|
MAC 3.75 5F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.75 6F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.75 6F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 4.0 5F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 4.0 5F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 4.0 6F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 4.0 6F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MACH 4 12CM
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 12CM
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 30CM
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 30CM
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 40CM
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 40CM
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
MACH 4 50CM
|
Facility
|
IP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
MACH 4 50CM
|
Facility
|
OP
|
$29,693.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,908.12 |
| Max. Negotiated Rate |
$28,506.00 |
| Rate for Payer: Aetna Commercial |
$22,864.19
|
| Rate for Payer: Anthem Medicaid |
$10,211.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,161.12
|
| Rate for Payer: Cash Price |
$14,846.88
|
| Rate for Payer: Cigna Commercial |
$24,645.81
|
| Rate for Payer: First Health Commercial |
$28,209.06
|
| Rate for Payer: Humana Commercial |
$25,239.69
|
| Rate for Payer: Humana KY Medicaid |
$10,211.68
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,908.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,130.50
|
| Rate for Payer: Ohio Health Group HMO |
$22,270.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,833.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,488.69
|
| Rate for Payer: PHCS Commercial |
$28,506.00
|
| Rate for Payer: United Healthcare All Payer |
$26,130.50
|
|
|
MACROBID (NITROFURA 100MG/1CAP
|
Facility
|
IP
|
$10.60
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
25000937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.27
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: First Health Commercial |
$10.07
|
| Rate for Payer: Humana Commercial |
$9.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.31
|
| Rate for Payer: PHCS Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Payer |
$9.33
|
|
|
MACROBID (NITROFURA 100MG/1CAP
|
Facility
|
OP
|
$10.60
|
|
|
Service Code
|
NDC 50268062515
|
| Hospital Charge Code |
25000937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Anthem Medicaid |
$3.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.27
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna Commercial |
$8.80
|
| Rate for Payer: First Health Commercial |
$10.07
|
| Rate for Payer: Humana Commercial |
$9.01
|
| Rate for Payer: Humana KY Medicaid |
$3.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.31
|
| Rate for Payer: PHCS Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Payer |
$9.33
|
|
|
MACRODANTIN 50MG CAPSULE
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 57664023288
|
| Hospital Charge Code |
25003195
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.22
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
MACRODANTIN 50MG CAPSULE
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 57664023288
|
| Hospital Charge Code |
25003195
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.03
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.48
|
| Rate for Payer: First Health Commercial |
$8.56
|
| Rate for Payer: Humana Commercial |
$7.66
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.93
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.22
|
| Rate for Payer: PHCS Commercial |
$8.65
|
| Rate for Payer: United Healthcare All Payer |
$7.93
|
|
|
MACROSCOPIC ID ARTHROPOD
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87168
|
| Hospital Charge Code |
30001312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
MACROSCOPIC ID ARTHROPOD
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 87168
|
| Hospital Charge Code |
30001312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
MAGIC MOUTHWASH SUSP
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
MAGIC MOUTHWASH SUSP
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25003197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
MAGNESIUM 20GM/1000ML D5/WMTR
|
Facility
|
OP
|
$120.93
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$116.09 |
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Anthem Medicaid |
$41.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.33
|
| Rate for Payer: Cash Price |
$60.47
|
| Rate for Payer: Cigna Commercial |
$100.37
|
| Rate for Payer: First Health Commercial |
$114.88
|
| Rate for Payer: Humana Commercial |
$102.79
|
| Rate for Payer: Humana KY Medicaid |
$41.59
|
| Rate for Payer: Kentucky WC Medicaid |
$42.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.42
|
| Rate for Payer: Ohio Health Group HMO |
$90.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.44
|
| Rate for Payer: PHCS Commercial |
$116.09
|
| Rate for Payer: United Healthcare All Payer |
$106.42
|
|
|
MAGNESIUM 20GM/1000ML D5/WMTR
|
Facility
|
IP
|
$120.93
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$116.09 |
| Rate for Payer: Aetna Commercial |
$93.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.33
|
| Rate for Payer: Cash Price |
$60.47
|
| Rate for Payer: Cigna Commercial |
$100.37
|
| Rate for Payer: First Health Commercial |
$114.88
|
| Rate for Payer: Humana Commercial |
$102.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.42
|
| Rate for Payer: Ohio Health Group HMO |
$90.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.44
|
| Rate for Payer: PHCS Commercial |
$116.09
|
| Rate for Payer: United Healthcare All Payer |
$106.42
|
|
