|
FLUTED STEM MOB TIB COMP SZ6
|
Facility
|
IP
|
$9,532.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,859.83 |
| Max. Negotiated Rate |
$9,151.46 |
| Rate for Payer: Aetna Commercial |
$7,340.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.56
|
| Rate for Payer: Cash Price |
$4,766.38
|
| Rate for Payer: Cigna Commercial |
$7,912.20
|
| Rate for Payer: First Health Commercial |
$9,056.13
|
| Rate for Payer: Humana Commercial |
$8,102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,816.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,035.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,388.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,626.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,293.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,577.61
|
| Rate for Payer: PHCS Commercial |
$9,151.46
|
| Rate for Payer: United Healthcare All Payer |
$8,388.84
|
|
|
FLUTED STEM MOB TIB COMP SZ6
|
Facility
|
OP
|
$9,532.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,859.83 |
| Max. Negotiated Rate |
$9,151.46 |
| Rate for Payer: Aetna Commercial |
$7,340.23
|
| Rate for Payer: Anthem Medicaid |
$3,278.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.56
|
| Rate for Payer: Cash Price |
$4,766.38
|
| Rate for Payer: Cigna Commercial |
$7,912.20
|
| Rate for Payer: First Health Commercial |
$9,056.13
|
| Rate for Payer: Humana Commercial |
$8,102.85
|
| Rate for Payer: Humana KY Medicaid |
$3,278.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,311.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,816.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,035.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,388.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,626.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,293.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,577.61
|
| Rate for Payer: PHCS Commercial |
$9,151.46
|
| Rate for Payer: United Healthcare All Payer |
$8,388.84
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
OP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem Medicaid |
$22.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.00
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.34
|
| Rate for Payer: Humana Commercial |
$56.67
|
| Rate for Payer: Humana KY Medicaid |
$22.93
|
| Rate for Payer: Kentucky WC Medicaid |
$23.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.67
|
| Rate for Payer: Ohio Health Group HMO |
$50.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.00
|
| Rate for Payer: PHCS Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Payer |
$58.67
|
|
|
FLU VACCINE 3 YRS +
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
77000022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Ambetter Exchange |
$21.86
|
| Rate for Payer: Anthem Medicaid |
$21.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.23
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Healthspan PPO |
$17.84
|
| Rate for Payer: Humana Medicaid |
$21.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.30
|
| Rate for Payer: Molina Healthcare Passport |
$21.86
|
| Rate for Payer: Multiplan PHCS |
$40.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.42
|
| Rate for Payer: UHCCP Medicaid |
$23.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.86
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
OP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
636T0248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem Medicaid |
$22.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.00
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.34
|
| Rate for Payer: Humana Commercial |
$56.67
|
| Rate for Payer: Humana KY Medicaid |
$22.93
|
| Rate for Payer: Kentucky WC Medicaid |
$23.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.67
|
| Rate for Payer: Ohio Health Group HMO |
$50.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.00
|
| Rate for Payer: PHCS Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Payer |
$58.67
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
77000022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$23.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$23.04
|
| Rate for Payer: Kentucky WC Medicaid |
$23.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
IP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.00
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.34
|
| Rate for Payer: Humana Commercial |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.67
|
| Rate for Payer: Ohio Health Group HMO |
$50.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.00
|
| Rate for Payer: PHCS Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Payer |
$58.67
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
77000022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
IP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
636T0248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.00
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.34
|
| Rate for Payer: Humana Commercial |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.67
|
| Rate for Payer: Ohio Health Group HMO |
$50.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.00
|
| Rate for Payer: PHCS Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Payer |
$58.67
|
|
|
FLU VACCINE 3 YRS +
|
Professional
|
Both
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Ambetter Exchange |
$21.86
|
| Rate for Payer: Anthem Medicaid |
$21.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.23
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Healthspan PPO |
$17.84
|
| Rate for Payer: Humana Medicaid |
$21.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.30
|
| Rate for Payer: Molina Healthcare Passport |
$21.86
|
| Rate for Payer: Multiplan PHCS |
$40.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.42
|
| Rate for Payer: UHCCP Medicaid |
$23.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.86
|
|
|
FLU VACCINE 3 YRS +(T
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
770T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
FLU VACCINE 3 YRS +(T
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
770T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$23.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$23.04
|
| Rate for Payer: Kentucky WC Medicaid |
$23.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
OP
|
$347.49
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Professional
|
Both
|
$347.49
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Ambetter Exchange |
$83.49
|
| Rate for Payer: Anthem Medicaid |
$83.49
|
| 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 |
$173.74
|
| Rate for Payer: Cash Price |
$173.74
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$83.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| 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 |
$85.16
|
| Rate for Payer: Molina Healthcare Passport |
$83.49
|
| Rate for Payer: Multiplan PHCS |
$208.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.54
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.49
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Professional
|
Both
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
25000021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$194.24 |
| Rate for Payer: Ambetter Exchange |
$83.49
|
| Rate for Payer: Anthem Medicaid |
$83.49
|
| 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 |
$161.86
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$83.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| 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 |
$85.16
|
| Rate for Payer: Molina Healthcare Passport |
$83.49
|
| Rate for Payer: Multiplan PHCS |
$194.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.54
|
| Rate for Payer: UHCCP Medicaid |
$113.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.49
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
IP
|
$347.49
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
636T0003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
IP
|
$347.49
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
OP
|
$347.49
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
636T0003
|
|
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
|
|
|
FLUZONE VACC, 3 YRS & >, IM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Hospital Charge Code |
77000060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
FLUZONE VACC, 3 YRS & >, IM
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Hospital Charge Code |
77000060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
FLXOR BALKIN SHEATH 8.0 WO WIR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FLXOR BALKIN SHEATH 8.0 WO WIR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FNA BX W/CT GDN EA ADDL
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$468.60 |
| Rate for Payer: Ambetter Exchange |
$68.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$213.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.72
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$445.49
|
| Rate for Payer: Humana Medicaid |
$213.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.22
|
| Rate for Payer: Molina Healthcare Passport |
$213.94
|
| Rate for Payer: Multiplan PHCS |
$468.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.61
|
| Rate for Payer: UHCCP Medicaid |
$42.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.93
|
|
|
FNA BX W/CT GDN EA ADDL
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem Medicaid |
$268.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Humana KY Medicaid |
$268.59
|
| Rate for Payer: Kentucky WC Medicaid |
$271.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.89
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
FNA BX W/CT GDN EA ADDL
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.89
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
