|
EUFLEXXA SYRINGE 20MG/2ML
|
Professional
|
Both
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,179.25 |
| Rate for Payer: Aetna Commercial |
$189.89
|
| Rate for Payer: Ambetter Exchange |
$114.48
|
| Rate for Payer: Anthem Medicaid |
$131.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.38
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$131.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.83
|
| Rate for Payer: Molina Healthcare Passport |
$131.21
|
| Rate for Payer: Multiplan PHCS |
$1,179.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.82
|
| Rate for Payer: UHCCP Medicaid |
$687.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.48
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
OP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
636T0076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem Medicaid |
$675.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.55
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Humana KY Medicaid |
$675.91
|
| Rate for Payer: Humana Medicare Advantage |
$114.48
|
| Rate for Payer: Kentucky WC Medicaid |
$682.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
OP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem Medicaid |
$675.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.55
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Humana KY Medicaid |
$675.91
|
| Rate for Payer: Humana Medicare Advantage |
$114.48
|
| Rate for Payer: Kentucky WC Medicaid |
$682.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
IP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
636T0076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$589.63 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
OP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
25002488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem Medicaid |
$675.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.55
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Humana KY Medicaid |
$675.91
|
| Rate for Payer: Humana Medicare Advantage |
$114.48
|
| Rate for Payer: Kentucky WC Medicaid |
$682.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
IP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$589.63 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EUFLEXXA SYRINGE 20MG/2ML
|
Facility
|
IP
|
$1,965.42
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
25002488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$589.63 |
| Max. Negotiated Rate |
$1,886.80 |
| Rate for Payer: Aetna Commercial |
$1,513.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.03
|
| Rate for Payer: Cash Price |
$982.71
|
| Rate for Payer: Cigna Commercial |
$1,631.30
|
| Rate for Payer: First Health Commercial |
$1,867.15
|
| Rate for Payer: Humana Commercial |
$1,670.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.14
|
| Rate for Payer: PHCS Commercial |
$1,886.80
|
| Rate for Payer: United Healthcare All Payer |
$1,729.57
|
|
|
EVAC RPR A-BIILIAC NDGFT
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS 34705
|
| Hospital Charge Code |
76101347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.30
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
EVAC RPR A-BIILIAC NDGFT
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 34705
|
| Hospital Charge Code |
76101347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.50 |
| Max. Negotiated Rate |
$2,810.90 |
| Rate for Payer: Ambetter Exchange |
$1,428.61
|
| Rate for Payer: Anthem Medicaid |
$1,228.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,428.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,428.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,714.33
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,810.90
|
| Rate for Payer: Humana Medicaid |
$1,228.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,050.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,428.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,253.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,228.98
|
| Rate for Payer: Multiplan PHCS |
$1,062.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,857.19
|
| Rate for Payer: UHCCP Medicaid |
$619.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,241.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,428.61
|
|
|
EVAC RPR A-BIILIAC NDGFT
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS 34705
|
| Hospital Charge Code |
76101347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,221.30
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
EVAC RPR A-BIILIAC NDGFT(P
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 34705
|
| Hospital Charge Code |
761P1347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.50 |
| Max. Negotiated Rate |
$2,810.90 |
| Rate for Payer: Ambetter Exchange |
$1,428.61
|
| Rate for Payer: Anthem Medicaid |
$1,228.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,428.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,428.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,714.33
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,810.90
|
| Rate for Payer: Humana Medicaid |
$1,228.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,050.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,428.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,253.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,228.98
|
| Rate for Payer: Multiplan PHCS |
$1,062.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,857.19
|
| Rate for Payer: UHCCP Medicaid |
$619.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,241.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,428.61
|
|
|
EVAC SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
76100098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Ambetter Exchange |
$30.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.92
|
| Rate for Payer: Anthem Medicaid |
$22.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.43
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: Healthspan PPO |
$49.74
|
| Rate for Payer: Humana Medicaid |
$22.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.74
|
| Rate for Payer: Molina Healthcare Passport |
$22.29
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.47
|
| Rate for Payer: UHCCP Medicaid |
$16.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.36
|
|
|
EVAC SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EVAC SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
76100098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
EVAC SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EVAC SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
76100098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
EVAC SUBUNGUAL HEMATOMA(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
761P0098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: Ambetter Exchange |
$30.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.92
|
| Rate for Payer: Anthem Medicaid |
$22.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.43
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: Healthspan PPO |
$49.74
|
| Rate for Payer: Humana Medicaid |
$22.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.74
|
| Rate for Payer: Molina Healthcare Passport |
$22.29
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.47
|
| Rate for Payer: UHCCP Medicaid |
$16.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.36
|
|
|
EVAC SUBUNGUAL HEMATOMA(T
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
761T0098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EVAC SUBUNGUAL HEMATOMA(T
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
761T0098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
45000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
45000270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
45000271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
76101914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
76101914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$220.83 |
| Rate for Payer: Aetna Commercial |
$149.92
|
| Rate for Payer: Ambetter Exchange |
$104.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.05
|
| Rate for Payer: Anthem Medicaid |
$58.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.15
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$220.83
|
| Rate for Payer: Healthspan PPO |
$200.46
|
| Rate for Payer: Humana Medicaid |
$58.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.63
|
| Rate for Payer: Molina Healthcare Passport |
$58.46
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.58
|
| Rate for Payer: UHCCP Medicaid |
$67.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.29
|
|
|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
45000270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
