|
COS ANES FAT GRAF BILAL BREAS
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
COS ANES FAT GRAF BILAL BREAS
|
Professional
|
Both
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
|
|
COS ANES FAT GRAF BILAL BREAS
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
COSEAL 4ML
|
Facility
|
IP
|
$4,104.52
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$533.59 |
| Max. Negotiated Rate |
$3,940.34 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,029.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.40
|
| Rate for Payer: PHCS Commercial |
$3,940.34
|
| Rate for Payer: United Healthcare All Payer |
$3,611.98
|
| Rate for Payer: Aetna Commercial |
$3,160.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.53
|
| Rate for Payer: Cash Price |
$2,052.26
|
| Rate for Payer: Cigna Commercial |
$3,406.75
|
| Rate for Payer: First Health Commercial |
$3,899.29
|
| Rate for Payer: Humana Commercial |
$3,488.84
|
|
|
COSEAL 4ML
|
Facility
|
OP
|
$4,104.52
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$533.59 |
| Max. Negotiated Rate |
$3,940.34 |
| Rate for Payer: Aetna Commercial |
$3,160.48
|
| Rate for Payer: Anthem Medicaid |
$1,411.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,201.53
|
| Rate for Payer: Cash Price |
$2,052.26
|
| Rate for Payer: Cigna Commercial |
$3,406.75
|
| Rate for Payer: First Health Commercial |
$3,899.29
|
| Rate for Payer: Humana Commercial |
$3,488.84
|
| Rate for Payer: Humana KY Medicaid |
$1,411.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,365.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,029.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,078.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.40
|
| Rate for Payer: PHCS Commercial |
$3,940.34
|
| Rate for Payer: United Healthcare All Payer |
$3,611.98
|
|
|
COSEAL SPRAY SET 0600021
|
Facility
|
OP
|
$812.62
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.64 |
| Max. Negotiated Rate |
$780.12 |
| Rate for Payer: Aetna Commercial |
$625.72
|
| Rate for Payer: Anthem Medicaid |
$279.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$633.84
|
| Rate for Payer: Cash Price |
$406.31
|
| Rate for Payer: Cigna Commercial |
$674.47
|
| Rate for Payer: First Health Commercial |
$771.99
|
| Rate for Payer: Humana Commercial |
$690.73
|
| Rate for Payer: Humana KY Medicaid |
$279.46
|
| Rate for Payer: Kentucky WC Medicaid |
$282.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.11
|
| Rate for Payer: Ohio Health Group HMO |
$609.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.91
|
| Rate for Payer: PHCS Commercial |
$780.12
|
| Rate for Payer: United Healthcare All Payer |
$715.11
|
|
|
COSEAL SPRAY SET 0600021
|
Facility
|
IP
|
$812.62
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.64 |
| Max. Negotiated Rate |
$780.12 |
| Rate for Payer: Aetna Commercial |
$625.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$633.84
|
| Rate for Payer: Cash Price |
$406.31
|
| Rate for Payer: Cigna Commercial |
$674.47
|
| Rate for Payer: First Health Commercial |
$771.99
|
| Rate for Payer: Humana Commercial |
$690.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.11
|
| Rate for Payer: Ohio Health Group HMO |
$609.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.91
|
| Rate for Payer: PHCS Commercial |
$780.12
|
| Rate for Payer: United Healthcare All Payer |
$715.11
|
|
|
COSELA 1mg (300mg SDV)
|
Facility
|
IP
|
$8,523.80
|
|
|
Service Code
|
HCPCS J1448
|
| Hospital Charge Code |
25004183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,108.09 |
| Max. Negotiated Rate |
$8,182.85 |
| Rate for Payer: Ohio Health Group HMO |
$6,392.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.38
|
| Rate for Payer: PHCS Commercial |
$8,182.85
|
| Rate for Payer: United Healthcare All Payer |
$7,500.94
|
| Rate for Payer: Aetna Commercial |
$6,563.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.56
|
| Rate for Payer: Cash Price |
$4,261.90
|
| Rate for Payer: Cigna Commercial |
$7,074.75
|
| Rate for Payer: First Health Commercial |
$8,097.61
|
| Rate for Payer: Humana Commercial |
$7,245.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,500.94
|
|
|
COSELA 1mg (300mg SDV)
|
Facility
|
OP
|
$8,523.80
|
|
|
Service Code
|
HCPCS J1448
|
| Hospital Charge Code |
25004183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$8,182.85 |
| Rate for Payer: Aetna Commercial |
$6,563.33
|
| Rate for Payer: Anthem Medicaid |
$2,931.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.02
|
| Rate for Payer: Cash Price |
$4,261.90
|
| Rate for Payer: Cash Price |
$4,261.90
|
| Rate for Payer: Cigna Commercial |
$7,074.75
|
| Rate for Payer: First Health Commercial |
$8,097.61
|
| Rate for Payer: Humana Commercial |
$7,245.23
|
| Rate for Payer: Humana KY Medicaid |
$2,931.33
|
| Rate for Payer: Humana Medicare Advantage |
$5.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,500.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,392.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.38
|
| Rate for Payer: PHCS Commercial |
$8,182.85
|
| Rate for Payer: United Healthcare All Payer |
$7,500.94
|
|
|
COSM ANE BLEPH W/ CANTHOPLASTY
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
37000209
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
COSM ANE BLEPH W/ CANTHOPLASTY
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
37000209
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
COSM ANE BLEPH W/ CANTHOPLASTY
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
37000209
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
|
|
COSM ANES BRAZ BU LIFT NO IMP
|
Facility
|
OP
|
$530.00
|
|
| Hospital Charge Code |
37000228
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
COSM ANES BRAZ BU LIFT NO IMP
|
Facility
|
IP
|
$530.00
|
|
| Hospital Charge Code |
37000228
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
COSM ANES BRAZ BU LIFT NO IMP
|
Professional
|
Both
|
$530.00
|
|
| Hospital Charge Code |
37000228
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$185.50 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$185.50
|
|
|
COSME ANESBR LIFT LIMIT BILA
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
37000221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
COSME ANESBR LIFT LIMIT BILA
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
37000221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
COSME ANESBR LIFT LIMIT BILA
|
Professional
|
Both
|
$315.00
|
|
| Hospital Charge Code |
37000221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
|
|
COSMEGEN(DACTINOMYCI)0.5 MG C
|
Facility
|
OP
|
$14,761.54
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
25002593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$668.90 |
| Max. Negotiated Rate |
$14,171.08 |
| Rate for Payer: Aetna Commercial |
$11,366.39
|
| Rate for Payer: Anthem Medicaid |
$5,076.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$668.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,514.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$936.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$903.02
|
| Rate for Payer: Cash Price |
$7,380.77
|
| Rate for Payer: Cash Price |
$7,380.77
|
| Rate for Payer: Cigna Commercial |
$12,252.08
|
| Rate for Payer: First Health Commercial |
$14,023.46
|
| Rate for Payer: Humana Commercial |
$12,547.31
|
| Rate for Payer: Humana KY Medicaid |
$5,076.49
|
| Rate for Payer: Humana Medicare Advantage |
$668.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,128.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,104.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,894.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,178.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,990.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,071.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,576.08
|
| Rate for Payer: PHCS Commercial |
$14,171.08
|
| Rate for Payer: United Healthcare All Payer |
$12,990.16
|
|
|
COSMEGEN(DACTINOMYCI)0.5 MG C
|
Facility
|
IP
|
$14,761.54
|
|
|
Service Code
|
HCPCS J9120
|
| Hospital Charge Code |
25002593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,919.00 |
| Max. Negotiated Rate |
$14,171.08 |
| Rate for Payer: Aetna Commercial |
$11,366.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,514.00
|
| Rate for Payer: Cash Price |
$7,380.77
|
| Rate for Payer: Cigna Commercial |
$12,252.08
|
| Rate for Payer: First Health Commercial |
$14,023.46
|
| Rate for Payer: Humana Commercial |
$12,547.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,104.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,894.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,428.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,990.16
|
| Rate for Payer: Ohio Health Group HMO |
$11,071.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,576.08
|
| Rate for Payer: PHCS Commercial |
$14,171.08
|
| Rate for Payer: United Healthcare All Payer |
$12,990.16
|
|
|
COSMET ANESTH SCAR REVISI OR
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
37000220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.55
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
COSMET ANESTH SCAR REVISI OR
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
37000220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$36.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$36.11
|
| Rate for Payer: Kentucky WC Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.55
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
COSMET ANESTH SCAR REVISI OR
|
Professional
|
Both
|
$105.00
|
|
| Hospital Charge Code |
37000220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$105.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Multiplan PHCS |
$63.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$73.50
|
| Rate for Payer: UHCCP Medicaid |
$36.75
|
|
|
COSMET ANSETH BILAT FLANK LIFT
|
Professional
|
Both
|
$640.00
|
|
| Hospital Charge Code |
37000218
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
|
|
COSMET ANSETH BILAT FLANK LIFT
|
Facility
|
OP
|
$640.00
|
|
| Hospital Charge Code |
37000218
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
