|
DESMOPRESSIN1MCG[4MCG/1MLV10ML
|
Facility
|
IP
|
$1,537.20
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
25002322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.84 |
| Max. Negotiated Rate |
$1,475.71 |
| Rate for Payer: Aetna Commercial |
$1,183.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.02
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,275.88
|
| Rate for Payer: First Health Commercial |
$1,460.34
|
| Rate for Payer: Humana Commercial |
$1,306.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.53
|
| Rate for Payer: PHCS Commercial |
$1,475.71
|
| Rate for Payer: United Healthcare All Payer |
$1,352.74
|
|
|
DESMOPRESSIN1MCG[4MCG/1MLV10ML
|
Facility
|
OP
|
$1,537.20
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
25002322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$1,475.71 |
| Rate for Payer: Aetna Commercial |
$1,183.64
|
| Rate for Payer: Anthem Medicaid |
$528.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$1,275.88
|
| Rate for Payer: First Health Commercial |
$1,460.34
|
| Rate for Payer: Humana Commercial |
$1,306.62
|
| Rate for Payer: Humana KY Medicaid |
$528.64
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$534.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.53
|
| Rate for Payer: PHCS Commercial |
$1,475.71
|
| Rate for Payer: United Healthcare All Payer |
$1,352.74
|
|
|
DESMOPRESSIN 1MCG (4MCG SDV)
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
25002321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
DESMOPRESSIN 1MCG (4MCG SDV)
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
25002321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
DESONIDE 0.05% CREAM 15 GRAM
|
Facility
|
OP
|
$6.29
|
|
|
Service Code
|
NDC 51672128001
|
| Hospital Charge Code |
25002988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Anthem Medicaid |
$2.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.91
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna Commercial |
$5.22
|
| Rate for Payer: First Health Commercial |
$5.98
|
| Rate for Payer: Humana Commercial |
$5.35
|
| Rate for Payer: Humana KY Medicaid |
$2.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.54
|
| Rate for Payer: Ohio Health Group HMO |
$4.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.95
|
| Rate for Payer: PHCS Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Payer |
$5.54
|
|
|
DESONIDE 0.05% CREAM 15 GRAM
|
Facility
|
IP
|
$6.29
|
|
|
Service Code
|
NDC 51672128001
|
| Hospital Charge Code |
25002988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.91
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna Commercial |
$5.22
|
| Rate for Payer: First Health Commercial |
$5.98
|
| Rate for Payer: Humana Commercial |
$5.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.54
|
| Rate for Payer: Ohio Health Group HMO |
$4.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.95
|
| Rate for Payer: PHCS Commercial |
$6.04
|
| Rate for Payer: United Healthcare All Payer |
$5.54
|
|
|
DESONIDE 0.05% OINT(60GM)
|
Facility
|
IP
|
$5.21
|
|
|
Service Code
|
NDC 45802042337
|
| Hospital Charge Code |
25000543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.06
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: First Health Commercial |
$4.95
|
| Rate for Payer: Humana Commercial |
$4.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.58
|
| Rate for Payer: Ohio Health Group HMO |
$3.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.62
|
| Rate for Payer: PHCS Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Payer |
$4.58
|
|
|
DESONIDE 0.05% OINT(60GM)
|
Facility
|
OP
|
$5.21
|
|
|
Service Code
|
NDC 45802042337
|
| Hospital Charge Code |
25000543
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.01
|
| Rate for Payer: Anthem Medicaid |
$1.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.06
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: First Health Commercial |
$4.95
|
| Rate for Payer: Humana Commercial |
$4.43
|
| Rate for Payer: Humana KY Medicaid |
$1.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.58
|
| Rate for Payer: Ohio Health Group HMO |
$3.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.62
|
| Rate for Payer: PHCS Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Payer |
$4.58
|
|
|
DEST ANY METHOD 1ST LESION
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem Medicaid |
$141.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Humana KY Medicaid |
$141.34
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$142.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
DEST ANY METHOD 1ST LESION
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Aetna Commercial |
$316.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$320.58
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$341.13
|
| Rate for Payer: First Health Commercial |
$390.45
|
| Rate for Payer: Humana Commercial |
$349.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$337.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$303.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$361.68
|
| Rate for Payer: Ohio Health Group HMO |
$308.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.41
|
| Rate for Payer: PHCS Commercial |
$394.56
|
| Rate for Payer: United Healthcare All Payer |
$361.68
|
|
|
DEST ANY METHOD 1ST LESION
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$43.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$411.00
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$99.70
|
| Rate for Payer: Healthspan PPO |
$85.53
|
| Rate for Payer: Humana Medicaid |
$43.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.41
|
| Rate for Payer: Molina Healthcare Passport |
$43.54
|
| Rate for Payer: Multiplan PHCS |
$246.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.70
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.98
|
|
|
DEST ANY METHOD 1ST LESION(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761P0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.86
|
| Rate for Payer: Anthem Medicaid |
$43.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$99.70
|
| Rate for Payer: Healthspan PPO |
$85.53
|
| Rate for Payer: Humana Medicaid |
$43.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.41
|
| Rate for Payer: Molina Healthcare Passport |
$43.54
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$29.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.98
|
|
|
DEST ANY METHOD 1ST LESION(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761T0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
DEST ANY METHOD 1ST LESION(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
761T0247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DEST CUTAN VASC PROLIF<10SQCM
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DESTINATION 5FR 45CM STR CCV
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 5FR 45CM STR CCV
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 6FR. 45CM STR CCV
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 6FR. 45CM STR CCV
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 6FR 90CM RSC05
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
DESTINATION 6FR 90CM RSC05
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem Medicaid |
$540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Humana KY Medicaid |
$540.61
|
| Rate for Payer: Kentucky WC Medicaid |
$546.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
DESTINATION 7FR 45CM STR CCV
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
