|
COSEAL SPRAY SET 0600021
|
Facility
|
OP
|
$836.25
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Aetna Commercial |
$643.91
|
| Rate for Payer: Anthem Medicaid |
$287.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.27
|
| Rate for Payer: Cash Price |
$418.12
|
| Rate for Payer: Cigna Commercial |
$694.09
|
| Rate for Payer: First Health Commercial |
$794.44
|
| Rate for Payer: Humana Commercial |
$710.81
|
| Rate for Payer: Humana KY Medicaid |
$287.59
|
| Rate for Payer: Kentucky WC Medicaid |
$290.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.90
|
| Rate for Payer: Ohio Health Group HMO |
$627.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.01
|
| Rate for Payer: PHCS Commercial |
$802.80
|
| Rate for Payer: United Healthcare All Payer |
$735.90
|
|
|
COSELA 1mg (300mg SDV)
|
Facility
|
OP
|
$8,668.72
|
|
|
Service Code
|
HCPCS J1448
|
| Hospital Charge Code |
25004183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$8,321.97 |
| Rate for Payer: Aetna Commercial |
$6,674.91
|
| Rate for Payer: Anthem Medicaid |
$2,981.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,761.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.28
|
| Rate for Payer: Cash Price |
$4,334.36
|
| Rate for Payer: Cash Price |
$4,334.36
|
| Rate for Payer: Cigna Commercial |
$7,195.04
|
| Rate for Payer: First Health Commercial |
$8,235.28
|
| Rate for Payer: Humana Commercial |
$7,368.41
|
| Rate for Payer: Humana KY Medicaid |
$2,981.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,011.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,108.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,397.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,040.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,628.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,501.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,934.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,541.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,981.42
|
| Rate for Payer: PHCS Commercial |
$8,321.97
|
| Rate for Payer: United Healthcare All Payer |
$7,628.47
|
|
|
COSELA 1mg (300mg SDV)
|
Facility
|
IP
|
$8,668.72
|
|
|
Service Code
|
HCPCS J1448
|
| Hospital Charge Code |
25004183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,600.62 |
| Max. Negotiated Rate |
$8,321.97 |
| Rate for Payer: Aetna Commercial |
$6,674.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,761.60
|
| Rate for Payer: Cash Price |
$4,334.36
|
| Rate for Payer: Cigna Commercial |
$7,195.04
|
| Rate for Payer: First Health Commercial |
$8,235.28
|
| Rate for Payer: Humana Commercial |
$7,368.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,108.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,397.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,600.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,628.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,501.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,934.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,541.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,981.42
|
| Rate for Payer: PHCS Commercial |
$8,321.97
|
| Rate for Payer: United Healthcare All Payer |
$7,628.47
|
|
|
COS FEM HORMONE PELLET INSRT
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
22200726
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
|
|
COS FEM PELLET ONLY INSERTION
|
Professional
|
Both
|
$280.00
|
|
| Hospital Charge Code |
22200782
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
|
|
COS MALE HORMONE PEL INSRT
|
Professional
|
Both
|
$500.00
|
|
| Hospital Charge Code |
22200781
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
|
|
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 |
$210.00 |
| 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 ANE BLEPH W/ CANTHOPLASTY
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
37000209
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.00 |
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
COSM ANE BLEPH W/ CANTHOPLASTY
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
37000209
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.00 |
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
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 |
$371.00 |
| 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
|
|
|
COSM ANES BRAZ BU LIFT NO IMP
|
Facility
|
IP
|
$530.00
|
|
| Hospital Charge Code |
37000228
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$159.00 |
| 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 |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
COSM ANES BRAZ BU LIFT NO IMP
|
Facility
|
OP
|
$530.00
|
|
| Hospital Charge Code |
37000228
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$159.00 |
| 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 |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
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 |
$220.50 |
| 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
|
|
|
COSME ANESBR LIFT LIMIT BILA
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
37000221
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.50 |
| 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 |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| 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 |
$94.50 |
| 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 |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
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 |
$302.92 |
| 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 |
$302.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,514.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$424.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$408.94
|
| 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 |
$302.92
|
| 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 |
$363.50
|
| 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 |
$11,809.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,842.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,185.46
|
| 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 |
$4,428.46 |
| 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 |
$11,809.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,842.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,185.46
|
| Rate for Payer: PHCS Commercial |
$14,171.08
|
| Rate for Payer: United Healthcare All Payer |
$12,990.16
|
|
|
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 |
$73.50 |
| 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 ANESTH SCAR REVISI OR
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
37000220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$31.50 |
| 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 |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
COSMET ANESTH SCAR REVISI OR
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
37000220
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$31.50 |
| 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 |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
COSMET ANSETH BILAT FLANK LIFT
|
Facility
|
IP
|
$640.00
|
|
| Hospital Charge Code |
37000218
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| 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: 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: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
COSMET ANSETH BILAT FLANK LIFT
|
Facility
|
OP
|
$640.00
|
|
| Hospital Charge Code |
37000218
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$192.00 |
| 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 |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
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 |
$448.00 |
| 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
|
|
|
COSMETIC ANESTHESIA FACE LIFT
|
Professional
|
Both
|
$740.00
|
|
| Hospital Charge Code |
37000211
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Multiplan PHCS |
$444.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$518.00
|
| Rate for Payer: UHCCP Medicaid |
$259.00
|
|
|
COSMETIC ANESTHESIA FACE LIFT
|
Facility
|
OP
|
$740.00
|
|
| Hospital Charge Code |
37000211
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem Medicaid |
$254.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Humana KY Medicaid |
$254.49
|
| Rate for Payer: Kentucky WC Medicaid |
$257.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$259.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$510.60
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
