|
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
|
|
|
DECADRON 0.25MG(DEXA 4MG/1TAB)
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
DECADRON 0.25MG(DEXA 4MG/1TAB)
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
DECADRON 1MG (20MG VIAL)
|
Facility
|
OP
|
$77.95
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Anthem Medicaid |
$26.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.80
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cigna Commercial |
$64.70
|
| Rate for Payer: First Health Commercial |
$74.05
|
| Rate for Payer: Humana Commercial |
$66.26
|
| Rate for Payer: Humana KY Medicaid |
$26.81
|
| Rate for Payer: Kentucky WC Medicaid |
$27.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.60
|
| Rate for Payer: Ohio Health Group HMO |
$58.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.16
|
| Rate for Payer: PHCS Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Payer |
$68.60
|
|
|
DECADRON 1MG (20MG VIAL)
|
Facility
|
IP
|
$77.95
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
25002012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$60.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.80
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cigna Commercial |
$64.70
|
| Rate for Payer: First Health Commercial |
$74.05
|
| Rate for Payer: Humana Commercial |
$66.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.60
|
| Rate for Payer: Ohio Health Group HMO |
$58.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.16
|
| Rate for Payer: PHCS Commercial |
$74.83
|
| Rate for Payer: United Healthcare All Payer |
$68.60
|
|
|
DECADRON 1MG TABLET
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
DECADRON 1MG TABLET
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
25002539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
DECALCIFY TISSUE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
30001511
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
DECALCIFY TISSUE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
30001511
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.03
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
DECALCIFY TISSUE
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
30001511
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$28.13
|
| Rate for Payer: Anthem Medicaid |
$12.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$11.65
|
| Rate for Payer: Healthspan PPO |
$26.71
|
| Rate for Payer: Humana Medicaid |
$12.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.82
|
| Rate for Payer: Molina Healthcare Passport |
$12.57
|
| Rate for Payer: Multiplan PHCS |
$45.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.20
|
| Rate for Payer: UHCCP Medicaid |
$26.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.70
|
|
|
DECLOMYCIN(DEMECLOC 150MG/1TAB
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
NDC 53746055401
|
| Hospital Charge Code |
25000524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.20
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cigna Commercial |
$19.36
|
| Rate for Payer: First Health Commercial |
$22.16
|
| Rate for Payer: Humana Commercial |
$19.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.53
|
| Rate for Payer: Ohio Health Group HMO |
$17.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.23
|
| Rate for Payer: PHCS Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Payer |
$20.53
|
|
|
DECLOMYCIN(DEMECLOC 150MG/1TAB
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
NDC 53746055401
|
| Hospital Charge Code |
25000524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Anthem Medicaid |
$8.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.20
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cigna Commercial |
$19.36
|
| Rate for Payer: First Health Commercial |
$22.16
|
| Rate for Payer: Humana Commercial |
$19.83
|
| Rate for Payer: Humana KY Medicaid |
$8.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.53
|
| Rate for Payer: Ohio Health Group HMO |
$17.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.23
|
| Rate for Payer: PHCS Commercial |
$22.40
|
| Rate for Payer: United Healthcare All Payer |
$20.53
|
| Rate for Payer: Aetna Commercial |
$17.96
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
45000238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
76102777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
45000238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
76102777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
76101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECLOT IMPLANTED VASC ACC DEV
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
76101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.62
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
DECOMP FASCIOTOMY,LUMBAR PARAS
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem Medicaid |
$355.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Humana KY Medicaid |
$355.94
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$359.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$363.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
DECOMP FASCIOTOMY,LUMBAR PARAS
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
|
|
DECOMP FASCIOTOMY,LUMBAR PARAS
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76102804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
DECOMP. LOWER LET
|
Professional
|
Both
|
$5,593.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
76100883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: Aetna Commercial |
$623.57
|
| Rate for Payer: Anthem Medicaid |
$253.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,593.00
|
| Rate for Payer: Cash Price |
$2,796.50
|
| Rate for Payer: Cash Price |
$2,796.50
|
| Rate for Payer: Cigna Commercial |
$683.27
|
| Rate for Payer: Healthspan PPO |
$564.82
|
| Rate for Payer: Humana Medicaid |
$253.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.86
|
| Rate for Payer: Molina Healthcare Passport |
$253.78
|
| Rate for Payer: Multiplan PHCS |
$3,355.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,915.10
|
| Rate for Payer: UHCCP Medicaid |
$1,957.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.32
|
|
|
DECOMP. LOWER LET
|
Facility
|
OP
|
$5,593.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
76100883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$727.09 |
| Max. Negotiated Rate |
$5,369.28 |
| Rate for Payer: Aetna Commercial |
$4,306.61
|
| Rate for Payer: Anthem Medicaid |
$1,923.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,362.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,796.50
|
| Rate for Payer: Cash Price |
$2,796.50
|
| Rate for Payer: Cigna Commercial |
$4,642.19
|
| Rate for Payer: First Health Commercial |
$5,313.35
|
| Rate for Payer: Humana Commercial |
$4,754.05
|
| Rate for Payer: Humana KY Medicaid |
$1,923.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,943.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,586.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,127.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,962.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,921.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.83
|
| Rate for Payer: PHCS Commercial |
$5,369.28
|
| Rate for Payer: United Healthcare All Payer |
$4,921.84
|
|
|
DECOMP. LOWER LET
|
Facility
|
IP
|
$5,593.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
76100883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$727.09 |
| Max. Negotiated Rate |
$5,369.28 |
| Rate for Payer: Aetna Commercial |
$4,306.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,362.54
|
| Rate for Payer: Cash Price |
$2,796.50
|
| Rate for Payer: Cigna Commercial |
$4,642.19
|
| Rate for Payer: First Health Commercial |
$5,313.35
|
| Rate for Payer: Humana Commercial |
$4,754.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,586.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,127.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,921.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,194.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.83
|
| Rate for Payer: PHCS Commercial |
$5,369.28
|
| Rate for Payer: United Healthcare All Payer |
$4,921.84
|
|
|
DECOMP. LOWER LET(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
761P0883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$623.57
|
| Rate for Payer: Anthem Medicaid |
$253.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$683.27
|
| Rate for Payer: Healthspan PPO |
$564.82
|
| Rate for Payer: Humana Medicaid |
$253.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.86
|
| Rate for Payer: Molina Healthcare Passport |
$253.78
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.32
|
|
