|
HAVRIX 720 EL U/0.5 ML VIAL
|
Facility
|
IP
|
$194.38
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
25000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$186.60 |
| Rate for Payer: Aetna Commercial |
$149.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.62
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cigna Commercial |
$161.34
|
| Rate for Payer: First Health Commercial |
$184.66
|
| Rate for Payer: Humana Commercial |
$165.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.05
|
| Rate for Payer: Ohio Health Group HMO |
$145.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.12
|
| Rate for Payer: PHCS Commercial |
$186.60
|
| Rate for Payer: United Healthcare All Payer |
$171.05
|
|
|
HAWK 1 7FR STD. NOSECONE
|
Facility
|
IP
|
$17,886.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,365.95 |
| Max. Negotiated Rate |
$17,171.04 |
| Rate for Payer: Aetna Commercial |
$13,772.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,951.47
|
| Rate for Payer: Cash Price |
$8,943.25
|
| Rate for Payer: Cigna Commercial |
$14,845.80
|
| Rate for Payer: First Health Commercial |
$16,992.17
|
| Rate for Payer: Humana Commercial |
$15,203.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,666.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,200.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,365.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,740.12
|
| Rate for Payer: Ohio Health Group HMO |
$13,414.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,309.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,561.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,341.68
|
| Rate for Payer: PHCS Commercial |
$17,171.04
|
| Rate for Payer: United Healthcare All Payer |
$15,740.12
|
|
|
HAWK 1 7FR STD. NOSECONE
|
Facility
|
OP
|
$17,886.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,365.95 |
| Max. Negotiated Rate |
$17,171.04 |
| Rate for Payer: Aetna Commercial |
$13,772.60
|
| Rate for Payer: Anthem Medicaid |
$6,151.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,951.47
|
| Rate for Payer: Cash Price |
$8,943.25
|
| Rate for Payer: Cigna Commercial |
$14,845.80
|
| Rate for Payer: First Health Commercial |
$16,992.17
|
| Rate for Payer: Humana Commercial |
$15,203.52
|
| Rate for Payer: Humana KY Medicaid |
$6,151.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,213.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,666.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,200.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,365.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,274.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,740.12
|
| Rate for Payer: Ohio Health Group HMO |
$13,414.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,309.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,561.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,341.68
|
| Rate for Payer: PHCS Commercial |
$17,171.04
|
| Rate for Payer: United Healthcare All Payer |
$15,740.12
|
|
|
HAWK 1 LONG NOSECONE
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
HAWK 1 LONG NOSECONE
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
HAWKONE V01
|
Facility
|
IP
|
$29,375.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
HAWKONE V01
|
Facility
|
OP
|
$29,375.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem Medicaid |
$10,102.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Humana KY Medicaid |
$10,102.06
|
| Rate for Payer: Kentucky WC Medicaid |
$10,204.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,304.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
HAWKONE V02
|
Facility
|
IP
|
$29,375.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
HAWKONE V02
|
Facility
|
OP
|
$29,375.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem Medicaid |
$10,102.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Humana KY Medicaid |
$10,102.06
|
| Rate for Payer: Kentucky WC Medicaid |
$10,204.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,304.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
HBO TX (GROUP)
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
76001123
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$127.42 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$127.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$178.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.02
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Humana KY Medicaid |
$173.33
|
| Rate for Payer: Humana Medicare Advantage |
$127.42
|
| Rate for Payer: Kentucky WC Medicaid |
$175.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
HBO TX (GROUP)
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
76001123
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
HBO TX PER SESSION > 91 MIN
|
Professional
|
Both
|
$2,348.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$1,408.80 |
| Rate for Payer: Aetna Commercial |
$180.73
|
| Rate for Payer: Ambetter Exchange |
$100.26
|
| 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 Individual/Medicaid |
$100.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.31
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cash Price |
$1,174.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.45
|
| Rate for Payer: Molina Healthcare Passport |
$116.13
|
| Rate for Payer: Multiplan PHCS |
$1,408.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.34
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.26
|
|
|
HBO TX PER SESSION > 91 MIN
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$704.40 |
| Max. Negotiated Rate |
$2,254.08 |
| Rate for Payer: Aetna Commercial |
$1,807.96
|
| Rate for Payer: Anthem Medicaid |
$807.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,831.44
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cigna Commercial |
$1,948.84
|
| Rate for Payer: First Health Commercial |
$2,230.60
|
| Rate for Payer: Humana Commercial |
$1,995.80
|
| Rate for Payer: Humana KY Medicaid |
$807.48
|
| Rate for Payer: Kentucky WC Medicaid |
$815.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,925.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$704.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$823.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,066.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,761.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,042.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.12
|
| Rate for Payer: PHCS Commercial |
$2,254.08
|
| Rate for Payer: United Healthcare All Payer |
$2,066.24
|
|
|
HBO TX PER SESSION > 91 MIN
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
76001122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$704.40 |
| Max. Negotiated Rate |
$2,254.08 |
| Rate for Payer: Aetna Commercial |
$1,807.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,831.44
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cigna Commercial |
$1,948.84
|
| Rate for Payer: First Health Commercial |
$2,230.60
|
| Rate for Payer: Humana Commercial |
$1,995.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,925.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$704.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,066.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,761.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,042.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.12
|
| Rate for Payer: PHCS Commercial |
$2,254.08
|
| Rate for Payer: United Healthcare All Payer |
$2,066.24
|
|
|
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 |
$180.73 |
| Rate for Payer: Aetna Commercial |
$180.73
|
| Rate for Payer: Ambetter Exchange |
$100.26
|
| 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 Individual/Medicaid |
$100.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.26
|
| 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 |
$130.34
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.26
|
|
|
HBO TX PER SESSION > 91 MIN(T
|
Facility
|
OP
|
$2,048.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
760T1122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$614.40 |
| Max. Negotiated Rate |
$1,966.08 |
| Rate for Payer: Aetna Commercial |
$1,576.96
|
| Rate for Payer: Anthem Medicaid |
$704.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.44
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cigna Commercial |
$1,699.84
|
| Rate for Payer: First Health Commercial |
$1,945.60
|
| Rate for Payer: Humana Commercial |
$1,740.80
|
| Rate for Payer: Humana KY Medicaid |
$704.31
|
| Rate for Payer: Kentucky WC Medicaid |
$711.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$718.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,536.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.12
|
| Rate for Payer: PHCS Commercial |
$1,966.08
|
| Rate for Payer: United Healthcare All Payer |
$1,802.24
|
|
|
HBO TX PER SESSION > 91 MIN(T
|
Facility
|
IP
|
$2,048.00
|
|
|
Service Code
|
HCPCS 99183
|
| Hospital Charge Code |
760T1122
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$614.40 |
| Max. Negotiated Rate |
$1,966.08 |
| Rate for Payer: Aetna Commercial |
$1,576.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.44
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cigna Commercial |
$1,699.84
|
| Rate for Payer: First Health Commercial |
$1,945.60
|
| Rate for Payer: Humana Commercial |
$1,740.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,536.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.12
|
| Rate for Payer: PHCS Commercial |
$1,966.08
|
| Rate for Payer: United Healthcare All Payer |
$1,802.24
|
|
|
HCG-PREG (QUAL) BETA
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$7.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.52
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| 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 |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
HCG-PREG (QUAL) BETA
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$13.56
|
| Rate for Payer: Ambetter Exchange |
$7.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.02
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$10.74
|
| Rate for Payer: Healthspan PPO |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.52
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.78
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.52
|
|
|
HCG-PREG (QUAL) BETA
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
30000562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
H CHLOR 12 0.125% SOLUTION
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
25003091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
H CHLOR 12 0.125% SOLUTION
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 39328006412
|
| Hospital Charge Code |
25003091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem Medicaid |
$0.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Humana KY Medicaid |
$0.48
|
| Rate for Payer: Kentucky WC Medicaid |
$0.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
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: Ambetter Exchange |
$124.82
|
| Rate for Payer: Anthem Medicaid |
$65.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$124.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.82
|
| 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 |
$162.27
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.82
|
|
|
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 |
$176.58 |
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Ambetter Exchange |
$100.93
|
| Rate for Payer: Anthem Medicaid |
$59.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.93
|
| 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 |
$131.21
|
| 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
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.93
|
|
|
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 |
$62.61 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Ambetter Exchange |
$37.24
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$37.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.24
|
| 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 |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.24
|
|
