|
CLIPS LIGATING TI 20 SILVER ME
|
Facility
|
OP
|
$165.65
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$159.02 |
| Rate for Payer: Aetna Commercial |
$127.55
|
| Rate for Payer: Anthem Medicaid |
$56.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.21
|
| Rate for Payer: Cash Price |
$82.82
|
| Rate for Payer: Cigna Commercial |
$137.49
|
| Rate for Payer: First Health Commercial |
$157.37
|
| Rate for Payer: Humana Commercial |
$140.80
|
| Rate for Payer: Humana KY Medicaid |
$56.97
|
| Rate for Payer: Kentucky WC Medicaid |
$57.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.77
|
| Rate for Payer: Ohio Health Group HMO |
$124.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.30
|
| Rate for Payer: PHCS Commercial |
$159.02
|
| Rate for Payer: United Healthcare All Payer |
$145.77
|
|
|
CLOBAZAM 10mg TABLET
|
Facility
|
IP
|
$60.31
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$57.90 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.04
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.06
|
| Rate for Payer: First Health Commercial |
$57.29
|
| Rate for Payer: Humana Commercial |
$51.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.07
|
| Rate for Payer: Ohio Health Group HMO |
$45.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.61
|
| Rate for Payer: PHCS Commercial |
$57.90
|
| Rate for Payer: United Healthcare All Payer |
$53.07
|
|
|
CLOBAZAM 10mg TABLET
|
Facility
|
OP
|
$60.31
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$57.90 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Anthem Medicaid |
$20.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.04
|
| Rate for Payer: Cash Price |
$30.16
|
| Rate for Payer: Cigna Commercial |
$50.06
|
| Rate for Payer: First Health Commercial |
$57.29
|
| Rate for Payer: Humana Commercial |
$51.26
|
| Rate for Payer: Humana KY Medicaid |
$20.74
|
| Rate for Payer: Kentucky WC Medicaid |
$20.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.07
|
| Rate for Payer: Ohio Health Group HMO |
$45.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.61
|
| Rate for Payer: PHCS Commercial |
$57.90
|
| Rate for Payer: United Healthcare All Payer |
$53.07
|
|
|
cloBAZam 5 MG/2 ML ORAL.SUSP
|
Facility
|
IP
|
$60.98
|
|
|
Service Code
|
NDC 67386031321
|
| Hospital Charge Code |
25004002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$58.54 |
| Rate for Payer: Aetna Commercial |
$46.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.56
|
| Rate for Payer: Cash Price |
$30.49
|
| Rate for Payer: Cigna Commercial |
$50.61
|
| Rate for Payer: First Health Commercial |
$57.93
|
| Rate for Payer: Humana Commercial |
$51.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.66
|
| Rate for Payer: Ohio Health Group HMO |
$45.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.08
|
| Rate for Payer: PHCS Commercial |
$58.54
|
| Rate for Payer: United Healthcare All Payer |
$53.66
|
|
|
cloBAZam 5 MG/2 ML ORAL.SUSP
|
Facility
|
OP
|
$60.98
|
|
|
Service Code
|
NDC 67386031321
|
| Hospital Charge Code |
25004002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$58.54 |
| Rate for Payer: Aetna Commercial |
$46.95
|
| Rate for Payer: Anthem Medicaid |
$20.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.56
|
| Rate for Payer: Cash Price |
$30.49
|
| Rate for Payer: Cigna Commercial |
$50.61
|
| Rate for Payer: First Health Commercial |
$57.93
|
| Rate for Payer: Humana Commercial |
$51.83
|
| Rate for Payer: Humana KY Medicaid |
$20.97
|
| Rate for Payer: Kentucky WC Medicaid |
$21.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.66
|
| Rate for Payer: Ohio Health Group HMO |
$45.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.08
|
| Rate for Payer: PHCS Commercial |
$58.54
|
| Rate for Payer: United Healthcare All Payer |
$53.66
|
|
|
CLOMID EQUIVALENT 50MG TABLET
|
Facility
|
IP
|
$9.87
|
|
|
Service Code
|
NDC 49884070155
|
| Hospital Charge Code |
25000436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.19
|
| Rate for Payer: First Health Commercial |
$9.38
|
| Rate for Payer: Humana Commercial |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.69
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.81
|
| Rate for Payer: PHCS Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Payer |
$8.69
|
|
|
CLOMID EQUIVALENT 50MG TABLET
|
Facility
|
OP
|
$9.87
|
|
|
Service Code
|
NDC 49884070155
|
| Hospital Charge Code |
25000436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Anthem Medicaid |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.19
|
| Rate for Payer: First Health Commercial |
$9.38
|
| Rate for Payer: Humana Commercial |
$8.39
|
| Rate for Payer: Humana KY Medicaid |
$3.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.69
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.81
|
| Rate for Payer: PHCS Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Payer |
$8.69
|
|
|
[C]LOMOTIL (DIPHENOX/ATR 1TAB
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 406123601
|
| Hospital Charge Code |
25000073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
[C]LOMOTIL (DIPHENOX/ATR 1TAB
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 406123601
|
| Hospital Charge Code |
25000073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
[C]LOMOTIL(DIPHENOXY/ATR)L 5ML
|
Facility
|
IP
|
$6.12
|
|
|
Service Code
|
NDC 54319446
|
| Hospital Charge Code |
25000104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.77
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$5.08
|
| Rate for Payer: First Health Commercial |
$5.81
|
| Rate for Payer: Humana Commercial |
$5.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.39
|
| Rate for Payer: Ohio Health Group HMO |
$4.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.22
|
| Rate for Payer: PHCS Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Payer |
$5.39
|
|
|
[C]LOMOTIL(DIPHENOXY/ATR)L 5ML
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
NDC 54319446
|
| Hospital Charge Code |
25000104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Anthem Medicaid |
$2.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.77
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$5.08
|
| Rate for Payer: First Health Commercial |
$5.81
|
| Rate for Payer: Humana Commercial |
$5.20
|
| Rate for Payer: Humana KY Medicaid |
$2.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.39
|
| Rate for Payer: Ohio Health Group HMO |
$4.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.22
|
| Rate for Payer: PHCS Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Payer |
$5.39
|
|
|
CLONIDINE 20MCG/ML ORALS .5ML
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 68001023800
|
| Hospital Charge Code |
25002955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
CLONIDINE 20MCG/ML ORALS .5ML
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 68001023800
|
| Hospital Charge Code |
25002955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
CLOSED MANIP,KNEE W/OTH ANES
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
CLOSED MANIP,KNEE W/OTH ANES
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
CLOSED MANIP,KNEE W/OTH ANES
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
76101035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$857.28 |
| Rate for Payer: Aetna Commercial |
$687.61
|
| Rate for Payer: Anthem Medicaid |
$307.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$696.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$741.19
|
| Rate for Payer: First Health Commercial |
$848.35
|
| Rate for Payer: Humana Commercial |
$759.05
|
| Rate for Payer: Humana KY Medicaid |
$307.10
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$310.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$732.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$785.84
|
| Rate for Payer: Ohio Health Group HMO |
$669.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.17
|
| Rate for Payer: PHCS Commercial |
$857.28
|
| Rate for Payer: United Healthcare All Payer |
$785.84
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
45000182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
45000182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.74 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
76101035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna Commercial |
$123.70
|
| Rate for Payer: Ambetter Exchange |
$89.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$52.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.70
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$162.25
|
| Rate for Payer: Healthspan PPO |
$135.79
|
| Rate for Payer: Humana Medicaid |
$52.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.04
|
| Rate for Payer: Molina Healthcare Passport |
$52.98
|
| Rate for Payer: Multiplan PHCS |
$535.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.67
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.75
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
76101035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.90 |
| Max. Negotiated Rate |
$857.28 |
| Rate for Payer: Aetna Commercial |
$687.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$696.54
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$741.19
|
| Rate for Payer: First Health Commercial |
$848.35
|
| Rate for Payer: Humana Commercial |
$759.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$732.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$785.84
|
| Rate for Payer: Ohio Health Group HMO |
$669.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.17
|
| Rate for Payer: PHCS Commercial |
$857.28
|
| Rate for Payer: United Healthcare All Payer |
$785.84
|
|
|
CLOSED REDUC INTRPHLANG JNT(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761P1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$123.70
|
| Rate for Payer: Ambetter Exchange |
$89.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$52.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.70
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$162.25
|
| Rate for Payer: Healthspan PPO |
$135.79
|
| Rate for Payer: Humana Medicaid |
$52.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.04
|
| Rate for Payer: Molina Healthcare Passport |
$52.98
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.67
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.75
|
|
|
CLOSED REDUC INTRPHLANG JNT(T
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761T1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CLOSED REDUC INTRPHLANG JNT(T
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761T1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.74 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.67
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
45000103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
