FASCIOTOMY, HIP/THIGH, ANY
|
Facility
|
OP
|
$1,120.00
|
|
Service Code
|
HCPCS 27025
|
Hospital Charge Code |
76100762
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$145.60 |
Max. Negotiated Rate |
$1,075.20 |
Rate for Payer: Aetna Commercial |
$862.40
|
Rate for Payer: Anthem Medicaid |
$385.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cigna Commercial |
$929.60
|
Rate for Payer: First Health Commercial |
$1,064.00
|
Rate for Payer: Humana Commercial |
$952.00
|
Rate for Payer: Humana KY Medicaid |
$385.17
|
Rate for Payer: Kentucky WC Medicaid |
$389.09
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
Rate for Payer: Ohio Health Group HMO |
$840.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$145.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.20
|
Rate for Payer: PHCS Commercial |
$1,075.20
|
Rate for Payer: United Healthcare All Payer |
$985.60
|
|
FASCIOTOMY, HIP/THIGH, ANY
|
Facility
|
IP
|
$1,120.00
|
|
Service Code
|
HCPCS 27025
|
Hospital Charge Code |
76100762
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$145.60 |
Max. Negotiated Rate |
$1,075.20 |
Rate for Payer: Aetna Commercial |
$862.40
|
Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cigna Commercial |
$929.60
|
Rate for Payer: First Health Commercial |
$1,064.00
|
Rate for Payer: Humana Commercial |
$952.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
Rate for Payer: Ohio Health Group HMO |
$840.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$145.60
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.20
|
Rate for Payer: PHCS Commercial |
$1,075.20
|
Rate for Payer: United Healthcare All Payer |
$985.60
|
|
FASCIOTOMY, HIP/THIGH, ANY
|
Professional
|
Both
|
$1,120.00
|
|
Service Code
|
HCPCS 27025
|
Hospital Charge Code |
76100762
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$392.00 |
Max. Negotiated Rate |
$1,404.81 |
Rate for Payer: Aetna Commercial |
$1,310.51
|
Rate for Payer: Anthem Medicaid |
$487.07
|
Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cigna Commercial |
$1,404.81
|
Rate for Payer: Healthspan PPO |
$1,187.04
|
Rate for Payer: Humana Medicaid |
$487.07
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,129.58
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.81
|
Rate for Payer: Molina Healthcare Passport |
$487.07
|
Rate for Payer: Multiplan PHCS |
$672.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
Rate for Payer: UHCCP Medicaid |
$392.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$491.94
|
|
FASCIOTOMY, HIP/THIGH, ANY(P
|
Professional
|
Both
|
$1,120.00
|
|
Service Code
|
HCPCS 27025
|
Hospital Charge Code |
761P0762
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$392.00 |
Max. Negotiated Rate |
$1,404.81 |
Rate for Payer: Aetna Commercial |
$1,310.51
|
Rate for Payer: Anthem Medicaid |
$487.07
|
Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cash Price |
$560.00
|
Rate for Payer: Cigna Commercial |
$1,404.81
|
Rate for Payer: Healthspan PPO |
$1,187.04
|
Rate for Payer: Humana Medicaid |
$487.07
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,129.58
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.81
|
Rate for Payer: Molina Healthcare Passport |
$487.07
|
Rate for Payer: Multiplan PHCS |
$672.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
Rate for Payer: UHCCP Medicaid |
$392.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$491.94
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
Service Code
|
HCPCS 26045
|
Hospital Charge Code |
76100659
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$156.00 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$924.00
|
Rate for Payer: Anthem Medicaid |
$412.68
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$996.00
|
Rate for Payer: First Health Commercial |
$1,140.00
|
Rate for Payer: Humana Commercial |
$1,020.00
|
Rate for Payer: Humana KY Medicaid |
$412.68
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$416.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
Rate for Payer: Ohio Health Group HMO |
$900.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
Rate for Payer: PHCS Commercial |
$1,152.00
|
Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Facility
|
IP
|
$1,200.00
|
|
Service Code
|
HCPCS 26045
|
Hospital Charge Code |
76100659
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$156.00 |
Max. Negotiated Rate |
$1,152.00 |
Rate for Payer: Aetna Commercial |
$924.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$996.00
|
Rate for Payer: First Health Commercial |
$1,140.00
|
Rate for Payer: Humana Commercial |
$1,020.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
Rate for Payer: Ohio Health Group HMO |
$900.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
Rate for Payer: PHCS Commercial |
$1,152.00
|
Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Professional
|
Both
|
$1,200.00
|
|
Service Code
|
HCPCS 26045
|
Hospital Charge Code |
76100659
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$303.87 |
Max. Negotiated Rate |
$1,200.00 |
Rate for Payer: Aetna Commercial |
$665.73
|
Rate for Payer: Anthem Medicaid |
$303.87
|
Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$736.98
|
Rate for Payer: Healthspan PPO |
$603.01
|
Rate for Payer: Humana Medicaid |
$303.87
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.95
|
Rate for Payer: Molina Healthcare Passport |
$303.87
|
Rate for Payer: Multiplan PHCS |
$720.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
Rate for Payer: UHCCP Medicaid |
$420.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$306.91
|
|
FASCIOTOMY - OPEN - PARTIAL(P
|
Professional
|
Both
|
$1,200.00
|
|
Service Code
|
HCPCS 26045
|
Hospital Charge Code |
761P0659
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$303.87 |
Max. Negotiated Rate |
$1,200.00 |
Rate for Payer: Aetna Commercial |
$665.73
|
Rate for Payer: Anthem Medicaid |
$303.87
|
Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$736.98
|
Rate for Payer: Healthspan PPO |
$603.01
|
Rate for Payer: Humana Medicaid |
$303.87
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.95
|
Rate for Payer: Molina Healthcare Passport |
$303.87
|
Rate for Payer: Multiplan PHCS |
$720.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
Rate for Payer: UHCCP Medicaid |
$420.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$306.91
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Facility
|
OP
|
$1,640.00
|
|
Service Code
|
HCPCS 26121
|
Hospital Charge Code |
76100672
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$213.20 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$1,262.80
|
Rate for Payer: Anthem Medicaid |
$564.00
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cigna Commercial |
$1,361.20
|
Rate for Payer: First Health Commercial |
$1,558.00
|
Rate for Payer: Humana Commercial |
$1,394.00
|
Rate for Payer: Humana KY Medicaid |
$564.00
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$569.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
Rate for Payer: PHCS Commercial |
$1,574.40
|
Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Facility
|
IP
|
$1,640.00
|
|
Service Code
|
HCPCS 26121
|
Hospital Charge Code |
76100672
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$213.20 |
Max. Negotiated Rate |
$1,574.40 |
Rate for Payer: Aetna Commercial |
$1,262.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cigna Commercial |
$1,361.20
|
Rate for Payer: First Health Commercial |
$1,558.00
|
Rate for Payer: Humana Commercial |
$1,394.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
Rate for Payer: PHCS Commercial |
$1,574.40
|
Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Professional
|
Both
|
$1,640.00
|
|
Service Code
|
HCPCS 26121
|
Hospital Charge Code |
76100672
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$506.63 |
Max. Negotiated Rate |
$1,640.00 |
Rate for Payer: Aetna Commercial |
$859.78
|
Rate for Payer: Anthem Medicaid |
$506.63
|
Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cigna Commercial |
$950.36
|
Rate for Payer: Healthspan PPO |
$778.78
|
Rate for Payer: Humana Medicaid |
$506.63
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.76
|
Rate for Payer: Molina Healthcare Passport |
$506.63
|
Rate for Payer: Multiplan PHCS |
$984.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
Rate for Payer: UHCCP Medicaid |
$574.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$511.70
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Professional
|
Both
|
$1,640.00
|
|
Service Code
|
HCPCS 26121
|
Hospital Charge Code |
761P0672
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$506.63 |
Max. Negotiated Rate |
$1,640.00 |
Rate for Payer: Aetna Commercial |
$859.78
|
Rate for Payer: Anthem Medicaid |
$506.63
|
Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cash Price |
$820.00
|
Rate for Payer: Cigna Commercial |
$950.36
|
Rate for Payer: Healthspan PPO |
$778.78
|
Rate for Payer: Humana Medicaid |
$506.63
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.76
|
Rate for Payer: Molina Healthcare Passport |
$506.63
|
Rate for Payer: Multiplan PHCS |
$984.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
Rate for Payer: UHCCP Medicaid |
$574.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$511.70
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Facility
|
IP
|
$2,000.00
|
|
Service Code
|
HCPCS 26123
|
Hospital Charge Code |
76100673
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$1,920.00 |
Rate for Payer: Aetna Commercial |
$1,540.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,660.00
|
Rate for Payer: First Health Commercial |
$1,900.00
|
Rate for Payer: Humana Commercial |
$1,700.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
Rate for Payer: PHCS Commercial |
$1,920.00
|
Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Professional
|
Both
|
$2,000.00
|
|
Service Code
|
HCPCS 26123
|
Hospital Charge Code |
761P0673
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$534.78 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Aetna Commercial |
$1,171.45
|
Rate for Payer: Anthem Medicaid |
$534.78
|
Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,273.22
|
Rate for Payer: Healthspan PPO |
$1,061.08
|
Rate for Payer: Humana Medicaid |
$534.78
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.42
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.48
|
Rate for Payer: Molina Healthcare Passport |
$534.78
|
Rate for Payer: Multiplan PHCS |
$1,200.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
Rate for Payer: UHCCP Medicaid |
$700.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$540.13
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Professional
|
Both
|
$2,000.00
|
|
Service Code
|
HCPCS 26123
|
Hospital Charge Code |
76100673
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$534.78 |
Max. Negotiated Rate |
$2,000.00 |
Rate for Payer: Aetna Commercial |
$1,171.45
|
Rate for Payer: Anthem Medicaid |
$534.78
|
Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,273.22
|
Rate for Payer: Healthspan PPO |
$1,061.08
|
Rate for Payer: Humana Medicaid |
$534.78
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.42
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.48
|
Rate for Payer: Molina Healthcare Passport |
$534.78
|
Rate for Payer: Multiplan PHCS |
$1,200.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
Rate for Payer: UHCCP Medicaid |
$700.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$540.13
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Facility
|
OP
|
$2,000.00
|
|
Service Code
|
HCPCS 26123
|
Hospital Charge Code |
76100673
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$260.00 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$1,540.00
|
Rate for Payer: Anthem Medicaid |
$687.80
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cash Price |
$1,000.00
|
Rate for Payer: Cigna Commercial |
$1,660.00
|
Rate for Payer: First Health Commercial |
$1,900.00
|
Rate for Payer: Humana Commercial |
$1,700.00
|
Rate for Payer: Humana KY Medicaid |
$687.80
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$694.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
Rate for Payer: PHCS Commercial |
$1,920.00
|
Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
FASENRA 30MG/ML SYRINGE
|
Facility
|
OP
|
$30,938.29
|
|
Service Code
|
HCPCS J0517
|
Hospital Charge Code |
25001889
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$169.50 |
Max. Negotiated Rate |
$29,700.76 |
Rate for Payer: Aetna Commercial |
$23,822.48
|
Rate for Payer: Anthem Medicaid |
$10,639.68
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$169.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$24,131.87
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$237.30
|
Rate for Payer: CareSource Just4Me Medicare |
$228.83
|
Rate for Payer: Cash Price |
$15,469.15
|
Rate for Payer: Cash Price |
$15,469.15
|
Rate for Payer: Cigna Commercial |
$25,678.78
|
Rate for Payer: First Health Commercial |
$29,391.38
|
Rate for Payer: Humana Commercial |
$26,297.55
|
Rate for Payer: Humana KY Medicaid |
$10,639.68
|
Rate for Payer: Humana Medicare Advantage |
$169.50
|
Rate for Payer: Kentucky WC Medicaid |
$10,747.96
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$25,369.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,832.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$203.40
|
Rate for Payer: Molina Healthcare Medicaid |
$10,853.15
|
Rate for Payer: Ohio Health Choice Commercial |
$27,225.70
|
Rate for Payer: Ohio Health Group HMO |
$23,203.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$6,187.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,021.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,590.87
|
Rate for Payer: PHCS Commercial |
$29,700.76
|
Rate for Payer: United Healthcare All Payer |
$27,225.70
|
|
FASENRA 30MG/ML SYRINGE
|
Facility
|
IP
|
$30,938.29
|
|
Service Code
|
HCPCS J0517
|
Hospital Charge Code |
25001889
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$4,021.98 |
Max. Negotiated Rate |
$29,700.76 |
Rate for Payer: Aetna Commercial |
$23,822.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$24,131.87
|
Rate for Payer: Cash Price |
$15,469.15
|
Rate for Payer: Cigna Commercial |
$25,678.78
|
Rate for Payer: First Health Commercial |
$29,391.38
|
Rate for Payer: Humana Commercial |
$26,297.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$25,369.40
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,832.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,281.49
|
Rate for Payer: Ohio Health Choice Commercial |
$27,225.70
|
Rate for Payer: Ohio Health Group HMO |
$23,203.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$6,187.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,021.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,590.87
|
Rate for Payer: PHCS Commercial |
$29,700.76
|
Rate for Payer: United Healthcare All Payer |
$27,225.70
|
|
FASLODEX 25MG(250MG/5ML SYR
|
Facility
|
OP
|
$1,911.53
|
|
Service Code
|
HCPCS J9395
|
Hospital Charge Code |
25002693
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.44 |
Max. Negotiated Rate |
$1,835.07 |
Rate for Payer: Aetna Commercial |
$1,471.88
|
Rate for Payer: Anthem Medicaid |
$657.38
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$8.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.99
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.82
|
Rate for Payer: CareSource Just4Me Medicare |
$11.40
|
Rate for Payer: Cash Price |
$955.76
|
Rate for Payer: Cash Price |
$955.76
|
Rate for Payer: Cigna Commercial |
$1,586.57
|
Rate for Payer: First Health Commercial |
$1,815.95
|
Rate for Payer: Humana Commercial |
$1,624.80
|
Rate for Payer: Humana KY Medicaid |
$657.38
|
Rate for Payer: Humana Medicare Advantage |
$8.44
|
Rate for Payer: Kentucky WC Medicaid |
$664.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.71
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$10.13
|
Rate for Payer: Molina Healthcare Medicaid |
$670.56
|
Rate for Payer: Ohio Health Choice Commercial |
$1,682.15
|
Rate for Payer: Ohio Health Group HMO |
$1,433.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.31
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.57
|
Rate for Payer: PHCS Commercial |
$1,835.07
|
Rate for Payer: United Healthcare All Payer |
$1,682.15
|
|
FASLODEX 25MG(250MG/5ML SYR
|
Facility
|
IP
|
$1,911.53
|
|
Service Code
|
HCPCS J9395
|
Hospital Charge Code |
25002693
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$248.50 |
Max. Negotiated Rate |
$1,835.07 |
Rate for Payer: Aetna Commercial |
$1,471.88
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.99
|
Rate for Payer: Cash Price |
$955.76
|
Rate for Payer: Cigna Commercial |
$1,586.57
|
Rate for Payer: First Health Commercial |
$1,815.95
|
Rate for Payer: Humana Commercial |
$1,624.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.71
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$573.46
|
Rate for Payer: Ohio Health Choice Commercial |
$1,682.15
|
Rate for Payer: Ohio Health Group HMO |
$1,433.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$382.31
|
Rate for Payer: Ohio Health Group PPO No Differential |
$248.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.57
|
Rate for Payer: PHCS Commercial |
$1,835.07
|
Rate for Payer: United Healthcare All Payer |
$1,682.15
|
|
FAST CATH DUO HEMOSTASIS 12F
|
Facility
|
OP
|
$482.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$62.66 |
Max. Negotiated Rate |
$462.72 |
Rate for Payer: Aetna Commercial |
$371.14
|
Rate for Payer: Anthem Medicaid |
$165.76
|
Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
Rate for Payer: Cash Price |
$241.00
|
Rate for Payer: Cigna Commercial |
$400.06
|
Rate for Payer: First Health Commercial |
$457.90
|
Rate for Payer: Humana Commercial |
$409.70
|
Rate for Payer: Humana KY Medicaid |
$165.76
|
Rate for Payer: Kentucky WC Medicaid |
$167.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
Rate for Payer: Ohio Health Group HMO |
$361.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
Rate for Payer: PHCS Commercial |
$462.72
|
Rate for Payer: United Healthcare All Payer |
$424.16
|
|
FAST CATH DUO HEMOSTASIS 12F
|
Facility
|
IP
|
$482.00
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$62.66 |
Max. Negotiated Rate |
$462.72 |
Rate for Payer: Aetna Commercial |
$371.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
Rate for Payer: Cash Price |
$241.00
|
Rate for Payer: Cigna Commercial |
$400.06
|
Rate for Payer: First Health Commercial |
$457.90
|
Rate for Payer: Humana Commercial |
$409.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
Rate for Payer: Ohio Health Group HMO |
$361.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
Rate for Payer: PHCS Commercial |
$462.72
|
Rate for Payer: United Healthcare All Payer |
$424.16
|
|
FASTPASS SCORPION SL-MF
|
Facility
|
IP
|
$18,582.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,415.66 |
Max. Negotiated Rate |
$17,838.72 |
Rate for Payer: Aetna Commercial |
$14,308.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
Rate for Payer: Cash Price |
$9,291.00
|
Rate for Payer: Cigna Commercial |
$15,423.06
|
Rate for Payer: First Health Commercial |
$17,652.90
|
Rate for Payer: Humana Commercial |
$15,794.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
Rate for Payer: PHCS Commercial |
$17,838.72
|
Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
FASTPASS SCORPION SL-MF
|
Facility
|
OP
|
$18,582.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,415.66 |
Max. Negotiated Rate |
$17,838.72 |
Rate for Payer: Aetna Commercial |
$14,308.14
|
Rate for Payer: Anthem Medicaid |
$6,390.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
Rate for Payer: Cash Price |
$9,291.00
|
Rate for Payer: Cigna Commercial |
$15,423.06
|
Rate for Payer: First Health Commercial |
$17,652.90
|
Rate for Payer: Humana Commercial |
$15,794.70
|
Rate for Payer: Humana KY Medicaid |
$6,390.35
|
Rate for Payer: Kentucky WC Medicaid |
$6,455.39
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
Rate for Payer: Molina Healthcare Medicaid |
$6,518.57
|
Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
Rate for Payer: PHCS Commercial |
$17,838.72
|
Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
FATHOM 16 PRELOAD
|
Facility
|
OP
|
$4,356.00
|
|
Service Code
|
HCPCS C1886
|
Hospital Charge Code |
27000013
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$566.28 |
Max. Negotiated Rate |
$4,181.76 |
Rate for Payer: Aetna Commercial |
$3,354.12
|
Rate for Payer: Anthem Medicaid |
$1,498.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,397.68
|
Rate for Payer: Cash Price |
$2,178.00
|
Rate for Payer: Cigna Commercial |
$3,615.48
|
Rate for Payer: First Health Commercial |
$4,138.20
|
Rate for Payer: Humana Commercial |
$3,702.60
|
Rate for Payer: Humana KY Medicaid |
$1,498.03
|
Rate for Payer: Kentucky WC Medicaid |
$1,513.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,214.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.80
|
Rate for Payer: Molina Healthcare Medicaid |
$1,528.08
|
Rate for Payer: Ohio Health Choice Commercial |
$3,833.28
|
Rate for Payer: Ohio Health Group HMO |
$3,267.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$871.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$566.28
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,350.36
|
Rate for Payer: PHCS Commercial |
$4,181.76
|
Rate for Payer: United Healthcare All Payer |
$3,833.28
|
|