|
AP SKSB T/A/L ADTL25CM HC
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$9.00
|
| Rate for Payer: Anthem Medicaid |
$14.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$29.49
|
| Rate for Payer: Healthspan PPO |
$24.55
|
| Rate for Payer: Humana Medicaid |
$14.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.30
|
| Rate for Payer: Molina Healthcare Passport |
$14.02
|
| Rate for Payer: Multiplan PHCS |
$253.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$295.40
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.16
|
|
|
AP SKSB T/A/L ADTL25CM HC
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$405.12 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem Medicaid |
$145.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Humana KY Medicaid |
$145.13
|
| Rate for Payer: Kentucky WC Medicaid |
$146.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$148.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
AP SKSB T/A/L ADTL25CM HC
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$405.12 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
AP SKSB T/A/L ADTL25CM HC(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
761P0191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$9.00
|
| Rate for Payer: Anthem Medicaid |
$14.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$29.49
|
| Rate for Payer: Healthspan PPO |
$24.55
|
| Rate for Payer: Humana Medicaid |
$14.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$14.30
|
| Rate for Payer: Molina Healthcare Passport |
$14.02
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$14.16
|
|
|
AP SKSB T/A/L ADTL25CM HC(T
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
761T0191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
AP SKSB T/A/L ADTL25CM HC(T
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
761T0191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
AQMBF PET REST & RX STRESS
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
404T0005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$556.66 |
| Max. Negotiated Rate |
$4,110.72 |
| Rate for Payer: Aetna Commercial |
$3,297.14
|
| Rate for Payer: Anthem Medicaid |
$1,472.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,339.96
|
| Rate for Payer: Cash Price |
$2,141.00
|
| Rate for Payer: Cigna Commercial |
$3,554.06
|
| Rate for Payer: First Health Commercial |
$4,067.90
|
| Rate for Payer: Humana Commercial |
$3,639.70
|
| Rate for Payer: Humana KY Medicaid |
$1,472.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.42
|
| Rate for Payer: PHCS Commercial |
$4,110.72
|
| Rate for Payer: United Healthcare All Payer |
$3,768.16
|
|
|
AQMBF PET REST & RX STRESS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
404P0005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.27
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
|
|
AQMBF PET REST & RX STRESS
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
404T0005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$556.66 |
| Max. Negotiated Rate |
$4,110.72 |
| Rate for Payer: Aetna Commercial |
$3,297.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,339.96
|
| Rate for Payer: Cash Price |
$2,141.00
|
| Rate for Payer: Cigna Commercial |
$3,554.06
|
| Rate for Payer: First Health Commercial |
$4,067.90
|
| Rate for Payer: Humana Commercial |
$3,639.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.42
|
| Rate for Payer: PHCS Commercial |
$4,110.72
|
| Rate for Payer: United Healthcare All Payer |
$3,768.16
|
|
|
AQUABEAM DRAPE PACK
|
Facility
|
OP
|
$1,945.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.85 |
| Max. Negotiated Rate |
$1,867.20 |
| Rate for Payer: Aetna Commercial |
$1,497.65
|
| Rate for Payer: Anthem Medicaid |
$668.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
| Rate for Payer: Cash Price |
$972.50
|
| Rate for Payer: Cigna Commercial |
$1,614.35
|
| Rate for Payer: First Health Commercial |
$1,847.75
|
| Rate for Payer: Humana Commercial |
$1,653.25
|
| Rate for Payer: Humana KY Medicaid |
$668.89
|
| Rate for Payer: Kentucky WC Medicaid |
$675.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
| Rate for Payer: PHCS Commercial |
$1,867.20
|
| Rate for Payer: United Healthcare All Payer |
$1,711.60
|
|
|
AQUABEAM DRAPE PACK
|
Facility
|
IP
|
$1,945.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.85 |
| Max. Negotiated Rate |
$1,867.20 |
| Rate for Payer: Aetna Commercial |
$1,497.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
| Rate for Payer: Cash Price |
$972.50
|
| Rate for Payer: Cigna Commercial |
$1,614.35
|
| Rate for Payer: First Health Commercial |
$1,847.75
|
| Rate for Payer: Humana Commercial |
$1,653.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
| Rate for Payer: PHCS Commercial |
$1,867.20
|
| Rate for Payer: United Healthcare All Payer |
$1,711.60
|
|
|
AQUABEAM HANDPIECE
|
Facility
|
OP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C2596
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem Medicaid |
$5,468.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Humana KY Medicaid |
$5,468.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,523.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
AQUABEAM HANDPIECE
|
Facility
|
IP
|
$15,900.00
|
|
|
Service Code
|
HCPCS C2596
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,067.00 |
| Max. Negotiated Rate |
$15,264.00 |
| Rate for Payer: Aetna Commercial |
$12,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,402.00
|
| Rate for Payer: Cash Price |
$7,950.00
|
| Rate for Payer: Cigna Commercial |
$13,197.00
|
| Rate for Payer: First Health Commercial |
$15,105.00
|
| Rate for Payer: Humana Commercial |
$13,515.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,038.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,734.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,770.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,067.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,929.00
|
| Rate for Payer: PHCS Commercial |
$15,264.00
|
| Rate for Payer: United Healthcare All Payer |
$13,992.00
|
|
|
AQUA MEPHYTON (PHYTON) 1 MG
|
Facility
|
IP
|
$204.97
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
25002427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$196.77 |
| Rate for Payer: Aetna Commercial |
$157.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.88
|
| Rate for Payer: Cash Price |
$102.48
|
| Rate for Payer: Cigna Commercial |
$170.13
|
| Rate for Payer: First Health Commercial |
$194.72
|
| Rate for Payer: Humana Commercial |
$174.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.37
|
| Rate for Payer: Ohio Health Group HMO |
$153.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.54
|
| Rate for Payer: PHCS Commercial |
$196.77
|
| Rate for Payer: United Healthcare All Payer |
$180.37
|
|
|
AQUA MEPHYTON (PHYTON) 1 MG
|
Facility
|
OP
|
$204.97
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
25002427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$196.77 |
| Rate for Payer: Aetna Commercial |
$157.83
|
| Rate for Payer: Anthem Medicaid |
$70.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.88
|
| Rate for Payer: Cash Price |
$102.48
|
| Rate for Payer: Cigna Commercial |
$170.13
|
| Rate for Payer: First Health Commercial |
$194.72
|
| Rate for Payer: Humana Commercial |
$174.22
|
| Rate for Payer: Humana KY Medicaid |
$70.49
|
| Rate for Payer: Kentucky WC Medicaid |
$71.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.37
|
| Rate for Payer: Ohio Health Group HMO |
$153.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.54
|
| Rate for Payer: PHCS Commercial |
$196.77
|
| Rate for Payer: United Healthcare All Payer |
$180.37
|
|
|
AQUA MEPHYTON(PHYTONA 1MG/.5ML
|
Facility
|
OP
|
$80.75
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
25002428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$62.18
|
| Rate for Payer: Anthem Medicaid |
$27.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.98
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cigna Commercial |
$67.02
|
| Rate for Payer: First Health Commercial |
$76.71
|
| Rate for Payer: Humana Commercial |
$68.64
|
| Rate for Payer: Humana KY Medicaid |
$27.77
|
| Rate for Payer: Kentucky WC Medicaid |
$28.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.06
|
| Rate for Payer: Ohio Health Group HMO |
$60.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.03
|
| Rate for Payer: PHCS Commercial |
$77.52
|
| Rate for Payer: United Healthcare All Payer |
$71.06
|
|
|
AQUA MEPHYTON(PHYTONA 1MG/.5ML
|
Facility
|
IP
|
$80.75
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
25002428
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$62.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.98
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cigna Commercial |
$67.02
|
| Rate for Payer: First Health Commercial |
$76.71
|
| Rate for Payer: Humana Commercial |
$68.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.06
|
| Rate for Payer: Ohio Health Group HMO |
$60.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.03
|
| Rate for Payer: PHCS Commercial |
$77.52
|
| Rate for Payer: United Healthcare All Payer |
$71.06
|
|
|
AQUATIC THERAPY - 15 MIN 1
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
AQUATIC THERAPY - 15 MIN 1
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
AQUATIC THERAPY-15 MIN 1
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
42000019
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
AQUATIC THERAPY-15 MIN 1
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
42000019
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
AR1 GUIDE 5F
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
AR1 GUIDE 5F
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
AR 1 GUIDE CATH 8FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
AR 1 GUIDE CATH 8FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
