|
CLARIA MRI SURESCAN CRT-D
|
Facility
|
IP
|
$96,159.60
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,847.88 |
| Max. Negotiated Rate |
$92,313.22 |
| Rate for Payer: Aetna Commercial |
$74,042.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75,004.49
|
| Rate for Payer: Cash Price |
$48,079.80
|
| Rate for Payer: Cigna Commercial |
$79,812.47
|
| Rate for Payer: First Health Commercial |
$91,351.62
|
| Rate for Payer: Humana Commercial |
$81,735.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,850.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,965.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,847.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,620.45
|
| Rate for Payer: Ohio Health Group HMO |
$72,119.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76,927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83,658.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66,350.12
|
| Rate for Payer: PHCS Commercial |
$92,313.22
|
| Rate for Payer: United Healthcare All Payer |
$84,620.45
|
|
|
CLARITIN 10MG TABLET
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 24385047152
|
| Hospital Charge Code |
25000424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CLARITIN 10MG TABLET
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 24385047152
|
| Hospital Charge Code |
25000424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
CLASSC SHEATH HEMO INTRO 9.5FR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASSC SHEATH HEMO INTRO 9.5FR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASSIC SHEATH HEMO INTRO 7FR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASSIC SHEATH HEMO INTRO 7FR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASSIC SHEATH HEMO INTRO 9FR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASSIC SHEATH HEMO INTRO 9FR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASS SHEATH HEMO INTRO 10.5FR
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLASS SHEATH HEMO INTRO 10.5FR
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLAVICLE LT COMPLETE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
CLAVICLE LT COMPLETE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.63
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
CLAVICLE LT COMPLETE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Ambetter Exchange |
$29.42
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.30
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$196.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$114.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.42
|
|
|
CLAVICLE LT COMPLETE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320P0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Ambetter Exchange |
$29.42
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.30
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.42
|
|
|
CLAVICLE LT COMPLETE(T
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
CLAVICLE LT COMPLETE(T
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem Medicaid |
$95.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Humana KY Medicaid |
$95.26
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$96.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
CLAVICULECTOMY; PARTIAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.76 |
| Max. Negotiated Rate |
$900.35 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Ambetter Exchange |
$561.03
|
| Rate for Payer: Anthem Medicaid |
$336.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$561.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$561.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$673.24
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Healthspan PPO |
$755.99
|
| Rate for Payer: Humana Medicaid |
$336.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$714.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$561.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.50
|
| Rate for Payer: Molina Healthcare Passport |
$336.76
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$729.34
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$561.03
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLAVICULECTOMY; PARTIAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
761P0445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.76 |
| Max. Negotiated Rate |
$900.35 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Ambetter Exchange |
$561.03
|
| Rate for Payer: Anthem Medicaid |
$336.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$561.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$561.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$673.24
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Healthspan PPO |
$755.99
|
| Rate for Payer: Humana Medicaid |
$336.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$714.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$561.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.50
|
| Rate for Payer: Molina Healthcare Passport |
$336.76
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$729.34
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$561.03
|
|
|
CLAVICULECTOMY; TOTAL
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$2,323.20 |
| Rate for Payer: Aetna Commercial |
$1,863.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,887.60
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$2,008.60
|
| Rate for Payer: First Health Commercial |
$2,299.00
|
| Rate for Payer: Humana Commercial |
$2,057.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,984.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,785.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,129.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,105.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,669.80
|
| Rate for Payer: PHCS Commercial |
$2,323.20
|
| Rate for Payer: United Healthcare All Payer |
$2,129.60
|
|
|
CLAVICULECTOMY; TOTAL
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.74 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,032.58
|
| Rate for Payer: Ambetter Exchange |
$678.22
|
| Rate for Payer: Anthem Medicaid |
$519.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$678.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$678.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$813.86
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$1,128.27
|
| Rate for Payer: Healthspan PPO |
$935.29
|
| Rate for Payer: Humana Medicaid |
$519.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$873.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$678.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.13
|
| Rate for Payer: Molina Healthcare Passport |
$519.74
|
| Rate for Payer: Multiplan PHCS |
$1,452.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$881.69
|
| Rate for Payer: UHCCP Medicaid |
$847.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$678.22
|
|
