|
EPIC STENT 120CM 8*30
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 8*30
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 8*40
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 8*40
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 8*50
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 8*50
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 8*60
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 8*60
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
EPIC STENT 120CM 9*30
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 9*30
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 9*40
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 9*40
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 9*50
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIC STENT 120CM 9*50
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
EPIDURAL LYSIS ON SINGLE DA(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
761P2289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.31 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$370.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.31
|
| Rate for Payer: Anthem Medicaid |
$169.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$340.56
|
| Rate for Payer: Healthspan PPO |
$477.40
|
| Rate for Payer: Humana Medicaid |
$169.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.60
|
| Rate for Payer: Molina Healthcare Passport |
$169.22
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$171.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.91
|
|
|
EPIDURAL LYSIS ON SINGLE DA(T
|
Facility
|
IP
|
$2,971.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
761T2289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.23 |
| Max. Negotiated Rate |
$2,852.16 |
| Rate for Payer: Aetna Commercial |
$2,287.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,317.38
|
| Rate for Payer: Cash Price |
$1,485.50
|
| Rate for Payer: Cigna Commercial |
$2,465.93
|
| Rate for Payer: First Health Commercial |
$2,822.45
|
| Rate for Payer: Humana Commercial |
$2,525.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,436.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,192.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,614.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,228.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$594.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$921.01
|
| Rate for Payer: PHCS Commercial |
$2,852.16
|
| Rate for Payer: United Healthcare All Payer |
$2,614.48
|
|
|
EPIDURAL LYSIS ON SINGLE DA(T
|
Facility
|
OP
|
$2,971.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
761T2289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.23 |
| Max. Negotiated Rate |
$2,852.16 |
| Rate for Payer: Aetna Commercial |
$2,287.67
|
| Rate for Payer: Anthem Medicaid |
$1,021.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,317.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,485.50
|
| Rate for Payer: Cash Price |
$1,485.50
|
| Rate for Payer: Cigna Commercial |
$2,465.93
|
| Rate for Payer: First Health Commercial |
$2,822.45
|
| Rate for Payer: Humana Commercial |
$2,525.35
|
| Rate for Payer: Humana KY Medicaid |
$1,021.73
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,032.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,436.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,192.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,042.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,614.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,228.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$594.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$921.01
|
| Rate for Payer: PHCS Commercial |
$2,852.16
|
| Rate for Payer: United Healthcare All Payer |
$2,614.48
|
|
|
EPIDURAL LYSIS ON SINGLE DAY
|
Facility
|
IP
|
$3,996.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
76102289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.48 |
| Max. Negotiated Rate |
$3,836.16 |
| Rate for Payer: Aetna Commercial |
$3,076.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,116.88
|
| Rate for Payer: Cash Price |
$1,998.00
|
| Rate for Payer: Cigna Commercial |
$3,316.68
|
| Rate for Payer: First Health Commercial |
$3,796.20
|
| Rate for Payer: Humana Commercial |
$3,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,276.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,198.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,516.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.76
|
| Rate for Payer: PHCS Commercial |
$3,836.16
|
| Rate for Payer: United Healthcare All Payer |
$3,516.48
|
|
|
EPIDURAL LYSIS ON SINGLE DAY
|
Facility
|
OP
|
$3,996.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
76102289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.48 |
| Max. Negotiated Rate |
$3,836.16 |
| Rate for Payer: Aetna Commercial |
$3,076.92
|
| Rate for Payer: Anthem Medicaid |
$1,374.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,116.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,998.00
|
| Rate for Payer: Cash Price |
$1,998.00
|
| Rate for Payer: Cigna Commercial |
$3,316.68
|
| Rate for Payer: First Health Commercial |
$3,796.20
|
| Rate for Payer: Humana Commercial |
$3,396.60
|
| Rate for Payer: Humana KY Medicaid |
$1,374.22
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,388.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,276.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,401.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,516.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.76
|
| Rate for Payer: PHCS Commercial |
$3,836.16
|
| Rate for Payer: United Healthcare All Payer |
$3,516.48
|
|
|
EPIDURAL LYSIS ON SINGLE DAY
|
Professional
|
Both
|
$3,996.00
|
|
|
Service Code
|
HCPCS 62264
|
| Hospital Charge Code |
76102289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.31 |
| Max. Negotiated Rate |
$3,996.00 |
| Rate for Payer: Aetna Commercial |
$370.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.31
|
| Rate for Payer: Anthem Medicaid |
$169.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,996.00
|
| Rate for Payer: Cash Price |
$1,998.00
|
| Rate for Payer: Cash Price |
$1,998.00
|
| Rate for Payer: Cigna Commercial |
$340.56
|
| Rate for Payer: Healthspan PPO |
$477.40
|
| Rate for Payer: Humana Medicaid |
$169.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.60
|
| Rate for Payer: Molina Healthcare Passport |
$169.22
|
| Rate for Payer: Multiplan PHCS |
$2,397.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,797.20
|
| Rate for Payer: UHCCP Medicaid |
$171.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.91
|
|
|
EPINEPHRINE[0.1MG]1MG/10ML SYR
|
Facility
|
IP
|
$119.50
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$114.72 |
| Rate for Payer: Aetna Commercial |
$92.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.21
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cigna Commercial |
$99.18
|
| Rate for Payer: First Health Commercial |
$113.52
|
| Rate for Payer: Humana Commercial |
$101.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.16
|
| Rate for Payer: Ohio Health Group HMO |
$89.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.04
|
| Rate for Payer: PHCS Commercial |
$114.72
|
| Rate for Payer: United Healthcare All Payer |
$105.16
|
|
|
EPINEPHRINE[0.1MG]1MG/10ML SYR
|
Facility
|
OP
|
$119.50
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$114.72 |
| Rate for Payer: Aetna Commercial |
$92.02
|
| Rate for Payer: Anthem Medicaid |
$41.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.21
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cigna Commercial |
$99.18
|
| Rate for Payer: First Health Commercial |
$113.52
|
| Rate for Payer: Humana Commercial |
$101.58
|
| Rate for Payer: Humana KY Medicaid |
$41.10
|
| Rate for Payer: Kentucky WC Medicaid |
$41.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.16
|
| Rate for Payer: Ohio Health Group HMO |
$89.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.04
|
| Rate for Payer: PHCS Commercial |
$114.72
|
| Rate for Payer: United Healthcare All Payer |
$105.16
|
|
|
EPINEPHRINE 0.1MG (1MG SDV)
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
EPINEPHRINE 0.1MG (1MG SDV)
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
EPINEPHRINE DRIP NS4MG/250ML
|
Facility
|
OP
|
$268.41
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.89 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Aetna Commercial |
$206.68
|
| Rate for Payer: Anthem Medicaid |
$92.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.36
|
| Rate for Payer: Cash Price |
$134.21
|
| Rate for Payer: Cigna Commercial |
$222.78
|
| Rate for Payer: First Health Commercial |
$254.99
|
| Rate for Payer: Humana Commercial |
$228.15
|
| Rate for Payer: Humana KY Medicaid |
$92.31
|
| Rate for Payer: Kentucky WC Medicaid |
$93.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.20
|
| Rate for Payer: Ohio Health Group HMO |
$201.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.21
|
| Rate for Payer: PHCS Commercial |
$257.67
|
| Rate for Payer: United Healthcare All Payer |
$236.20
|
|
