|
MCR ANNL WELLNESS VISIT INT
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
51000325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.69
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
MCV4 MENACWY VACCINE IM
|
Facility
|
IP
|
$568.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna Commercial |
$437.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.51
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Cigna Commercial |
$471.94
|
| Rate for Payer: First Health Commercial |
$540.17
|
| Rate for Payer: Humana Commercial |
$483.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.37
|
| Rate for Payer: Ohio Health Group HMO |
$426.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.27
|
| Rate for Payer: PHCS Commercial |
$545.86
|
| Rate for Payer: United Healthcare All Payer |
$500.37
|
|
|
MCV4 MENACWY VACCINE IM
|
Professional
|
Both
|
$568.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$568.60 |
| Rate for Payer: Buckeye Medicare Advantage |
$568.60
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Healthspan PPO |
$84.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.49
|
| Rate for Payer: Multiplan PHCS |
$341.16
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.02
|
| Rate for Payer: UHCCP Medicaid |
$199.01
|
|
|
MCV4 MENACWY VACCINE IM
|
Facility
|
OP
|
$568.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna Commercial |
$437.82
|
| Rate for Payer: Anthem Medicaid |
$195.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.51
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Cigna Commercial |
$471.94
|
| Rate for Payer: First Health Commercial |
$540.17
|
| Rate for Payer: Humana Commercial |
$483.31
|
| Rate for Payer: Humana KY Medicaid |
$195.54
|
| Rate for Payer: Kentucky WC Medicaid |
$197.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.37
|
| Rate for Payer: Ohio Health Group HMO |
$426.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.27
|
| Rate for Payer: PHCS Commercial |
$545.86
|
| Rate for Payer: United Healthcare All Payer |
$500.37
|
|
|
MCV4 MENACWY VACCINE IM(T
|
Facility
|
OP
|
$568.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
770T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna Commercial |
$437.82
|
| Rate for Payer: Anthem Medicaid |
$195.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.51
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Cigna Commercial |
$471.94
|
| Rate for Payer: First Health Commercial |
$540.17
|
| Rate for Payer: Humana Commercial |
$483.31
|
| Rate for Payer: Humana KY Medicaid |
$195.54
|
| Rate for Payer: Kentucky WC Medicaid |
$197.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.37
|
| Rate for Payer: Ohio Health Group HMO |
$426.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.27
|
| Rate for Payer: PHCS Commercial |
$545.86
|
| Rate for Payer: United Healthcare All Payer |
$500.37
|
|
|
MCV4 MENACWY VACCINE IM(T
|
Facility
|
IP
|
$568.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
770T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna Commercial |
$437.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.51
|
| Rate for Payer: Cash Price |
$284.30
|
| Rate for Payer: Cigna Commercial |
$471.94
|
| Rate for Payer: First Health Commercial |
$540.17
|
| Rate for Payer: Humana Commercial |
$483.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.37
|
| Rate for Payer: Ohio Health Group HMO |
$426.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.27
|
| Rate for Payer: PHCS Commercial |
$545.86
|
| Rate for Payer: United Healthcare All Payer |
$500.37
|
|
|
MD CERTIFICATION HHA PATIENT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$36.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$36.80
|
| Rate for Payer: Kentucky WC Medicaid |
$37.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
MD CERTIFICATION HHA PATIENT
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.00
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.01
|
| Rate for Payer: Multiplan PHCS |
$64.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.90
|
| Rate for Payer: UHCCP Medicaid |
$37.45
|
|
|
MD CERTIFICATION HHA PATIENT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
MD INR TEST REVIE INTER MGMT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.60
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna Commercial |
$16.60
|
| Rate for Payer: First Health Commercial |
$19.00
|
| Rate for Payer: Humana Commercial |
$17.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.60
|
| Rate for Payer: Ohio Health Group HMO |
$15.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.20
|
| Rate for Payer: PHCS Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Payer |
$17.60
|
|
|
MD INR TEST REVIE INTER MGMT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.38
|
| Rate for Payer: Anthem Medicaid |
$7.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Humana Medicaid |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.58
|
| Rate for Payer: Molina Healthcare Passport |
$7.43
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.50
|
|
|
MD INR TEST REVIE INTER MGMT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
761P2637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.38
|
| Rate for Payer: Anthem Medicaid |
$7.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Humana Medicaid |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.58
|
| Rate for Payer: Molina Healthcare Passport |
$7.43
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.50
|
|
|
MD INR TEST REVIE INTER MGMT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Anthem Medicaid |
$6.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.60
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna Commercial |
$16.60
|
| Rate for Payer: First Health Commercial |
$19.00
|
| Rate for Payer: Humana Commercial |
$17.00
|
| Rate for Payer: Humana KY Medicaid |
$6.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.60
|
| Rate for Payer: Ohio Health Group HMO |
$15.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.20
|
| Rate for Payer: PHCS Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Payer |
$17.60
|
|
|
MD RECERTIFICATION HHA PT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.94
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
MD RECERTIFICATION HHA PT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$25.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.94
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$25.10
|
| Rate for Payer: Kentucky WC Medicaid |
$25.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
MD RECERTIFICATION HHA PT
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.00
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Healthspan PPO |
$67.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.34
|
| Rate for Payer: Multiplan PHCS |
$43.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.10
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
|
|
MD SERVICE REQUIRED FOR PMD
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0372
|
| Hospital Charge Code |
51000139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.00
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.06
|
| Rate for Payer: Multiplan PHCS |
$18.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.70
|
| Rate for Payer: UHCCP Medicaid |
$10.85
|
|
|
MEASLESMUMPSAND RUBELLA 1EA
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
25000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$347.47 |
| Rate for Payer: Aetna Commercial |
$278.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.32
|
| Rate for Payer: Cash Price |
$180.98
|
| Rate for Payer: Cigna Commercial |
$300.42
|
| Rate for Payer: First Health Commercial |
$343.85
|
| Rate for Payer: Humana Commercial |
$307.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.52
|
| Rate for Payer: Ohio Health Group HMO |
$271.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.20
|
| Rate for Payer: PHCS Commercial |
$347.47
|
| Rate for Payer: United Healthcare All Payer |
$318.52
|
|
|
MEASLESMUMPSAND RUBELLA 1EA
|
Facility
|
OP
|
$361.95
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
25000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$347.47 |
| Rate for Payer: Aetna Commercial |
$278.70
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.32
|
| Rate for Payer: Cash Price |
$180.98
|
| Rate for Payer: Cigna Commercial |
$300.42
|
| Rate for Payer: First Health Commercial |
$343.85
|
| Rate for Payer: Humana Commercial |
$307.66
|
| Rate for Payer: Humana KY Medicaid |
$124.47
|
| Rate for Payer: Kentucky WC Medicaid |
$125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.52
|
| Rate for Payer: Ohio Health Group HMO |
$271.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.20
|
| Rate for Payer: PHCS Commercial |
$347.47
|
| Rate for Payer: United Healthcare All Payer |
$318.52
|
|
|
MEASLES (RUBEOLA) IGG
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$139.44
|
| Rate for Payer: First Health Commercial |
$159.60
|
| Rate for Payer: Humana Commercial |
$142.80
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.84
|
| Rate for Payer: Ohio Health Group HMO |
$126.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.08
|
| Rate for Payer: PHCS Commercial |
$161.28
|
| Rate for Payer: United Healthcare All Payer |
$147.84
|
|
|
MEASLES (RUBEOLA) IGG
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$161.28 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$139.44
|
| Rate for Payer: First Health Commercial |
$159.60
|
| Rate for Payer: Humana Commercial |
$142.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.84
|
| Rate for Payer: Ohio Health Group HMO |
$126.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.08
|
| Rate for Payer: PHCS Commercial |
$161.28
|
| Rate for Payer: United Healthcare All Payer |
$147.84
|
|
|
MECHANICAL PERCUSSION EA SESS
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94669
|
| Hospital Charge Code |
41000084
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
MECHANICAL PERCUSSION EA SESS
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94669
|
| Hospital Charge Code |
41000084
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
MECHANICAL TRACTION
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$44.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$44.02
|
| Rate for Payer: Kentucky WC Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
MECHANICAL TRACTION
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$44.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$44.02
|
| Rate for Payer: Kentucky WC Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
