|
HAWKONE V02
|
Facility
|
IP
|
$28,525.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,708.25 |
| Max. Negotiated Rate |
$27,384.00 |
| Rate for Payer: Aetna Commercial |
$21,964.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,249.50
|
| Rate for Payer: Cash Price |
$14,262.50
|
| Rate for Payer: Cigna Commercial |
$23,675.75
|
| Rate for Payer: First Health Commercial |
$27,098.75
|
| Rate for Payer: Humana Commercial |
$24,246.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,390.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,051.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,557.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,102.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,705.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,842.75
|
| Rate for Payer: PHCS Commercial |
$27,384.00
|
| Rate for Payer: United Healthcare All Payer |
$25,102.00
|
|
|
HBO TX (GROUP)
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
76001123
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem Medicaid |
$165.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$167.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.99
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Humana KY Medicaid |
$165.42
|
| Rate for Payer: Humana Medicare Advantage |
$119.99
|
| Rate for Payer: Kentucky WC Medicaid |
$167.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
HBO TX (GROUP)
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
76001123
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$461.76 |
| Rate for Payer: Aetna Commercial |
$370.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.18
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cigna Commercial |
$399.23
|
| Rate for Payer: First Health Commercial |
$456.95
|
| Rate for Payer: Humana Commercial |
$408.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.28
|
| Rate for Payer: Ohio Health Group HMO |
$360.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.11
|
| Rate for Payer: PHCS Commercial |
$461.76
|
| Rate for Payer: United Healthcare All Payer |
$423.28
|
|
|
HBO TX PER SESSION > 91 MIN
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$288.99 |
| Max. Negotiated Rate |
$2,134.08 |
| Rate for Payer: Aetna Commercial |
$1,711.71
|
| Rate for Payer: Anthem Medicaid |
$764.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.94
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cigna Commercial |
$1,845.09
|
| Rate for Payer: First Health Commercial |
$2,111.85
|
| Rate for Payer: Humana Commercial |
$1,889.55
|
| Rate for Payer: Humana KY Medicaid |
$764.49
|
| Rate for Payer: Kentucky WC Medicaid |
$772.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.13
|
| Rate for Payer: PHCS Commercial |
$2,134.08
|
| Rate for Payer: United Healthcare All Payer |
$1,956.24
|
|
|
HBO TX PER SESSION > 91 MIN
|
Professional
|
Both
|
$2,223.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$180.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.33
|
| Rate for Payer: Anthem Medicaid |
$116.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cigna Commercial |
$148.78
|
| Rate for Payer: Humana Medicaid |
$116.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.45
|
| Rate for Payer: Molina Healthcare Passport |
$116.13
|
| Rate for Payer: Multiplan PHCS |
$1,333.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,556.10
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.29
|
|
|
HBO TX PER SESSION > 91 MIN
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$288.99 |
| Max. Negotiated Rate |
$2,134.08 |
| Rate for Payer: Aetna Commercial |
$1,711.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.94
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cigna Commercial |
$1,845.09
|
| Rate for Payer: First Health Commercial |
$2,111.85
|
| Rate for Payer: Humana Commercial |
$1,889.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.13
|
| Rate for Payer: PHCS Commercial |
$2,134.08
|
| Rate for Payer: United Healthcare All Payer |
$1,956.24
|
|
|
HBO TX PER SESSION > 91 MIN(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
760P1122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$180.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.33
|
| Rate for Payer: Anthem Medicaid |
$116.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$148.78
|
| Rate for Payer: Humana Medicaid |
$116.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.45
|
| Rate for Payer: Molina Healthcare Passport |
$116.13
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.29
|
|
|
HBO TX PER SESSION > 91 MIN(T
|
Facility
|
IP
|
$1,923.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
760T1122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$249.99 |
| Max. Negotiated Rate |
$1,846.08 |
| Rate for Payer: Aetna Commercial |
$1,480.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,499.94
|
| Rate for Payer: Cash Price |
$961.50
|
| Rate for Payer: Cigna Commercial |
$1,596.09
|
| Rate for Payer: First Health Commercial |
$1,826.85
|
| Rate for Payer: Humana Commercial |
$1,634.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,576.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.13
|
| Rate for Payer: PHCS Commercial |
$1,846.08
|
| Rate for Payer: United Healthcare All Payer |
$1,692.24
|
|
|
HBO TX PER SESSION > 91 MIN(T
|
Facility
|
OP
|
$1,923.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
760T1122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$249.99 |
| Max. Negotiated Rate |
$1,846.08 |
| Rate for Payer: Aetna Commercial |
$1,480.71
|
| Rate for Payer: Anthem Medicaid |
$661.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,499.94
|
| Rate for Payer: Cash Price |
$961.50
|
| Rate for Payer: Cigna Commercial |
$1,596.09
|
| Rate for Payer: First Health Commercial |
$1,826.85
|
| Rate for Payer: Humana Commercial |
$1,634.55
|
| Rate for Payer: Humana KY Medicaid |
$661.32
|
| Rate for Payer: Kentucky WC Medicaid |
$668.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,576.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.13
|
| Rate for Payer: PHCS Commercial |
$1,846.08
|
| Rate for Payer: United Healthcare All Payer |
$1,692.24
|
|
|
HCG-PREG (QUAL) BETA
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$7.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.52
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$7.52
|
| Rate for Payer: Humana Medicare Advantage |
$7.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
HCG-PREG (QUAL) BETA
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$10.74
|
| Rate for Payer: Healthspan PPO |
$7.87
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.20
|
| Rate for Payer: UHCCP Medicaid |
$23.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.51
|
|
|
HCG-PREG (QUAL) BETA
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
H CHLOR 12 0.125% SOLUTION
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
25003091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.01
|
| Rate for Payer: Anthem Medicaid |
$0.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.02
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna Commercial |
$1.09
|
| Rate for Payer: First Health Commercial |
$1.24
|
| Rate for Payer: Humana Commercial |
$1.11
|
| Rate for Payer: Humana KY Medicaid |
$0.45
|
| Rate for Payer: Kentucky WC Medicaid |
$0.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.15
|
| Rate for Payer: Ohio Health Group HMO |
$0.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Payer |
$1.15
|
|
|
H CHLOR 12 0.125% SOLUTION
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
25003091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.02
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna Commercial |
$1.09
|
| Rate for Payer: First Health Commercial |
$1.24
|
| Rate for Payer: Humana Commercial |
$1.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.15
|
| Rate for Payer: Ohio Health Group HMO |
$0.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Payer |
$1.15
|
|
|
HC NURSING FACILITY CARE INIT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99305
|
| Hospital Charge Code |
51000301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$176.84 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Anthem Medicaid |
$65.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$123.78
|
| Rate for Payer: Healthspan PPO |
$131.46
|
| Rate for Payer: Humana Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.97
|
| Rate for Payer: Molina Healthcare Passport |
$65.66
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.32
|
|
|
HC NURSING FACILITY CARE SUBSQ
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000302
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
|
|
HC NURSING FACILITY CARE SUBSQ
|
Professional
|
Both
|
$294.30
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
51000303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Anthem Medicaid |
$59.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.30
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna Commercial |
$112.61
|
| Rate for Payer: Healthspan PPO |
$94.37
|
| Rate for Payer: Humana Medicaid |
$59.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.70
|
| Rate for Payer: Molina Healthcare Passport |
$59.51
|
| Rate for Payer: Multiplan PHCS |
$176.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.01
|
| Rate for Payer: UHCCP Medicaid |
$103.00
|
| Rate for Payer: United Healthcare Non-Options |
$87.43
|
| Rate for Payer: United Healthcare Options |
$71.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.11
|
|
|
HC NURSING FACILITY CARE SUBSQ
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
51000340
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Healthspan PPO |
$46.54
|
| Rate for Payer: Humana Medicaid |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.11
|
| Rate for Payer: Molina Healthcare Passport |
$34.42
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
|
|
HCTZ 12.5 MG CAP
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 60687068301
|
| Hospital Charge Code |
25000756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
HCTZ 12.5 MG CAP
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 60687068301
|
| Hospital Charge Code |
25000756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
HCU CRITICAL CARE ROOM RATE
|
Facility
|
IP
|
$3,432.00
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
HCU RECOVERY CARE
|
Facility
|
OP
|
$1,960.00
|
|
| Hospital Charge Code |
71000004
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem Medicaid |
$674.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Humana KY Medicaid |
$674.04
|
| Rate for Payer: Kentucky WC Medicaid |
$680.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
HCU RECOVERY CARE
|
Facility
|
IP
|
$1,960.00
|
|
| Hospital Charge Code |
71000004
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
HCU ROOM RATE
|
Facility
|
IP
|
$3,432.00
|
|
| Hospital Charge Code |
21000001
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
HCV RNA DETECT/QUANT S
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
30001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
