|
INGEST CHALLENGE INI 120 MI(T
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
922T0019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$258.27 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
INGEST CHALLENGE INI 120 MI(T
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
922T0019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,623.00 |
| Max. Negotiated Rate |
$5,193.60 |
| Rate for Payer: Aetna Commercial |
$4,165.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.80
|
| Rate for Payer: Cash Price |
$2,705.00
|
| Rate for Payer: Cigna Commercial |
$4,490.30
|
| Rate for Payer: First Health Commercial |
$5,139.50
|
| Rate for Payer: Humana Commercial |
$4,598.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,436.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,623.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.90
|
| Rate for Payer: PHCS Commercial |
$5,193.60
|
| Rate for Payer: United Healthcare All Payer |
$4,760.80
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Facility
|
OP
|
$5,410.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$5,193.60 |
| Rate for Payer: Aetna Commercial |
$4,165.70
|
| Rate for Payer: Anthem Medicaid |
$1,860.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$2,705.00
|
| Rate for Payer: Cash Price |
$2,705.00
|
| Rate for Payer: Cigna Commercial |
$4,490.30
|
| Rate for Payer: First Health Commercial |
$5,139.50
|
| Rate for Payer: Humana Commercial |
$4,598.50
|
| Rate for Payer: Humana KY Medicaid |
$1,860.50
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,436.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,706.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.90
|
| Rate for Payer: PHCS Commercial |
$5,193.60
|
| Rate for Payer: United Healthcare All Payer |
$4,760.80
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Professional
|
Both
|
$5,410.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,787.00 |
| Rate for Payer: Cash Price |
$2,705.00
|
| Rate for Payer: Cash Price |
$2,705.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,787.00
|
| Rate for Payer: UHCCP Medicaid |
$1,893.50
|
|
|
INGUINAL LYMPH NODE BIOPSY(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761P1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
|
|
INGUINAL LYMPH NODE BIOPSY(T
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761T1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
INGUINAL LYMPH NODE BIOPSY(T
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761T1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.95 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,712.80 |
| Rate for Payer: Anthem Medicaid |
$3,640.00
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$3,640.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,712.80
|
| Rate for Payer: Molina Healthcare Passport |
$3,640.00
|
| Rate for Payer: Multiplan PHCS |
$897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,046.50
|
| Rate for Payer: UHCCP Medicaid |
$523.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,676.40
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.96 |
| Max. Negotiated Rate |
$1,230.90 |
| Rate for Payer: Aetna Commercial |
$1,230.90
|
| Rate for Payer: Ambetter Exchange |
$796.32
|
| Rate for Payer: Anthem Medicaid |
$450.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$796.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$955.58
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,149.46
|
| Rate for Payer: Healthspan PPO |
$984.22
|
| Rate for Payer: Humana Medicaid |
$450.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,078.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$796.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.98
|
| Rate for Payer: Molina Healthcare Passport |
$450.96
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,035.22
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$796.32
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
761P1609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.96 |
| Max. Negotiated Rate |
$1,230.90 |
| Rate for Payer: Aetna Commercial |
$1,230.90
|
| Rate for Payer: Ambetter Exchange |
$796.32
|
| Rate for Payer: Anthem Medicaid |
$450.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$796.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$955.58
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,149.46
|
| Rate for Payer: Healthspan PPO |
$984.22
|
| Rate for Payer: Humana Medicaid |
$450.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,078.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$796.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.98
|
| Rate for Payer: Molina Healthcare Passport |
$450.96
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,035.22
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$796.32
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.26 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$931.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
INHIBIN B S
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$67.80 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Ambetter Exchange |
$17.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.72
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Multiplan PHCS |
$67.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.45
|
| Rate for Payer: UHCCP Medicaid |
$39.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.27
|
|
|
INHIBIN B S
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
INHIBIN B S
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
INH (ISONIAZID) 300 300MG/1TAB
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
25000781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.58
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.95
|
| Rate for Payer: Ohio Health Group HMO |
$6.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.23
|
| Rate for Payer: PHCS Commercial |
$8.67
|
| Rate for Payer: United Healthcare All Payer |
$7.95
|
|
|
INH (ISONIAZID) 300 300MG/1TAB
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
25000781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.58
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.95
|
| Rate for Payer: Ohio Health Group HMO |
$6.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.23
|
| Rate for Payer: PHCS Commercial |
$8.67
|
| Rate for Payer: United Healthcare All Payer |
$7.95
|
|
|
INIT HOSPITAL CARE LEVEL 1
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$142.42 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Ambetter Exchange |
$77.85
|
| Rate for Payer: Anthem Medicaid |
$51.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.42
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$130.22
|
| Rate for Payer: Healthspan PPO |
$105.87
|
| Rate for Payer: Humana Medicaid |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.69
|
| Rate for Payer: Molina Healthcare Passport |
$51.66
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.20
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.85
|
|
|
INIT HOSPITAL CARE LEVEL 1
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
INIT HOSPITAL CARE LEVEL 1
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
INIT HOSPITAL CARE LEVEL 1(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
510P0011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$142.42 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Ambetter Exchange |
$77.85
|
| Rate for Payer: Anthem Medicaid |
$51.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.42
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$130.22
|
| Rate for Payer: Healthspan PPO |
$105.87
|
| Rate for Payer: Humana Medicaid |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.69
|
| Rate for Payer: Molina Healthcare Passport |
$51.66
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.20
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.85
|
|
|
INIT HOSPITAL CARE LEVEL 2
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
51000012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$194.52 |
| Rate for Payer: Aetna Commercial |
$194.52
|
| Rate for Payer: Ambetter Exchange |
$122.69
|
| Rate for Payer: Anthem Medicaid |
$85.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.23
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$182.25
|
| Rate for Payer: Healthspan PPO |
$144.60
|
| Rate for Payer: Humana Medicaid |
$85.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.31
|
| Rate for Payer: Molina Healthcare Passport |
$85.60
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: United Healthcare Non-Options |
$133.97
|
| Rate for Payer: United Healthcare Options |
$109.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.69
|
|
