|
ANKLE MIN OF 3V(T
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320T0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
ANKLE MIN OF 3V(T
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
320T0107
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
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 |
$277.11 |
| 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 |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| 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 |
$277.11
|
| 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 |
$332.53
|
| 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 |
$668.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.98
|
| Rate for Payer: PHCS Commercial |
$802.76
|
| Rate for Payer: United Healthcare All Payer |
$735.86
|
|
|
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 |
$250.86 |
| 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 |
$668.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.98
|
| 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 |
$501.73 |
| Rate for Payer: Ambetter Exchange |
$43.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.36
|
| Rate for Payer: Anthem Medicaid |
$101.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.03
|
| 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 |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.47
|
| Rate for Payer: Molina Healthcare Passport |
$101.44
|
| Rate for Payer: Multiplan PHCS |
$501.73
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.37
|
| Rate for Payer: UHCCP Medicaid |
$24.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.36
|
|
|
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: Ambetter Exchange |
$43.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.36
|
| Rate for Payer: Anthem Medicaid |
$101.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.03
|
| 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 |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.47
|
| Rate for Payer: Molina Healthcare Passport |
$101.44
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.37
|
| Rate for Payer: UHCCP Medicaid |
$24.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.36
|
|
|
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 |
$244.86 |
| 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 |
$652.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.18
|
| 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
|
OP
|
$816.21
|
|
|
Service Code
|
HCPCS 62370
|
| Hospital Charge Code |
761T2304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.11 |
| 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 |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| 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 |
$277.11
|
| 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 |
$332.53
|
| 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 |
$652.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.18
|
| 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 |
$13.50 |
| 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 |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| 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 |
$8.51 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Ambetter Exchange |
$8.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$8.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.51
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.06
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.51
|
|
|
ANNUAL ALCOHOL SCREEN 15MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS G0442
|
| Hospital Charge Code |
51000320
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.48 |
| 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 |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| 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 |
$27.53
|
| 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 |
$33.04
|
| 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 |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| 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 |
$17.40 |
| 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 |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| 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 |
$17.40 |
| 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 |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANODYNE THERAPY CASH
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$4.20 |
| 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 |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
ANODYNE THERAPY CASH
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
42000060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$4.20 |
| 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 |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
ANODYNE THERAPY CO
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
43000038
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.40 |
| 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 |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ANODYNE THERAPY CO
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 97026
|
| Hospital Charge Code |
43000038
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.40 |
| 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 |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| 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
|
$3,547.47
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,533.91 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
|
|
ANORO ELLIPTA 30 DOSE INHALER
|
Facility
|
IP
|
$36.47
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.45
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cigna Commercial |
$30.27
|
| Rate for Payer: First Health Commercial |
$34.65
|
| Rate for Payer: Humana Commercial |
$31.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.09
|
| Rate for Payer: Ohio Health Group HMO |
$27.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.16
|
| Rate for Payer: PHCS Commercial |
$35.01
|
| Rate for Payer: United Healthcare All Payer |
$32.09
|
|
|
ANORO ELLIPTA 30 DOSE INHALER
|
Facility
|
OP
|
$36.47
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Anthem Medicaid |
$12.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.45
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cigna Commercial |
$30.27
|
| Rate for Payer: First Health Commercial |
$34.65
|
| Rate for Payer: Humana Commercial |
$31.00
|
| Rate for Payer: Humana KY Medicaid |
$12.54
|
| Rate for Payer: Kentucky WC Medicaid |
$12.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.09
|
| Rate for Payer: Ohio Health Group HMO |
$27.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.16
|
| Rate for Payer: PHCS Commercial |
$35.01
|
| Rate for Payer: United Healthcare All Payer |
$32.09
|
|
|
ANORO ELLIPTA 7 DOSE INHALER
|
Facility
|
IP
|
$76.51
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$58.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.68
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$63.50
|
| Rate for Payer: First Health Commercial |
$72.68
|
| Rate for Payer: Humana Commercial |
$65.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.33
|
| Rate for Payer: Ohio Health Group HMO |
$57.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.79
|
| Rate for Payer: PHCS Commercial |
$73.45
|
| Rate for Payer: United Healthcare All Payer |
$67.33
|
|
|
ANORO ELLIPTA 7 DOSE INHALER
|
Facility
|
OP
|
$76.51
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$58.91
|
| Rate for Payer: Anthem Medicaid |
$26.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.68
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$63.50
|
| Rate for Payer: First Health Commercial |
$72.68
|
| Rate for Payer: Humana Commercial |
$65.03
|
| Rate for Payer: Humana KY Medicaid |
$26.31
|
| Rate for Payer: Kentucky WC Medicaid |
$26.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.33
|
| Rate for Payer: Ohio Health Group HMO |
$57.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.79
|
| Rate for Payer: PHCS Commercial |
$73.45
|
| Rate for Payer: United Healthcare All Payer |
$67.33
|
|
|
ANOSCOPE - EXPLORATION
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
76101925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$113.77 |
| Rate for Payer: Aetna Commercial |
$55.12
|
| Rate for Payer: Ambetter Exchange |
$38.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.40
|
| Rate for Payer: Anthem Medicaid |
$22.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.48
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$113.77
|
| Rate for Payer: Healthspan PPO |
$93.42
|
| Rate for Payer: Humana Medicaid |
$22.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.37
|
| Rate for Payer: Molina Healthcare Passport |
$22.91
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.35
|
| Rate for Payer: UHCCP Medicaid |
$42.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.73
|
|
|
ANOSCOPE - EXPLORATION
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
45000273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
ANOSCOPE - EXPLORATION
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
76101925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.27 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
