|
CHANGE OF URETER TUBE/STENT
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
HCPCS 50688
|
| Hospital Charge Code |
761T2771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,250.08 |
| Max. Negotiated Rate |
$3,489.60 |
| Rate for Payer: Aetna Commercial |
$2,798.95
|
| Rate for Payer: Anthem Medicaid |
$1,250.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,835.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,817.50
|
| Rate for Payer: Cash Price |
$1,817.50
|
| Rate for Payer: Cigna Commercial |
$3,017.05
|
| Rate for Payer: First Health Commercial |
$3,453.25
|
| Rate for Payer: Humana Commercial |
$3,089.75
|
| Rate for Payer: Humana KY Medicaid |
$1,250.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,262.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,980.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,275.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,198.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,726.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,162.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.15
|
| Rate for Payer: PHCS Commercial |
$3,489.60
|
| Rate for Payer: United Healthcare All Payer |
$3,198.80
|
|
|
CHANGE OF URETER TUBE/STENT
|
Facility
|
IP
|
$3,735.00
|
|
|
Service Code
|
HCPCS 50688
|
| Hospital Charge Code |
76102771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,120.50 |
| Max. Negotiated Rate |
$3,585.60 |
| Rate for Payer: Aetna Commercial |
$2,875.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,913.30
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$3,100.05
|
| Rate for Payer: First Health Commercial |
$3,548.25
|
| Rate for Payer: Humana Commercial |
$3,174.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,062.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,756.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,120.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,286.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,801.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,249.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,577.15
|
| Rate for Payer: PHCS Commercial |
$3,585.60
|
| Rate for Payer: United Healthcare All Payer |
$3,286.80
|
|
|
CHANGE OF URETER TUBE/STENT
|
Facility
|
IP
|
$3,635.00
|
|
|
Service Code
|
HCPCS 50688
|
| Hospital Charge Code |
761T2771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,090.50 |
| Max. Negotiated Rate |
$3,489.60 |
| Rate for Payer: Aetna Commercial |
$2,798.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,835.30
|
| Rate for Payer: Cash Price |
$1,817.50
|
| Rate for Payer: Cigna Commercial |
$3,017.05
|
| Rate for Payer: First Health Commercial |
$3,453.25
|
| Rate for Payer: Humana Commercial |
$3,089.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,980.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,198.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,726.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,908.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,162.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.15
|
| Rate for Payer: PHCS Commercial |
$3,489.60
|
| Rate for Payer: United Healthcare All Payer |
$3,198.80
|
|
|
CHANGE OF URETER TUBE/STENT
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 50688
|
| Hospital Charge Code |
761P2771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$127.17 |
| Rate for Payer: Aetna Commercial |
$127.17
|
| Rate for Payer: Ambetter Exchange |
$73.22
|
| Rate for Payer: Anthem Medicaid |
$44.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.86
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$122.23
|
| Rate for Payer: Healthspan PPO |
$101.68
|
| Rate for Payer: Humana Medicaid |
$44.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.78
|
| Rate for Payer: Molina Healthcare Passport |
$44.88
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.19
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.22
|
|
|
CHANGE OF URETER TUBE/STENT
|
Professional
|
Both
|
$3,735.00
|
|
|
Service Code
|
HCPCS 50688
|
| Hospital Charge Code |
76102771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$2,241.00 |
| Rate for Payer: Aetna Commercial |
$127.17
|
| Rate for Payer: Ambetter Exchange |
$73.22
|
| Rate for Payer: Anthem Medicaid |
$44.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.86
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$122.23
|
| Rate for Payer: Healthspan PPO |
$101.68
|
| Rate for Payer: Humana Medicaid |
$44.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.78
|
| Rate for Payer: Molina Healthcare Passport |
$44.88
|
| Rate for Payer: Multiplan PHCS |
$2,241.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.19
|
| Rate for Payer: UHCCP Medicaid |
$1,307.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.22
|
|
|
CHANGE OF WINDPIPE AIRWAY
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Ambetter Exchange |
$32.54
|
| Rate for Payer: Anthem Medicaid |
$36.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.05
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$52.75
|
| Rate for Payer: Healthspan PPO |
$45.48
|
| Rate for Payer: Humana Medicaid |
$36.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.06
|
| Rate for Payer: Molina Healthcare Passport |
$36.33
|
| Rate for Payer: Multiplan PHCS |
$501.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.30
|
| Rate for Payer: UHCCP Medicaid |
$292.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.54
|
|
|
CHANGE OF WINDPIPE AIRWAY
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
CHANGE OF WINDPIPE AIRWAY
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
41000014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
CHANGE OF WINDPIPE AIRWAY(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
410P0014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$53.93 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Ambetter Exchange |
$32.54
|
| Rate for Payer: Anthem Medicaid |
$36.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.05
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$52.75
|
| Rate for Payer: Healthspan PPO |
$45.48
|
| Rate for Payer: Humana Medicaid |
$36.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.06
|
| Rate for Payer: Molina Healthcare Passport |
$36.33
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.30
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.54
|
|
|
CHANGE OF WINDPIPE AIRWAY(T
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
410T0014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$229.80 |
| Max. Negotiated Rate |
$735.36 |
| Rate for Payer: Aetna Commercial |
$589.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$597.48
|
| Rate for Payer: Cash Price |
$383.00
|
| Rate for Payer: Cigna Commercial |
$635.78
|
| Rate for Payer: First Health Commercial |
$727.70
|
| Rate for Payer: Humana Commercial |
$651.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$565.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.08
|
| Rate for Payer: Ohio Health Group HMO |
$574.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$612.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.54
|
| Rate for Payer: PHCS Commercial |
$735.36
|
| Rate for Payer: United Healthcare All Payer |
$674.08
|
|
|
CHANGE OF WINDPIPE AIRWAY(T
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
410T0014
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$735.36 |
| Rate for Payer: Aetna Commercial |
$589.82
|
| Rate for Payer: Anthem Medicaid |
$263.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$597.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$383.00
|
| Rate for Payer: Cash Price |
$383.00
|
| Rate for Payer: Cigna Commercial |
$635.78
|
| Rate for Payer: First Health Commercial |
$727.70
|
| Rate for Payer: Humana Commercial |
$651.10
|
| Rate for Payer: Humana KY Medicaid |
$263.43
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$266.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$565.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.08
|
| Rate for Payer: Ohio Health Group HMO |
$574.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$612.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.54
|
| Rate for Payer: PHCS Commercial |
$735.36
|
| Rate for Payer: United Healthcare All Payer |
$674.08
|
|
|
CHANTIX (VARENICLINE)0.5MG TAB
|
Facility
|
OP
|
$5.18
|
|
|
Service Code
|
NDC 49884015576
|
| Hospital Charge Code |
25000411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.04
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna Commercial |
$4.30
|
| Rate for Payer: First Health Commercial |
$4.92
|
| Rate for Payer: Humana Commercial |
$4.40
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.56
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Payer |
$4.56
|
|
|
CHANTIX (VARENICLINE)0.5MG TAB
|
Facility
|
IP
|
$5.18
|
|
|
Service Code
|
NDC 49884015576
|
| Hospital Charge Code |
25000411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.04
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cigna Commercial |
$4.30
|
| Rate for Payer: First Health Commercial |
$4.92
|
| Rate for Payer: Humana Commercial |
$4.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.56
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.97
|
| Rate for Payer: United Healthcare All Payer |
$4.56
|
|
|
CHARCOCAP(ACTIVATED 260MG/1CAP
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 89411043110
|
| Hospital Charge Code |
25000413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
CHARCOCAP(ACTIVATED 260MG/1CAP
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 89411043110
|
| Hospital Charge Code |
25000413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
CHARGING SYSTEM
|
Facility
|
IP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
CHARGING SYSTEM
|
Facility
|
OP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem Medicaid |
$1,790.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Humana KY Medicaid |
$1,790.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,808.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,826.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
CHARTIS PREC CATH 15.0
|
Facility
|
OP
|
$7,325.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,197.57 |
| Max. Negotiated Rate |
$7,032.24 |
| Rate for Payer: Aetna Commercial |
$5,640.44
|
| Rate for Payer: Anthem Medicaid |
$2,519.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,713.69
|
| Rate for Payer: Cash Price |
$3,662.62
|
| Rate for Payer: Cigna Commercial |
$6,079.96
|
| Rate for Payer: First Health Commercial |
$6,958.99
|
| Rate for Payer: Humana Commercial |
$6,226.46
|
| Rate for Payer: Humana KY Medicaid |
$2,519.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,544.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,006.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,569.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,860.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,372.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,054.42
|
| Rate for Payer: PHCS Commercial |
$7,032.24
|
| Rate for Payer: United Healthcare All Payer |
$6,446.22
|
|
|
CHARTIS PREC CATH 15.0
|
Facility
|
IP
|
$7,325.25
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,197.57 |
| Max. Negotiated Rate |
$7,032.24 |
| Rate for Payer: Aetna Commercial |
$5,640.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,713.69
|
| Rate for Payer: Cash Price |
$3,662.62
|
| Rate for Payer: Cigna Commercial |
$6,079.96
|
| Rate for Payer: First Health Commercial |
$6,958.99
|
| Rate for Payer: Humana Commercial |
$6,226.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,006.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,860.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,372.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,054.42
|
| Rate for Payer: PHCS Commercial |
$7,032.24
|
| Rate for Payer: United Healthcare All Payer |
$6,446.22
|
|
|
CHECK FLO INTRODUCER LG 16F
|
Facility
|
OP
|
$1,799.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.85 |
| Max. Negotiated Rate |
$1,727.53 |
| Rate for Payer: Aetna Commercial |
$1,385.62
|
| Rate for Payer: Anthem Medicaid |
$618.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.62
|
| Rate for Payer: Cash Price |
$899.76
|
| Rate for Payer: Cigna Commercial |
$1,493.59
|
| Rate for Payer: First Health Commercial |
$1,709.53
|
| Rate for Payer: Humana Commercial |
$1,529.58
|
| Rate for Payer: Humana KY Medicaid |
$618.85
|
| Rate for Payer: Kentucky WC Medicaid |
$625.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,439.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.66
|
| Rate for Payer: PHCS Commercial |
$1,727.53
|
| Rate for Payer: United Healthcare All Payer |
$1,583.57
|
|
|
CHECK FLO INTRODUCER LG 16F
|
Facility
|
IP
|
$1,799.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.85 |
| Max. Negotiated Rate |
$1,727.53 |
| Rate for Payer: Aetna Commercial |
$1,385.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.62
|
| Rate for Payer: Cash Price |
$899.76
|
| Rate for Payer: Cigna Commercial |
$1,493.59
|
| Rate for Payer: First Health Commercial |
$1,709.53
|
| Rate for Payer: Humana Commercial |
$1,529.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,439.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.66
|
| Rate for Payer: PHCS Commercial |
$1,727.53
|
| Rate for Payer: United Healthcare All Payer |
$1,583.57
|
|
|
CHECK FLO INTRODUCER LG 18F
|
Facility
|
OP
|
$1,799.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.85 |
| Max. Negotiated Rate |
$1,727.53 |
| Rate for Payer: Aetna Commercial |
$1,385.62
|
| Rate for Payer: Anthem Medicaid |
$618.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.62
|
| Rate for Payer: Cash Price |
$899.76
|
| Rate for Payer: Cigna Commercial |
$1,493.59
|
| Rate for Payer: First Health Commercial |
$1,709.53
|
| Rate for Payer: Humana Commercial |
$1,529.58
|
| Rate for Payer: Humana KY Medicaid |
$618.85
|
| Rate for Payer: Kentucky WC Medicaid |
$625.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,439.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.66
|
| Rate for Payer: PHCS Commercial |
$1,727.53
|
| Rate for Payer: United Healthcare All Payer |
$1,583.57
|
|
|
CHECK FLO INTRODUCER LG 18F
|
Facility
|
IP
|
$1,799.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.85 |
| Max. Negotiated Rate |
$1,727.53 |
| Rate for Payer: Aetna Commercial |
$1,385.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.62
|
| Rate for Payer: Cash Price |
$899.76
|
| Rate for Payer: Cigna Commercial |
$1,493.59
|
| Rate for Payer: First Health Commercial |
$1,709.53
|
| Rate for Payer: Humana Commercial |
$1,529.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,439.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.66
|
| Rate for Payer: PHCS Commercial |
$1,727.53
|
| Rate for Payer: United Healthcare All Payer |
$1,583.57
|
|
|
CHECK FLO INTRODUCER LG 20F
|
Facility
|
OP
|
$3,308.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.62 |
| Max. Negotiated Rate |
$3,176.40 |
| Rate for Payer: Aetna Commercial |
$2,547.74
|
| Rate for Payer: Anthem Medicaid |
$1,137.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.82
|
| Rate for Payer: Cash Price |
$1,654.38
|
| Rate for Payer: Cigna Commercial |
$2,746.26
|
| Rate for Payer: First Health Commercial |
$3,143.31
|
| Rate for Payer: Humana Commercial |
$2,812.44
|
| Rate for Payer: Humana KY Medicaid |
$1,137.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,713.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,878.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.04
|
| Rate for Payer: PHCS Commercial |
$3,176.40
|
| Rate for Payer: United Healthcare All Payer |
$2,911.70
|
|
|
CHECK FLO INTRODUCER LG 20F
|
Facility
|
IP
|
$3,308.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.62 |
| Max. Negotiated Rate |
$3,176.40 |
| Rate for Payer: Aetna Commercial |
$2,547.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.82
|
| Rate for Payer: Cash Price |
$1,654.38
|
| Rate for Payer: Cigna Commercial |
$2,746.26
|
| Rate for Payer: First Health Commercial |
$3,143.31
|
| Rate for Payer: Humana Commercial |
$2,812.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,713.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,878.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.04
|
| Rate for Payer: PHCS Commercial |
$3,176.40
|
| Rate for Payer: United Healthcare All Payer |
$2,911.70
|
|
