|
FLUOROSCOPY
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
FLUOROSCOPY
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Ambetter Exchange |
$39.03
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.84
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$487.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$284.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.03
|
|
|
FLUOROSCOPY
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
FLUOROSCOPY CHARGE
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY CHARGE
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Ambetter Exchange |
$39.03
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.84
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$460.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$268.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.03
|
|
|
FLUOROSCOPY CHARGE
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY CHARGE (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320P1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Ambetter Exchange |
$39.03
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.84
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.03
|
|
|
FLUOROSCOPY CHARGE (T
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.17
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROSCOPY CHARGE (T
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem Medicaid |
$238.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Humana KY Medicaid |
$238.32
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$240.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.17
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROSCOPY (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320P0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Ambetter Exchange |
$39.03
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.84
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.74
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.03
|
|
|
FLUOROSCOPY (T
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.22
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
FLUOROSCOPY (T
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem Medicaid |
$253.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Humana KY Medicaid |
$253.80
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.22
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
FLUOROURACIL 500MG
|
Facility
|
OP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
25002617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Kentucky WC Medicaid |
$6.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLUOROURACIL 500MG
|
Facility
|
IP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
25002617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
FLUOROURACIL 500MG AMB
|
Facility
|
IP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
63600260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLUOROURACIL 500MG AMB
|
Facility
|
OP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
636T0260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLUOROURACIL 500MG AMB
|
Professional
|
Both
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
636P0260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Ambetter Exchange |
$1.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.06
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.72
|
| Rate for Payer: Multiplan PHCS |
$11.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$6.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.72
|
|
|
FLUOROURACIL 500MG AMB
|
Facility
|
IP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
636T0260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLUOROURACIL 500MG AMB
|
Professional
|
Both
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
63600260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Ambetter Exchange |
$1.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.06
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.72
|
| Rate for Payer: Multiplan PHCS |
$11.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$6.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.72
|
|
|
FLUOROURACIL 500MG AMB
|
Facility
|
OP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
63600260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.86
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Facility
|
IP
|
$322.77
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$248.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.76
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: First Health Commercial |
$306.63
|
| Rate for Payer: Humana Commercial |
$274.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.04
|
| Rate for Payer: Ohio Health Group HMO |
$242.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.71
|
| Rate for Payer: PHCS Commercial |
$309.86
|
| Rate for Payer: United Healthcare All Payer |
$284.04
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Professional
|
Both
|
$322.77
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Anthem Medicaid |
$77.36
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Humana Medicaid |
$77.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.91
|
| Rate for Payer: Molina Healthcare Passport |
$77.36
|
| Rate for Payer: Multiplan PHCS |
$193.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$225.94
|
| Rate for Payer: UHCCP Medicaid |
$112.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.13
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Facility
|
OP
|
$322.77
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$248.53
|
| Rate for Payer: Anthem Medicaid |
$111.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.76
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: First Health Commercial |
$306.63
|
| Rate for Payer: Humana Commercial |
$274.35
|
| Rate for Payer: Humana KY Medicaid |
$111.00
|
| Rate for Payer: Kentucky WC Medicaid |
$112.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.04
|
| Rate for Payer: Ohio Health Group HMO |
$242.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.71
|
| Rate for Payer: PHCS Commercial |
$309.86
|
| Rate for Payer: United Healthcare All Payer |
$284.04
|
|
|
FLU QUAD PFS 0.5ML PFS (T
|
Facility
|
IP
|
$322.77
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
636T0192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$248.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.76
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: First Health Commercial |
$306.63
|
| Rate for Payer: Humana Commercial |
$274.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.04
|
| Rate for Payer: Ohio Health Group HMO |
$242.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.71
|
| Rate for Payer: PHCS Commercial |
$309.86
|
| Rate for Payer: United Healthcare All Payer |
$284.04
|
|
|
FLU QUAD PFS 0.5ML PFS (T
|
Facility
|
OP
|
$322.77
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
636T0192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$248.53
|
| Rate for Payer: Anthem Medicaid |
$111.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.76
|
| Rate for Payer: Cash Price |
$161.38
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: First Health Commercial |
$306.63
|
| Rate for Payer: Humana Commercial |
$274.35
|
| Rate for Payer: Humana KY Medicaid |
$111.00
|
| Rate for Payer: Kentucky WC Medicaid |
$112.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.04
|
| Rate for Payer: Ohio Health Group HMO |
$242.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.71
|
| Rate for Payer: PHCS Commercial |
$309.86
|
| Rate for Payer: United Healthcare All Payer |
$284.04
|
|
