|
DEB SKIN BONE AT FX SITE(T
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS 11012
|
| Hospital Charge Code |
761T0025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.25 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$2,945.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,983.50
|
| Rate for Payer: Cash Price |
$1,912.50
|
| Rate for Payer: Cigna Commercial |
$3,174.75
|
| Rate for Payer: First Health Commercial |
$3,633.75
|
| Rate for Payer: Humana Commercial |
$3,251.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,366.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,868.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,185.75
|
| Rate for Payer: PHCS Commercial |
$3,672.00
|
| Rate for Payer: United Healthcare All Payer |
$3,366.00
|
|
|
DEB SUB MUSC FASC ABD WALL
|
Facility
|
IP
|
$5,605.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.65 |
| Max. Negotiated Rate |
$5,380.80 |
| Rate for Payer: Aetna Commercial |
$4,315.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,371.90
|
| Rate for Payer: Cash Price |
$2,802.50
|
| Rate for Payer: Cigna Commercial |
$4,652.15
|
| Rate for Payer: First Health Commercial |
$5,324.75
|
| Rate for Payer: Humana Commercial |
$4,764.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,596.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,136.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,681.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,932.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,203.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.55
|
| Rate for Payer: PHCS Commercial |
$5,380.80
|
| Rate for Payer: United Healthcare All Payer |
$4,932.40
|
|
|
DEB SUB MUSC FASC ABD WALL
|
Facility
|
OP
|
$5,605.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.65 |
| Max. Negotiated Rate |
$5,380.80 |
| Rate for Payer: Aetna Commercial |
$4,315.85
|
| Rate for Payer: Anthem Medicaid |
$1,927.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,371.90
|
| Rate for Payer: Cash Price |
$2,802.50
|
| Rate for Payer: Cigna Commercial |
$4,652.15
|
| Rate for Payer: First Health Commercial |
$5,324.75
|
| Rate for Payer: Humana Commercial |
$4,764.25
|
| Rate for Payer: Humana KY Medicaid |
$1,927.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,947.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,596.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,136.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,681.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,966.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,932.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,203.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,737.55
|
| Rate for Payer: PHCS Commercial |
$5,380.80
|
| Rate for Payer: United Healthcare All Payer |
$4,932.40
|
|
|
DEB SUB MUSC FASC ABD WALL
|
Professional
|
Both
|
$5,605.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$574.70 |
| Max. Negotiated Rate |
$5,605.00 |
| Rate for Payer: Aetna Commercial |
$1,127.55
|
| Rate for Payer: Anthem Medicaid |
$574.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,605.00
|
| Rate for Payer: Cash Price |
$2,802.50
|
| Rate for Payer: Cash Price |
$2,802.50
|
| Rate for Payer: Cigna Commercial |
$1,099.09
|
| Rate for Payer: Healthspan PPO |
$901.58
|
| Rate for Payer: Humana Medicaid |
$574.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$997.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.19
|
| Rate for Payer: Molina Healthcare Passport |
$574.70
|
| Rate for Payer: Multiplan PHCS |
$3,363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,923.50
|
| Rate for Payer: UHCCP Medicaid |
$1,961.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$580.45
|
|
|
DEB SUB MUSC FASC ABD WALL(P
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
761P0020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.85 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Aetna Commercial |
$1,127.55
|
| Rate for Payer: Anthem Medicaid |
$574.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,331.00
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cigna Commercial |
$1,099.09
|
| Rate for Payer: Healthspan PPO |
$901.58
|
| Rate for Payer: Humana Medicaid |
$574.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$997.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.19
|
| Rate for Payer: Molina Healthcare Passport |
$574.70
|
| Rate for Payer: Multiplan PHCS |
$798.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.70
|
| Rate for Payer: UHCCP Medicaid |
$465.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$580.45
|
|
|
DEB SUB MUSC FASC ABD WALL(T
|
Facility
|
IP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
761T0020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.62 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
DEB SUB MUSC FASC ABD WALL(T
|
Facility
|
OP
|
$4,274.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
761T0020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.62 |
| Max. Negotiated Rate |
$4,103.04 |
| Rate for Payer: Aetna Commercial |
$3,290.98
|
| Rate for Payer: Anthem Medicaid |
$1,469.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.72
|
| Rate for Payer: Cash Price |
$2,137.00
|
| Rate for Payer: Cigna Commercial |
$3,547.42
|
| Rate for Payer: First Health Commercial |
$4,060.30
|
| Rate for Payer: Humana Commercial |
$3,632.90
|
| Rate for Payer: Humana KY Medicaid |
$1,469.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.94
|
| Rate for Payer: PHCS Commercial |
$4,103.04
|
| Rate for Payer: United Healthcare All Payer |
$3,761.12
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.03 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.61
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.03 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem Medicaid |
$285.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Humana KY Medicaid |
$285.78
|
| Rate for Payer: Kentucky WC Medicaid |
$288.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.61
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
761P0019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.85 |
| Max. Negotiated Rate |
$861.74 |
| Rate for Payer: Aetna Commercial |
$861.74
|
| Rate for Payer: Anthem Medicaid |
$422.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$831.00
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$816.94
|
| Rate for Payer: Healthspan PPO |
$689.04
|
| Rate for Payer: Humana Medicaid |
$422.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$741.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.23
|
| Rate for Payer: Molina Healthcare Passport |
$422.77
|
| Rate for Payer: Multiplan PHCS |
$498.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.70
|
| Rate for Payer: UHCCP Medicaid |
$290.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.00
|
|
|
DEB SUB MUSC FASC EXT GEN PERI
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 11004
|
| Hospital Charge Code |
76100019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.85 |
| Max. Negotiated Rate |
$861.74 |
| Rate for Payer: Aetna Commercial |
$861.74
|
| Rate for Payer: Anthem Medicaid |
$422.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$831.00
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$816.94
|
| Rate for Payer: Healthspan PPO |
$689.04
|
| Rate for Payer: Humana Medicaid |
$422.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$741.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.23
|
| Rate for Payer: Molina Healthcare Passport |
$422.77
|
| Rate for Payer: Multiplan PHCS |
$498.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.70
|
| Rate for Payer: UHCCP Medicaid |
$290.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$427.00
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$1,564.80 |
| Rate for Payer: Aetna Commercial |
$1,255.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,271.40
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cigna Commercial |
$1,352.90
|
| Rate for Payer: First Health Commercial |
$1,548.50
|
| Rate for Payer: Humana Commercial |
$1,385.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,336.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,202.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,434.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.30
|
| Rate for Payer: PHCS Commercial |
$1,564.80
|
| Rate for Payer: United Healthcare All Payer |
$1,434.40
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$1,630.00 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.46
|
| Rate for Payer: Anthem Medicaid |
$48.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,630.00
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cigna Commercial |
$108.94
|
| Rate for Payer: Healthspan PPO |
$84.98
|
| Rate for Payer: Humana Medicaid |
$48.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare Passport |
$48.18
|
| Rate for Payer: Multiplan PHCS |
$978.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,141.00
|
| Rate for Payer: UHCCP Medicaid |
$31.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.66
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$1,564.80 |
| Rate for Payer: Aetna Commercial |
$1,255.10
|
| Rate for Payer: Anthem Medicaid |
$560.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,271.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cash Price |
$815.00
|
| Rate for Payer: Cigna Commercial |
$1,352.90
|
| Rate for Payer: First Health Commercial |
$1,548.50
|
| Rate for Payer: Humana Commercial |
$1,385.50
|
| Rate for Payer: Humana KY Medicaid |
$560.56
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$566.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,336.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,202.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$571.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,434.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.30
|
| Rate for Payer: PHCS Commercial |
$1,564.80
|
| Rate for Payer: United Healthcare All Payer |
$1,434.40
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761P0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.46
|
| Rate for Payer: Anthem Medicaid |
$48.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$108.94
|
| Rate for Payer: Healthspan PPO |
$84.98
|
| Rate for Payer: Humana Medicaid |
$48.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.14
|
| Rate for Payer: Molina Healthcare Passport |
$48.18
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$31.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.66
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(T
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761T0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DEB SUBQ TISSUE 20 SQ CM/<(T
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
761T0026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
636T0078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Professional
|
Both
|
$4.26
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.26
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Healthspan PPO |
$0.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Multiplan PHCS |
$2.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.98
|
| Rate for Payer: UHCCP Medicaid |
$1.49
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
DECADRON 0.25MG(DEXA)0.5MG/5ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
