|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761T0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
761P0495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.37
|
| Rate for Payer: Anthem Medicaid |
$60.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Healthspan PPO |
$340.55
|
| Rate for Payer: Humana Medicaid |
$60.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.77
|
| Rate for Payer: Molina Healthcare Passport |
$60.56
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$86.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.17
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$224.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.37
|
| Rate for Payer: Anthem Medicaid |
$60.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$255.77
|
| Rate for Payer: Healthspan PPO |
$340.55
|
| Rate for Payer: Humana Medicaid |
$60.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$193.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.77
|
| Rate for Payer: Molina Healthcare Passport |
$60.56
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$86.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.17
|
|
|
I&D UPPER ARM/ELBOW AREA BURSA
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 23931
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
45000288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$139.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$139.28
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
45000288
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
I&D VULVA PERINEAL ABSCESS
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
76102154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$158.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.25
|
| Rate for Payer: Anthem Medicaid |
$54.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$162.24
|
| Rate for Payer: Healthspan PPO |
$156.55
|
| Rate for Payer: Humana Medicaid |
$54.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.71
|
| Rate for Payer: Molina Healthcare Passport |
$54.62
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$72.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.17
|
|
|
I&D VULVA PERINEAL ABSCESS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761P2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$158.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.25
|
| Rate for Payer: Anthem Medicaid |
$54.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$162.24
|
| Rate for Payer: Healthspan PPO |
$156.55
|
| Rate for Payer: Humana Medicaid |
$54.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.71
|
| Rate for Payer: Molina Healthcare Passport |
$54.62
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$72.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.17
|
|
|
I&D VULVA PERINEAL ABSCESS(T
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761T2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.60
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Humana Commercial |
$612.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.60
|
| Rate for Payer: Ohio Health Group HMO |
$540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.20
|
| Rate for Payer: PHCS Commercial |
$691.20
|
| Rate for Payer: United Healthcare All Payer |
$633.60
|
|
|
I&D VULVA PERINEAL ABSCESS(T
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
761T2154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Anthem Medicaid |
$247.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Humana Commercial |
$612.00
|
| Rate for Payer: Humana KY Medicaid |
$247.61
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$250.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.60
|
| Rate for Payer: Ohio Health Group HMO |
$540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.20
|
| Rate for Payer: PHCS Commercial |
$691.20
|
| Rate for Payer: United Healthcare All Payer |
$633.60
|
|
|
IFEX (IFOSFAMIDE) 1GM/20ML
|
Facility
|
IP
|
$200.23
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
25002629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$192.22 |
| Rate for Payer: Aetna Commercial |
$154.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.18
|
| Rate for Payer: Cash Price |
$100.11
|
| Rate for Payer: Cigna Commercial |
$166.19
|
| Rate for Payer: First Health Commercial |
$190.22
|
| Rate for Payer: Humana Commercial |
$170.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.20
|
| Rate for Payer: Ohio Health Group HMO |
$150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.07
|
| Rate for Payer: PHCS Commercial |
$192.22
|
| Rate for Payer: United Healthcare All Payer |
$176.20
|
|
|
IFEX (IFOSFAMIDE) 1GM/20ML
|
Facility
|
OP
|
$200.23
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
25002629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.03 |
| Max. Negotiated Rate |
$192.22 |
| Rate for Payer: Aetna Commercial |
$154.18
|
| Rate for Payer: Anthem Medicaid |
$68.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.18
|
| Rate for Payer: Cash Price |
$100.11
|
| Rate for Payer: Cigna Commercial |
$166.19
|
| Rate for Payer: First Health Commercial |
$190.22
|
| Rate for Payer: Humana Commercial |
$170.20
|
| Rate for Payer: Humana KY Medicaid |
$68.86
|
| Rate for Payer: Kentucky WC Medicaid |
$69.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.20
|
| Rate for Payer: Ohio Health Group HMO |
$150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.07
|
| Rate for Payer: PHCS Commercial |
$192.22
|
| Rate for Payer: United Healthcare All Payer |
$176.20
|
|
|
IFR MEASUREMENT
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
48100101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
IFR MEASUREMENT
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
48100101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$135.08 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.03
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
IFR MEASUREMENT
|
Professional
|
Both
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
48100101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,813.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,813.00
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,087.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,269.10
|
| Rate for Payer: UHCCP Medicaid |
$634.55
|
|
|
IFR MEASUREMENT (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
481P0101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
IFR MEASUREMENT (T
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
481T0101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$135.08 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
IFR MEASUREMENT (T
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
481T0101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
IIV3 VACC NO PRSV 0.25 ML IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90655
|
| Hospital Charge Code |
77000019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$93.00
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.74
|
| Rate for Payer: Multiplan PHCS |
$55.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.10
|
| Rate for Payer: UHCCP Medicaid |
$32.55
|
|
|
IIV3 VACC NO PRSV 0.25 ML IM
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 90655
|
| Hospital Charge Code |
77000019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
IIV3 VACC NO PRSV 0.25 ML IM
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 90655
|
| Hospital Charge Code |
77000019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
IIV3 VACC NO PRSV 0.25 ML I(T
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 90655
|
| Hospital Charge Code |
770T0019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
