|
[C]VALIUM (DIAZEPAM) 2MG/1TAB
|
Facility
|
IP
|
$60.06
|
|
|
Service Code
|
NDC 51079028420
|
| Hospital Charge Code |
25000086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$57.66 |
| Rate for Payer: Aetna Commercial |
$46.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.85
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cigna Commercial |
$49.85
|
| Rate for Payer: First Health Commercial |
$57.06
|
| Rate for Payer: Humana Commercial |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.85
|
| Rate for Payer: Ohio Health Group HMO |
$45.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.44
|
| Rate for Payer: PHCS Commercial |
$57.66
|
| Rate for Payer: United Healthcare All Payer |
$52.85
|
|
|
[C]VERSED (MIDAZOLAM) 10MG/2ML
|
Facility
|
OP
|
$76.23
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem Medicaid |
$26.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Humana KY Medicaid |
$26.22
|
| Rate for Payer: Kentucky WC Medicaid |
$26.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.60
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
[C]VERSED (MIDAZOLAM) 10MG/2ML
|
Facility
|
IP
|
$76.23
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$73.18 |
| Rate for Payer: Aetna Commercial |
$58.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.46
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cigna Commercial |
$63.27
|
| Rate for Payer: First Health Commercial |
$72.42
|
| Rate for Payer: Humana Commercial |
$64.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.08
|
| Rate for Payer: Ohio Health Group HMO |
$57.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.60
|
| Rate for Payer: PHCS Commercial |
$73.18
|
| Rate for Payer: United Healthcare All Payer |
$67.08
|
|
|
[C]XANAX (ALPRAZOLA .5MG/1TAB
|
Facility
|
IP
|
$60.05
|
|
|
Service Code
|
NDC 228202910
|
| Hospital Charge Code |
25000088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Aetna Commercial |
$46.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: First Health Commercial |
$57.05
|
| Rate for Payer: Humana Commercial |
$51.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.43
|
| Rate for Payer: PHCS Commercial |
$57.65
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
|
|
[C]XANAX (ALPRAZOLA .5MG/1TAB
|
Facility
|
OP
|
$60.05
|
|
|
Service Code
|
NDC 228202910
|
| Hospital Charge Code |
25000088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Aetna Commercial |
$46.24
|
| Rate for Payer: Anthem Medicaid |
$20.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: First Health Commercial |
$57.05
|
| Rate for Payer: Humana Commercial |
$51.04
|
| Rate for Payer: Humana KY Medicaid |
$20.65
|
| Rate for Payer: Kentucky WC Medicaid |
$20.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.43
|
| Rate for Payer: PHCS Commercial |
$57.65
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
|
|
[C]XANAX (ALPRZOL 0.25MG/1TAB
|
Facility
|
IP
|
$60.04
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
25000087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$57.64 |
| Rate for Payer: Aetna Commercial |
$46.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.83
|
| Rate for Payer: First Health Commercial |
$57.04
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.43
|
| Rate for Payer: PHCS Commercial |
$57.64
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
|
|
[C]XANAX (ALPRZOL 0.25MG/1TAB
|
Facility
|
OP
|
$60.04
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
25000087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$57.64 |
| Rate for Payer: Aetna Commercial |
$46.23
|
| Rate for Payer: Anthem Medicaid |
$20.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.83
|
| Rate for Payer: First Health Commercial |
$57.04
|
| Rate for Payer: Humana Commercial |
$51.03
|
| Rate for Payer: Humana KY Medicaid |
$20.65
|
| Rate for Payer: Kentucky WC Medicaid |
$20.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.43
|
| Rate for Payer: PHCS Commercial |
$57.64
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
|
|
CXI SUPPORT CATH. .014 ANG 150
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .014 ANG 150
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .014 STR 150
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .014 STR 150
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .018 ANG 150
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .018 ANG 150
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .018 STR 150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CXI SUPPORT CATH. .018 STR 150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CXI SUPPORT CATH .035 ANG 150
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH .035 ANG 150
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
CXI SUPPORT CATH. .035 STR 150
|
Facility
|
IP
|
$2,052.13
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.64 |
| Max. Negotiated Rate |
$1,970.04 |
| Rate for Payer: Aetna Commercial |
$1,580.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.66
|
| Rate for Payer: Cash Price |
$1,026.07
|
| Rate for Payer: Cigna Commercial |
$1,703.27
|
| Rate for Payer: First Health Commercial |
$1,949.52
|
| Rate for Payer: Humana Commercial |
$1,744.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,785.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.97
|
| Rate for Payer: PHCS Commercial |
$1,970.04
|
| Rate for Payer: United Healthcare All Payer |
$1,805.87
|
|
|
CXI SUPPORT CATH. .035 STR 150
|
Facility
|
OP
|
$2,052.13
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.64 |
| Max. Negotiated Rate |
$1,970.04 |
| Rate for Payer: Aetna Commercial |
$1,580.14
|
| Rate for Payer: Anthem Medicaid |
$705.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.66
|
| Rate for Payer: Cash Price |
$1,026.07
|
| Rate for Payer: Cigna Commercial |
$1,703.27
|
| Rate for Payer: First Health Commercial |
$1,949.52
|
| Rate for Payer: Humana Commercial |
$1,744.31
|
| Rate for Payer: Humana KY Medicaid |
$705.73
|
| Rate for Payer: Kentucky WC Medicaid |
$712.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,785.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.97
|
| Rate for Payer: PHCS Commercial |
$1,970.04
|
| Rate for Payer: United Healthcare All Payer |
$1,805.87
|
|
|
CXR INCLUDING APICAL LORDOTIC
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Ambetter Exchange |
$37.99
|
| Rate for Payer: Anthem Medicaid |
$29.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.59
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$61.57
|
| Rate for Payer: Humana Medicaid |
$29.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.03
|
| Rate for Payer: Molina Healthcare Passport |
$29.44
|
| Rate for Payer: Multiplan PHCS |
$297.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.39
|
| Rate for Payer: UHCCP Medicaid |
$173.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.99
|
|
|
CXR INCLUDING APICAL LORDOTIC
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CXR INCLUDING APICAL LORDOTIC
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CXR INCLUDING APICAL LORDOTI(P
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
320P0036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Ambetter Exchange |
$37.99
|
| Rate for Payer: Anthem Medicaid |
$29.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.59
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$61.57
|
| Rate for Payer: Humana Medicaid |
$29.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.03
|
| Rate for Payer: Molina Healthcare Passport |
$29.44
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.39
|
| Rate for Payer: UHCCP Medicaid |
$54.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.99
|
|
|
CXR INCLUDING APICAL LORDOTI(T
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
320T0036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$117.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$117.27
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$118.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
CXR INCLUDING APICAL LORDOTI(T
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
320T0036
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
