
$61.57
|
| Rate for Payer: Humana Commercial |
$55.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.03
|
| Rate for Payer: Ohio Health Group HMO |
$48.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.72
|
| Rate for Payer: PHCS Commercial |
$62.22
|
| Rate for Payer: United Healthcare All Payer |
$57.03
|
|
|
CELEXA 10 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 904608461
|
| Hospital Charge Code |
25000402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA 10 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 904608461
|
| Hospital Charge Code |
25000402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA(CITALOPRAM HYDRO)20MG T
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
25000403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA(CITALOPRAM HYDRO)20MG T
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
25000403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELLCEPT 500 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
CELLCEPT 500 MG TABLET
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
CELLCEPT(MYCOPHENMOFETIL)250MG
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
CELLCEPT(MYCOPHENMOFETIL)250MG
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
CELOX VASC. HEMOSTATIC PAD
|
Facility
|
OP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem Medicaid |
$160.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Humana KY Medicaid |
$160.34
|
| Rate for Payer: Kentucky WC Medicaid |
$161.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
CELOX VASC. HEMOSTATIC PAD
|
Facility
|
IP
|
$466.25
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.88 |
| Max. Negotiated Rate |
$447.60 |
| Rate for Payer: Aetna Commercial |
$359.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.68
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cigna Commercial |
$386.99
|
| Rate for Payer: First Health Commercial |
$442.94
|
| Rate for Payer: Humana Commercial |
$396.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.30
|
| Rate for Payer: Ohio Health Group HMO |
$349.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.71
|
| Rate for Payer: PHCS Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Payer |
$410.30
|
|
|
CELT ACD 5F
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CELT ACD 5F
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CELT ACD 6F
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CELT ACD 6F
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CEMENTED STEM TK TRIATHLON
|
Facility
|
IP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
CEMENTED STEM TK TRIATHLON
|
Facility
|
OP
|
$6,946.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,083.97 |
| Max. Negotiated Rate |
$6,668.70 |
| Rate for Payer: Aetna Commercial |
$5,348.85
|
| Rate for Payer: Anthem Medicaid |
$2,388.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.32
|
| Rate for Payer: Cash Price |
$3,473.28
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: First Health Commercial |
$6,599.23
|
| Rate for Payer: Humana Commercial |
$5,904.58
|
| Rate for Payer: Humana KY Medicaid |
$2,388.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,083.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,436.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,112.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,209.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,557.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,043.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,793.13
|
| Rate for Payer: PHCS Commercial |
$6,668.70
|
| Rate for Payer: United Healthcare All Payer |
$6,112.97
|
|
|
CEMENTRALIZER 10.0
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
CEMENTRALIZER 10.0
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
CEMENTRALIZER 10.5
|
Facility
|
IP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 10.5
|
Facility
|
OP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem Medicaid |
$684.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Humana KY Medicaid |
$684.91
|
| Rate for Payer: Kentucky WC Medicaid |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
