|
ANKLE MIN OF 3V
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem Medicaid |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Humana KY Medicaid |
$165.07
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$166.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.80
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
ANKLE MIN OF 3V
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
32000107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$44.19
|
| Rate for Payer: Healthspan PPO |
$43.29
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$288.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.00
|
| Rate for Payer: UHCCP Medicaid |
$168.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
|
ANKLE MIN OF 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320P0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$44.19
|
| Rate for Payer: Healthspan PPO |
$43.29
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
|
ANKLE MIN OF 3V(T
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320T0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANKLE MIN OF 3V(T
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320T0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANL SP INF PMP W/MDREPRG&FIL
|
Facility
|
OP
|
$836.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
76102304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$643.88
|
| Rate for Payer: Anthem Medicaid |
$287.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cigna Commercial |
$694.05
|
| Rate for Payer: First Health Commercial |
$794.40
|
| Rate for Payer: Humana Commercial |
$710.78
|
| Rate for Payer: Humana KY Medicaid |
$287.57
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$290.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.86
|
| Rate for Payer: Ohio Health Group HMO |
$627.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.23
|
| Rate for Payer: PHCS Commercial |
$802.76
|
| Rate for Payer: United Healthcare All Payer |
$735.86
|
|
|
ANL SP INF PMP W/MDREPRG&FIL
|
Professional
|
Both
|
$836.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
76102304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$836.21 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.36
|
| Rate for Payer: Anthem Medicaid |
$38.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$836.21
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cigna Commercial |
$223.79
|
| Rate for Payer: Healthspan PPO |
$121.00
|
| Rate for Payer: Humana Medicaid |
$38.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.88
|
| Rate for Payer: Molina Healthcare Passport |
$38.12
|
| Rate for Payer: Multiplan PHCS |
$501.73
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.35
|
| Rate for Payer: UHCCP Medicaid |
$24.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.50
|
|
|
ANL SP INF PMP W/MDREPRG&FIL
|
Facility
|
IP
|
$836.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
76102304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$643.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.24
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cigna Commercial |
$694.05
|
| Rate for Payer: First Health Commercial |
$794.40
|
| Rate for Payer: Humana Commercial |
$710.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.86
|
| Rate for Payer: Ohio Health Group HMO |
$627.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.23
|
| Rate for Payer: PHCS Commercial |
$802.76
|
| Rate for Payer: United Healthcare All Payer |
$735.86
|
|
|
ANL SP INF PMP W/MDREPRG&FI(P
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
761P2304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.36
|
| Rate for Payer: Anthem Medicaid |
$38.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna Commercial |
$223.79
|
| Rate for Payer: Healthspan PPO |
$121.00
|
| Rate for Payer: Humana Medicaid |
$38.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.88
|
| Rate for Payer: Molina Healthcare Passport |
$38.12
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$24.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.50
|
|
|
ANL SP INF PMP W/MDREPRG&FI(T
|
Facility
|
OP
|
$816.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
761T2304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$783.56 |
| Rate for Payer: Aetna Commercial |
$628.48
|
| Rate for Payer: Anthem Medicaid |
$280.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$775.40
|
| Rate for Payer: Humana Commercial |
$693.78
|
| Rate for Payer: Humana KY Medicaid |
$280.69
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$283.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.26
|
| Rate for Payer: Ohio Health Group HMO |
$612.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.03
|
| Rate for Payer: PHCS Commercial |
$783.56
|
| Rate for Payer: United Healthcare All Payer |
$718.26
|
|
|
ANL SP INF PMP W/MDREPRG&FI(T
|
Facility
|
IP
|
$816.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
761T2304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$783.56 |
| Rate for Payer: Aetna Commercial |
$628.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.64
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$775.40
|
| Rate for Payer: Humana Commercial |
$693.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.26
|
| Rate for Payer: Ohio Health Group HMO |
$612.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.03
|
| Rate for Payer: PHCS Commercial |
$783.56
|
| Rate for Payer: United Healthcare All Payer |
$718.26
|
|
|
ANNUAL ALCOHOL SCREEN 15MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
51000320
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
ANNUAL ALCOHOL SCREEN 15MIN
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
51000320
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.54
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
ANNUAL ALCOHOL SCREEN 15MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
51000320
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
ANODYNE THERAPY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
42000011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANODYNE THERAPY
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
42000011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$19.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$19.95
|
| Rate for Payer: Kentucky WC Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANODYNE THERAPY CASH
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
ANODYNE THERAPY CASH
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
ANODYNE THERAPY CO
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
43000038
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$19.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$19.95
|
| Rate for Payer: Kentucky WC Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANODYNE THERAPY CO
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
43000038
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
|
OP
|
$3,399.27
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.05 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
|
|
ANORO ELLIPTA 30 DOSE INHALER
|
Facility
|
OP
|
$35.99
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: Aetna Commercial |
$27.71
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.87
|
| Rate for Payer: First Health Commercial |
$34.19
|
| Rate for Payer: Humana Commercial |
$30.59
|
| Rate for Payer: Humana KY Medicaid |
$12.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.67
|
| Rate for Payer: Ohio Health Group HMO |
$26.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.16
|
| Rate for Payer: PHCS Commercial |
$34.55
|
| Rate for Payer: United Healthcare All Payer |
$31.67
|
|
|
ANORO ELLIPTA 30 DOSE INHALER
|
Facility
|
IP
|
$35.99
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: Aetna Commercial |
$27.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.87
|
| Rate for Payer: First Health Commercial |
$34.19
|
| Rate for Payer: Humana Commercial |
$30.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.67
|
| Rate for Payer: Ohio Health Group HMO |
$26.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.16
|
| Rate for Payer: PHCS Commercial |
$34.55
|
| Rate for Payer: United Healthcare All Payer |
$31.67
|
|
|
ANORO ELLIPTA 7 DOSE INHALER
|
Facility
|
OP
|
$76.02
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.30
|
| Rate for Payer: Cash Price |
$38.01
|
| Rate for Payer: Cigna Commercial |
$63.10
|
| Rate for Payer: First Health Commercial |
$72.22
|
| Rate for Payer: Humana Commercial |
$64.62
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Kentucky WC Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.90
|
| Rate for Payer: Ohio Health Group HMO |
$57.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.57
|
| Rate for Payer: PHCS Commercial |
$72.98
|
| Rate for Payer: United Healthcare All Payer |
$66.90
|
|
|
ANORO ELLIPTA 7 DOSE INHALER
|
Facility
|
IP
|
$76.02
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.98 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.30
|
| Rate for Payer: Cash Price |
$38.01
|
| Rate for Payer: Cigna Commercial |
$63.10
|
| Rate for Payer: First Health Commercial |
$72.22
|
| Rate for Payer: Humana Commercial |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.90
|
| Rate for Payer: Ohio Health Group HMO |
$57.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.57
|
| Rate for Payer: PHCS Commercial |
$72.98
|
| Rate for Payer: United Healthcare All Payer |
$66.90
|
|
