|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$942.00 |
| Rate for Payer: Aetna Commercial |
$650.04
|
| Rate for Payer: Ambetter Exchange |
$510.68
|
| Rate for Payer: Anthem Medicaid |
$239.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$510.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$612.82
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$705.52
|
| Rate for Payer: Healthspan PPO |
$588.80
|
| Rate for Payer: Humana Medicaid |
$239.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$510.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.19
|
| Rate for Payer: Molina Healthcare Passport |
$239.40
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$663.88
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$510.68
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761T0644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem Medicaid |
$539.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Humana KY Medicaid |
$539.92
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$545.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.30
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.00 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.30
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.10 |
| Max. Negotiated Rate |
$1,312.32 |
| Rate for Payer: Aetna Commercial |
$1,052.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,066.26
|
| Rate for Payer: Cash Price |
$683.50
|
| Rate for Payer: Cigna Commercial |
$1,134.61
|
| Rate for Payer: First Health Commercial |
$1,298.65
|
| Rate for Payer: Humana Commercial |
$1,161.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,120.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,008.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,202.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,025.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.23
|
| Rate for Payer: PHCS Commercial |
$1,312.32
|
| Rate for Payer: United Healthcare All Payer |
$1,202.96
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,312.32 |
| Rate for Payer: Aetna Commercial |
$1,052.59
|
| Rate for Payer: Anthem Medicaid |
$470.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,066.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$683.50
|
| Rate for Payer: Cash Price |
$683.50
|
| Rate for Payer: Cigna Commercial |
$1,134.61
|
| Rate for Payer: First Health Commercial |
$1,298.65
|
| Rate for Payer: Humana Commercial |
$1,161.95
|
| Rate for Payer: Humana KY Medicaid |
$470.11
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$474.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,120.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,008.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$479.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,202.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,025.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.23
|
| Rate for Payer: PHCS Commercial |
$1,312.32
|
| Rate for Payer: United Healthcare All Payer |
$1,202.96
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$820.20 |
| Rate for Payer: Aetna Commercial |
$379.17
|
| Rate for Payer: Ambetter Exchange |
$285.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.26
|
| Rate for Payer: Anthem Medicaid |
$185.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$285.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$342.31
|
| Rate for Payer: Cash Price |
$683.50
|
| Rate for Payer: Cash Price |
$683.50
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: Healthspan PPO |
$378.36
|
| Rate for Payer: Humana Medicaid |
$185.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$285.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.68
|
| Rate for Payer: Molina Healthcare Passport |
$185.96
|
| Rate for Payer: Multiplan PHCS |
$820.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$370.84
|
| Rate for Payer: UHCCP Medicaid |
$200.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$285.26
|
|
|
CLTX TRIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
761P0942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$379.17
|
| Rate for Payer: Ambetter Exchange |
$285.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.26
|
| Rate for Payer: Anthem Medicaid |
$185.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$285.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$342.31
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: Healthspan PPO |
$378.36
|
| Rate for Payer: Humana Medicaid |
$185.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$285.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.68
|
| Rate for Payer: Molina Healthcare Passport |
$185.96
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$370.84
|
| Rate for Payer: UHCCP Medicaid |
$200.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$285.26
|
|
|
CLTX TRIMALLEOLAR ANKLE FX(T
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
761T0942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$592.32 |
| Rate for Payer: Aetna Commercial |
$475.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.26
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cigna Commercial |
$512.11
|
| Rate for Payer: First Health Commercial |
$586.15
|
| Rate for Payer: Humana Commercial |
$524.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$455.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.96
|
| Rate for Payer: Ohio Health Group HMO |
$462.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$425.73
|
| Rate for Payer: PHCS Commercial |
$592.32
|
| Rate for Payer: United Healthcare All Payer |
$542.96
|
|
|
CLTX TRIMALLEOLAR ANKLE FX(T
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
761T0942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.19 |
| Max. Negotiated Rate |
$592.32 |
| Rate for Payer: Aetna Commercial |
$475.09
|
| Rate for Payer: Anthem Medicaid |
$212.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$481.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cash Price |
$308.50
|
| Rate for Payer: Cigna Commercial |
$512.11
|
| Rate for Payer: First Health Commercial |
$586.15
|
| Rate for Payer: Humana Commercial |
$524.45
|
| Rate for Payer: Humana KY Medicaid |
$212.19
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$214.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$505.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$455.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$542.96
|
| Rate for Payer: Ohio Health Group HMO |
$462.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$425.73
|
| Rate for Payer: PHCS Commercial |
$592.32
|
| Rate for Payer: United Healthcare All Payer |
$542.96
|
|
|
[C]MARINOL (DRONAB 2.5MG/1CAP
|
Facility
|
IP
|
$62.06
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
25002708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.41
|
| Rate for Payer: Cash Price |
$31.03
|
| Rate for Payer: Cigna Commercial |
$51.51
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: Humana Commercial |
$52.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.61
|
| Rate for Payer: Ohio Health Group HMO |
$46.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.82
|
| Rate for Payer: PHCS Commercial |
$59.58
|
| Rate for Payer: United Healthcare All Payer |
$54.61
|
|
|
[C]MARINOL (DRONAB 2.5MG/1CAP
|
Facility
|
OP
|
$62.06
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
25002708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$59.58 |
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Anthem Medicaid |
$21.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.41
|
| Rate for Payer: Cash Price |
$31.03
|
| Rate for Payer: Cigna Commercial |
$51.51
|
| Rate for Payer: First Health Commercial |
$58.96
|
| Rate for Payer: Humana Commercial |
$52.75
|
| Rate for Payer: Humana KY Medicaid |
$21.34
|
| Rate for Payer: Kentucky WC Medicaid |
$21.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.61
|
| Rate for Payer: Ohio Health Group HMO |
$46.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.82
|
| Rate for Payer: PHCS Commercial |
$59.58
|
| Rate for Payer: United Healthcare All Payer |
$54.61
|
|
|
[C]METHADONE 5 MG TA 5MG/1TAB
|
Facility
|
OP
|
$60.31
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
25000075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
|
|
[C]METHADONE 5 MG TA 5MG/1TAB
|
Facility
|
IP
|
$60.31
|
|
|
Service Code
|
NDC 54070920
|
| Hospital Charge Code |
25000075
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
|
|
CMNT HUMST0 W/RMVABL HD.12X210
|
Facility
|
IP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CMNT HUMST0 W/RMVABL HD.12X210
|
Facility
|
OP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem Medicaid |
$7,472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Humana KY Medicaid |
$7,472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,548.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CMNT HUMSTM W/RMOVBL HD 14X210
|
Facility
|
OP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem Medicaid |
$7,472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Humana KY Medicaid |
$7,472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,548.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CMNT HUMSTM W/RMOVBL HD 14X210
|
Facility
|
IP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
[C]MORPHINE(FRES) 2MG/1ML
|
Professional
|
Both
|
$77.13
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
63600243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$46.28 |
| Rate for Payer: Ambetter Exchange |
$8.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.76
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.13
|
| Rate for Payer: Multiplan PHCS |
$46.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.57
|
| Rate for Payer: UHCCP Medicaid |
$27.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.13
|
|
|
[C]MORPHINE(FRES) 2MG/1ML
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
63600243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(FRES) 2MG/1ML
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
63600243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(FRES) 2MG/1ML
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
636T0243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(FRES) 2MG/1ML
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
636T0243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(GEN) 10MG/1ML
|
Facility
|
IP
|
$76.93
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.08
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
[C]MORPHINE(GEN) 10MG/1ML
|
Facility
|
OP
|
$76.93
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.08
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
