|
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 |
$573.46 |
| 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 |
$1,529.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.96
|
| Rate for Payer: PHCS Commercial |
$1,835.07
|
| Rate for Payer: United Healthcare All Payer |
$1,682.15
|
|
|
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 |
$6.98 |
| 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 |
$6.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.42
|
| 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 |
$6.98
|
| 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 |
$8.38
|
| 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 |
$1,529.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.96
|
| Rate for Payer: PHCS Commercial |
$1,835.07
|
| Rate for Payer: United Healthcare All Payer |
$1,682.15
|
|
|
FAST CATH DUO HEMOSTASIS 12F
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
FAST CATH DUO HEMOSTASIS 12F
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem Medicaid |
$181.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Humana KY Medicaid |
$181.24
|
| Rate for Payer: Kentucky WC Medicaid |
$183.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
FASTPASS SCORPION SL-MF
|
Facility
|
IP
|
$10,290.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,087.26 |
| Max. Negotiated Rate |
$9,879.24 |
| Rate for Payer: Aetna Commercial |
$7,923.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,026.89
|
| Rate for Payer: Cash Price |
$5,145.44
|
| Rate for Payer: Cigna Commercial |
$8,541.43
|
| Rate for Payer: First Health Commercial |
$9,776.34
|
| Rate for Payer: Humana Commercial |
$8,747.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,438.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,594.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,087.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,055.97
|
| Rate for Payer: Ohio Health Group HMO |
$7,718.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,232.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,953.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,100.71
|
| Rate for Payer: PHCS Commercial |
$9,879.24
|
| Rate for Payer: United Healthcare All Payer |
$9,055.97
|
|
|
FASTPASS SCORPION SL-MF
|
Facility
|
OP
|
$10,290.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,087.26 |
| Max. Negotiated Rate |
$9,879.24 |
| Rate for Payer: Aetna Commercial |
$7,923.98
|
| Rate for Payer: Anthem Medicaid |
$3,539.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,026.89
|
| Rate for Payer: Cash Price |
$5,145.44
|
| Rate for Payer: Cigna Commercial |
$8,541.43
|
| Rate for Payer: First Health Commercial |
$9,776.34
|
| Rate for Payer: Humana Commercial |
$8,747.25
|
| Rate for Payer: Humana KY Medicaid |
$3,539.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,575.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,438.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,594.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,087.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,610.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,055.97
|
| Rate for Payer: Ohio Health Group HMO |
$7,718.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,232.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,953.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,100.71
|
| Rate for Payer: PHCS Commercial |
$9,879.24
|
| Rate for Payer: United Healthcare All Payer |
$9,055.97
|
|
|
FATHOM 16 PRELOAD
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,293.00 |
| Max. Negotiated Rate |
$4,137.60 |
| Rate for Payer: Aetna Commercial |
$3,318.70
|
| Rate for Payer: Anthem Medicaid |
$1,482.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.80
|
| Rate for Payer: Cash Price |
$2,155.00
|
| Rate for Payer: Cigna Commercial |
$3,577.30
|
| Rate for Payer: First Health Commercial |
$4,094.50
|
| Rate for Payer: Humana Commercial |
$3,663.50
|
| Rate for Payer: Humana KY Medicaid |
$1,482.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,511.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,749.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,973.90
|
| Rate for Payer: PHCS Commercial |
$4,137.60
|
| Rate for Payer: United Healthcare All Payer |
$3,792.80
|
|
|
FATHOM 16 PRELOAD
|
Facility
|
IP
|
$4,310.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,293.00 |
| Max. Negotiated Rate |
$4,137.60 |
| Rate for Payer: Aetna Commercial |
$3,318.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.80
|
| Rate for Payer: Cash Price |
$2,155.00
|
| Rate for Payer: Cigna Commercial |
$3,577.30
|
| Rate for Payer: First Health Commercial |
$4,094.50
|
| Rate for Payer: Humana Commercial |
$3,663.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,749.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,973.90
|
| Rate for Payer: PHCS Commercial |
$4,137.60
|
| Rate for Payer: United Healthcare All Payer |
$3,792.80
|
|
|
FAT W/FACELIFT ORTH COSMEC PX
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
22200089
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
FAT W/FACELIFT ORTH COSMEC PX
|
Professional
|
Both
|
$500.00
|
|
| Hospital Charge Code |
22200089
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
|
|
FAT W/FACELIFT ORTH COSMEC PX
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
22200089
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
FAT W/FACELIFT OTH COSM PX-80
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200385
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
FAT W/FACELIFT OTH COSM PX-80
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
22200385
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
FAT W/FACELIFT OTH COSM PX-80
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
22200385
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
76102381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem Medicaid |
$202.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Humana KY Medicaid |
$202.56
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$204.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.41
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
76102381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$60.25
|
| Rate for Payer: Ambetter Exchange |
$26.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.15
|
| Rate for Payer: Anthem Medicaid |
$33.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.24
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$74.23
|
| Rate for Payer: Healthspan PPO |
$66.27
|
| Rate for Payer: Humana Medicaid |
$33.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.97
|
| Rate for Payer: Molina Healthcare Passport |
$33.30
|
| Rate for Payer: Multiplan PHCS |
$353.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.93
|
| Rate for Payer: UHCCP Medicaid |
$27.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.87
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
76102381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$453.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$459.42
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$488.87
|
| Rate for Payer: First Health Commercial |
$559.55
|
| Rate for Payer: Humana Commercial |
$500.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$434.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$518.32
|
| Rate for Payer: Ohio Health Group HMO |
$441.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.41
|
| Rate for Payer: PHCS Commercial |
$565.44
|
| Rate for Payer: United Healthcare All Payer |
$518.32
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
45000297
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.70 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.81
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
45000297
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.81
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL(P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
761P2381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$60.25
|
| Rate for Payer: Ambetter Exchange |
$26.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.15
|
| Rate for Payer: Anthem Medicaid |
$33.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.24
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$74.23
|
| Rate for Payer: Healthspan PPO |
$66.27
|
| Rate for Payer: Humana Medicaid |
$33.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.97
|
| Rate for Payer: Molina Healthcare Passport |
$33.30
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.93
|
| Rate for Payer: UHCCP Medicaid |
$27.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.87
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL(T
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
761T2381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.81
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
FBR CONJUNCTIVAL SUPERFICIAL(T
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
761T2381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.70 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$303.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.81
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
FBR FOOT SUBCUTANIOUS
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
45000173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$618.33 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
FBR FOOT SUBCUTANIOUS
|
Professional
|
Both
|
$2,348.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
76100989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$1,408.80 |
| Rate for Payer: Aetna Commercial |
$202.76
|
| Rate for Payer: Ambetter Exchange |
$125.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.17
|
| Rate for Payer: Anthem Medicaid |
$71.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.05
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cigna Commercial |
$354.18
|
| Rate for Payer: Healthspan PPO |
$300.98
|
| Rate for Payer: Humana Medicaid |
$71.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.63
|
| Rate for Payer: Molina Healthcare Passport |
$71.21
|
| Rate for Payer: Multiplan PHCS |
$1,408.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.55
|
| Rate for Payer: UHCCP Medicaid |
$77.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.04
|
|
|
FBR FOOT SUBCUTANIOUS
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
76100989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,254.08 |
| Rate for Payer: Aetna Commercial |
$1,807.96
|
| Rate for Payer: Anthem Medicaid |
$807.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,831.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cigna Commercial |
$1,948.84
|
| Rate for Payer: First Health Commercial |
$2,230.60
|
| Rate for Payer: Humana Commercial |
$1,995.80
|
| Rate for Payer: Humana KY Medicaid |
$807.48
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$815.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,925.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$823.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,066.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,761.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,042.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.12
|
| Rate for Payer: PHCS Commercial |
$2,254.08
|
| Rate for Payer: United Healthcare All Payer |
$2,066.24
|
|
