|
FLOW RESERVE MEASURE - INITI(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761P2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$455.59 |
| Rate for Payer: Aetna Commercial |
$455.59
|
| Rate for Payer: Anthem Medicaid |
$198.80
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$427.67
|
| Rate for Payer: Healthspan PPO |
$418.89
|
| Rate for Payer: Humana Medicaid |
$198.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.78
|
| Rate for Payer: Molina Healthcare Passport |
$198.80
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.79
|
|
|
FLOW RESERVE MEASURE - INITI(T
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761T2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.90 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
FLOW RESERVE MEASURE - INITI(T
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761T2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.90 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.39
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem Medicaid |
$320.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Humana KY Medicaid |
$320.17
|
| Rate for Payer: Kentucky WC Medicaid |
$323.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.39
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Aetna Commercial |
$198.84
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$193.50
|
| Rate for Payer: Healthspan PPO |
$152.12
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$558.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$651.70
|
| Rate for Payer: UHCCP Medicaid |
$325.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320P0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna Commercial |
$198.84
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$193.50
|
| Rate for Payer: Healthspan PPO |
$152.12
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (T
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320T0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.30 |
| Max. Negotiated Rate |
$672.96 |
| Rate for Payer: Aetna Commercial |
$539.77
|
| Rate for Payer: Anthem Medicaid |
$241.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.78
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$581.83
|
| Rate for Payer: First Health Commercial |
$665.95
|
| Rate for Payer: Humana Commercial |
$595.85
|
| Rate for Payer: Humana KY Medicaid |
$241.07
|
| Rate for Payer: Kentucky WC Medicaid |
$243.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$517.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.88
|
| Rate for Payer: Ohio Health Group HMO |
$525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.69
|
| Rate for Payer: PHCS Commercial |
$672.96
|
| Rate for Payer: United Healthcare All Payer |
$616.88
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (T
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320T0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.30 |
| Max. Negotiated Rate |
$672.96 |
| Rate for Payer: Aetna Commercial |
$539.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.78
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$581.83
|
| Rate for Payer: First Health Commercial |
$665.95
|
| Rate for Payer: Humana Commercial |
$595.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$517.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.88
|
| Rate for Payer: Ohio Health Group HMO |
$525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.69
|
| Rate for Payer: PHCS Commercial |
$672.96
|
| Rate for Payer: United Healthcare All Payer |
$616.88
|
|
|
FLUAD PFS 24-25
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
77000140
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
636T0246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
25004494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Professional
|
Both
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$191.69 |
| Rate for Payer: Ambetter Exchange |
$83.49
|
| Rate for Payer: Anthem Medicaid |
$98.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.19
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$98.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.12
|
| Rate for Payer: Molina Healthcare Passport |
$98.16
|
| Rate for Payer: Multiplan PHCS |
$191.69
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.54
|
| Rate for Payer: UHCCP Medicaid |
$111.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.49
|
|
|
FLUAD PFS 24-25
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Professional
|
Both
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
77000140
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$191.69 |
| Rate for Payer: Ambetter Exchange |
$83.49
|
| Rate for Payer: Anthem Medicaid |
$98.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.19
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$98.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.12
|
| Rate for Payer: Molina Healthcare Passport |
$98.16
|
| Rate for Payer: Multiplan PHCS |
$191.69
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.54
|
| Rate for Payer: UHCCP Medicaid |
$111.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.49
|
|
|
FLUAD PFS 24-25
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
636T0246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
25004494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
77000140
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25 (T
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
770T0140
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25 (T
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
770T0140
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.45
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
OP
|
$347.49
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
636T0004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$333.59 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Anthem Medicaid |
$119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.04
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Cigna Commercial |
$288.42
|
| Rate for Payer: First Health Commercial |
$330.12
|
| Rate for Payer: Humana Commercial |
$295.37
|
| Rate for Payer: Humana KY Medicaid |
$119.50
|
| Rate for Payer: Kentucky WC Medicaid |
$120.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.79
|
| Rate for Payer: Ohio Health Group HMO |
$260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.77
|
| Rate for Payer: PHCS Commercial |
$333.59
|
| Rate for Payer: United Healthcare All Payer |
$305.79
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
IP
|
$347.49
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$333.59 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.04
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Cigna Commercial |
$288.42
|
| Rate for Payer: First Health Commercial |
$330.12
|
| Rate for Payer: Humana Commercial |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.79
|
| Rate for Payer: Ohio Health Group HMO |
$260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.77
|
| Rate for Payer: PHCS Commercial |
$333.59
|
| Rate for Payer: United Healthcare All Payer |
$305.79
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
IP
|
$347.49
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
636T0004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$333.59 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.04
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Cigna Commercial |
$288.42
|
| Rate for Payer: First Health Commercial |
$330.12
|
| Rate for Payer: Humana Commercial |
$295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.79
|
| Rate for Payer: Ohio Health Group HMO |
$260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.77
|
| Rate for Payer: PHCS Commercial |
$333.59
|
| Rate for Payer: United Healthcare All Payer |
$305.79
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
OP
|
$347.49
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$333.59 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Anthem Medicaid |
$119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$271.04
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Cigna Commercial |
$288.42
|
| Rate for Payer: First Health Commercial |
$330.12
|
| Rate for Payer: Humana Commercial |
$295.37
|
| Rate for Payer: Humana KY Medicaid |
$119.50
|
| Rate for Payer: Kentucky WC Medicaid |
$120.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.79
|
| Rate for Payer: Ohio Health Group HMO |
$260.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.77
|
| Rate for Payer: PHCS Commercial |
$333.59
|
| Rate for Payer: United Healthcare All Payer |
$305.79
|
|
