|
IR FNA BX W/FLUOR GDN 1ST (T
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
761T2780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.30 |
| Max. Negotiated Rate |
$2,007.36 |
| Rate for Payer: Aetna Commercial |
$1,610.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.98
|
| Rate for Payer: Cash Price |
$1,045.50
|
| Rate for Payer: Cigna Commercial |
$1,735.53
|
| Rate for Payer: First Health Commercial |
$1,986.45
|
| Rate for Payer: Humana Commercial |
$1,777.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,714.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,568.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,819.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,442.79
|
| Rate for Payer: PHCS Commercial |
$2,007.36
|
| Rate for Payer: United Healthcare All Payer |
$1,840.08
|
|
|
IR FNA BX W/FLUOR GDN 1ST (T
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
761T2780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$2,007.36 |
| Rate for Payer: Aetna Commercial |
$1,610.07
|
| Rate for Payer: Anthem Medicaid |
$719.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$1,045.50
|
| Rate for Payer: Cash Price |
$1,045.50
|
| Rate for Payer: Cigna Commercial |
$1,735.53
|
| Rate for Payer: First Health Commercial |
$1,986.45
|
| Rate for Payer: Humana Commercial |
$1,777.35
|
| Rate for Payer: Humana KY Medicaid |
$719.09
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$726.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,714.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,568.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,819.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,442.79
|
| Rate for Payer: PHCS Commercial |
$2,007.36
|
| Rate for Payer: United Healthcare All Payer |
$1,840.08
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$1,035.84 |
| Rate for Payer: Aetna Commercial |
$830.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$841.62
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$895.57
|
| Rate for Payer: First Health Commercial |
$1,025.05
|
| Rate for Payer: Humana Commercial |
$917.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$796.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$949.52
|
| Rate for Payer: Ohio Health Group HMO |
$809.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$863.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.51
|
| Rate for Payer: PHCS Commercial |
$1,035.84
|
| Rate for Payer: United Healthcare All Payer |
$949.52
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$647.40 |
| Rate for Payer: Ambetter Exchange |
$49.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.44
|
| Rate for Payer: Anthem Medicaid |
$123.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.64
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$255.53
|
| Rate for Payer: Humana Medicaid |
$123.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.50
|
| Rate for Payer: Molina Healthcare Passport |
$123.04
|
| Rate for Payer: Multiplan PHCS |
$647.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.61
|
| Rate for Payer: UHCCP Medicaid |
$19.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.70
|
|
|
IR FNA BX W/FLUOR GDN EA ADDL
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
76102781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$1,035.84 |
| Rate for Payer: Aetna Commercial |
$830.83
|
| Rate for Payer: Anthem Medicaid |
$371.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$841.62
|
| Rate for Payer: Cash Price |
$539.50
|
| Rate for Payer: Cigna Commercial |
$895.57
|
| Rate for Payer: First Health Commercial |
$1,025.05
|
| Rate for Payer: Humana Commercial |
$917.15
|
| Rate for Payer: Humana KY Medicaid |
$371.07
|
| Rate for Payer: Kentucky WC Medicaid |
$374.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$884.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$796.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$949.52
|
| Rate for Payer: Ohio Health Group HMO |
$809.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$863.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.51
|
| Rate for Payer: PHCS Commercial |
$1,035.84
|
| Rate for Payer: United Healthcare All Payer |
$949.52
|
|
|
IR FNA BX W/FLUOR GDN EA AD (P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761P2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$255.53 |
| Rate for Payer: Ambetter Exchange |
$49.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.44
|
| Rate for Payer: Anthem Medicaid |
$123.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.64
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$255.53
|
| Rate for Payer: Humana Medicaid |
$123.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.50
|
| Rate for Payer: Molina Healthcare Passport |
$123.04
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.61
|
| Rate for Payer: UHCCP Medicaid |
$19.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.70
|
|
|
IR FNA BX W/FLUOR GDN EA AD (T
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761T2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem Medicaid |
$307.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Humana KY Medicaid |
$307.45
|
| Rate for Payer: Kentucky WC Medicaid |
$310.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
IR FNA BX W/FLUOR GDN EA AD (T
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761T2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem Medicaid |
$245.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Humana KY Medicaid |
$245.20
|
| Rate for Payer: Kentucky WC Medicaid |
$247.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$48.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$48.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.99
|
| Rate for Payer: Molina Healthcare Passport |
$48.03
|
| Rate for Payer: Multiplan PHCS |
$427.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
IR FNA BX W/US GDN EA ADDL (P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761P2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$48.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$48.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.99
|
| Rate for Payer: Molina Healthcare Passport |
$48.03
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
IR FNA BX W/US GDN EA ADDL (T
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
IR FNA BX W/US GDN EA ADDL (T
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
IR LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$1,279.00
|
|
| Hospital Charge Code |
76102542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.70 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem Medicaid |
$439.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Humana KY Medicaid |
$439.85
|
| Rate for Payer: Kentucky WC Medicaid |
$444.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$448.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
|
IR LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$1,279.00
|
|
| Hospital Charge Code |
76102542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.70 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
|
IR LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$2,915.00
|
|
| Hospital Charge Code |
76102543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
IR LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$2,915.00
|
|
| Hospital Charge Code |
76102543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem Medicaid |
$1,002.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Humana KY Medicaid |
$1,002.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
IR LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$4,254.00
|
|
| Hospital Charge Code |
76102544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,276.20 |
| Max. Negotiated Rate |
$4,083.84 |
| Rate for Payer: Aetna Commercial |
$3,275.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.12
|
| Rate for Payer: Cash Price |
$2,127.00
|
| Rate for Payer: Cigna Commercial |
$3,530.82
|
| Rate for Payer: First Health Commercial |
$4,041.30
|
| Rate for Payer: Humana Commercial |
$3,615.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,700.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.26
|
| Rate for Payer: PHCS Commercial |
$4,083.84
|
| Rate for Payer: United Healthcare All Payer |
$3,743.52
|
|
|
IR LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$4,254.00
|
|
| Hospital Charge Code |
76102544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,276.20 |
| Max. Negotiated Rate |
$4,083.84 |
| Rate for Payer: Aetna Commercial |
$3,275.58
|
| Rate for Payer: Anthem Medicaid |
$1,462.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.12
|
| Rate for Payer: Cash Price |
$2,127.00
|
| Rate for Payer: Cigna Commercial |
$3,530.82
|
| Rate for Payer: First Health Commercial |
$4,041.30
|
| Rate for Payer: Humana Commercial |
$3,615.90
|
| Rate for Payer: Humana KY Medicaid |
$1,462.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,477.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,700.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.26
|
| Rate for Payer: PHCS Commercial |
$4,083.84
|
| Rate for Payer: United Healthcare All Payer |
$3,743.52
|
|
|
IR LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$4,542.00
|
|
| Hospital Charge Code |
76102545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
IR LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$4,542.00
|
|
| Hospital Charge Code |
76102545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem Medicaid |
$1,561.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Humana KY Medicaid |
$1,561.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,577.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,593.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
IRON BINDING CAPACITY
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Ambetter Exchange |
$8.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.49
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$7.67
|
| Rate for Payer: Healthspan PPO |
$9.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.74
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.36
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.74
|
|
|
IRON BINDING CAPACITY
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.74
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$8.74
|
| Rate for Payer: Kentucky WC Medicaid |
$8.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
IRON BINDING CAPACITY
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
