|
INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
51000142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.94
|
| Rate for Payer: Anthem Medicaid |
$20.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Humana Medicaid |
$20.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
|
|
INITIAL PREVENTIVE EXAM (P
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
500P0187
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$144.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.69
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
|
|
INITIATE AMB INFUS CHEMO PUMP
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
33100008
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$477.12 |
| Rate for Payer: Aetna Commercial |
$382.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.66
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$412.51
|
| Rate for Payer: First Health Commercial |
$472.15
|
| Rate for Payer: Humana Commercial |
$422.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.36
|
| Rate for Payer: Ohio Health Group HMO |
$372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.07
|
| Rate for Payer: PHCS Commercial |
$477.12
|
| Rate for Payer: United Healthcare All Payer |
$437.36
|
|
|
INITIATE AMB INFUS CHEMO PUMP
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
33100008
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$477.12 |
| Rate for Payer: Aetna Commercial |
$382.69
|
| Rate for Payer: Anthem Medicaid |
$170.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$412.51
|
| Rate for Payer: First Health Commercial |
$472.15
|
| Rate for Payer: Humana Commercial |
$422.45
|
| Rate for Payer: Humana KY Medicaid |
$170.92
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$172.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.36
|
| Rate for Payer: Ohio Health Group HMO |
$372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.07
|
| Rate for Payer: PHCS Commercial |
$477.12
|
| Rate for Payer: United Healthcare All Payer |
$437.36
|
|
|
INITIATION NCHEMO INFUS PUMP
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Kentucky WC Medicaid |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$165.76
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
|
|
INITIATION NCHEMO INFUS PUMP
|
Facility
|
IP
|
$482.00
|
|
| Hospital Charge Code |
26000016
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
INITIATION NCHEMO INFUS PUMP
|
Facility
|
OP
|
$482.00
|
|
| Hospital Charge Code |
26000016
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem Medicaid |
$165.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Humana KY Medicaid |
$165.76
|
| Rate for Payer: Kentucky WC Medicaid |
$167.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
INITIATION NCHEMO INFUS PUMP
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$462.72 |
| Rate for Payer: Aetna Commercial |
$371.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.96
|
| Rate for Payer: Cash Price |
$241.00
|
| Rate for Payer: Cigna Commercial |
$400.06
|
| Rate for Payer: First Health Commercial |
$457.90
|
| Rate for Payer: Humana Commercial |
$409.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.16
|
| Rate for Payer: Ohio Health Group HMO |
$361.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.42
|
| Rate for Payer: PHCS Commercial |
$462.72
|
| Rate for Payer: United Healthcare All Payer |
$424.16
|
|
|
INIT NB EM PER DAY HOSP
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
INIT NB EM PER DAY HOSP
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$89.31
|
| Rate for Payer: Anthem Medicaid |
$45.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$90.67
|
| Rate for Payer: Healthspan PPO |
$66.39
|
| Rate for Payer: Humana Medicaid |
$45.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.91
|
| Rate for Payer: Molina Healthcare Passport |
$45.99
|
| Rate for Payer: Multiplan PHCS |
$178.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.60
|
| Rate for Payer: UHCCP Medicaid |
$104.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.45
|
|
|
INIT NB EM PER DAY HOSP
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$102.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$102.48
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
INIT NB EM PER DAY HOSP(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510P0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$89.31
|
| Rate for Payer: Anthem Medicaid |
$45.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$90.67
|
| Rate for Payer: Healthspan PPO |
$66.39
|
| Rate for Payer: Humana Medicaid |
$45.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.91
|
| Rate for Payer: Molina Healthcare Passport |
$45.99
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.45
|
|
|
INIT NB EM PER DAY HOSP(T
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510T0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.94
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
INIT NB EM PER DAY HOSP(T
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510T0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$166.08 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Anthem Medicaid |
$59.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cigna Commercial |
$143.59
|
| Rate for Payer: First Health Commercial |
$164.35
|
| Rate for Payer: Humana Commercial |
$147.05
|
| Rate for Payer: Humana KY Medicaid |
$59.49
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$60.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
| Rate for Payer: Ohio Health Group HMO |
$129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
| Rate for Payer: PHCS Commercial |
$166.08
|
| Rate for Payer: United Healthcare All Payer |
$152.24
|
|
|
INIT PM E/M NEW PAT INFANT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
INIT PM E/M NEW PAT INFANT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$60.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$60.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.64
|
| Rate for Payer: Molina Healthcare Passport |
$60.43
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.03
|
|
|
INIT PM E/M NEW PAT INFANT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
INIT PM E/M NEW PAT INFANT(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
510P0096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$60.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$60.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.64
|
| Rate for Payer: Molina Healthcare Passport |
$60.43
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.03
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.93 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.91
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.35
|
| Rate for Payer: Anthem Medicaid |
$31.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$361.00
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$97.53
|
| Rate for Payer: Healthspan PPO |
$77.73
|
| Rate for Payer: Humana Medicaid |
$31.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.17
|
| Rate for Payer: Molina Healthcare Passport |
$31.54
|
| Rate for Payer: Multiplan PHCS |
$216.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.70
|
| Rate for Payer: UHCCP Medicaid |
$25.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.86
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.93 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem Medicaid |
$124.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Humana KY Medicaid |
$124.15
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$125.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.91
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
INIT TX 1STDGR BURN NOOTH TX(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761P0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.35
|
| Rate for Payer: Anthem Medicaid |
$31.54
|
| 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 |
$97.53
|
| Rate for Payer: Healthspan PPO |
$77.73
|
| Rate for Payer: Humana Medicaid |
$31.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.17
|
| Rate for Payer: Molina Healthcare Passport |
$31.54
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$25.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.86
|
|
|
INIT TX 1STDGR BURN NOOTH TX(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761T0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
