|
NB RESUSCITATION(T
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
HCPCS 99465
|
| Hospital Charge Code |
510T0121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$768.96 |
| Rate for Payer: Aetna Commercial |
$616.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.78
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$664.83
|
| Rate for Payer: First Health Commercial |
$760.95
|
| Rate for Payer: Humana Commercial |
$680.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.88
|
| Rate for Payer: Ohio Health Group HMO |
$600.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.31
|
| Rate for Payer: PHCS Commercial |
$768.96
|
| Rate for Payer: United Healthcare All Payer |
$704.88
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
761T2290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem Medicaid |
$409.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Humana KY Medicaid |
$409.58
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$413.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.21
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
76102290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.83 |
| Max. Negotiated Rate |
$1,815.36 |
| Rate for Payer: Aetna Commercial |
$1,456.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,474.98
|
| Rate for Payer: Cash Price |
$945.50
|
| Rate for Payer: Cigna Commercial |
$1,569.53
|
| Rate for Payer: First Health Commercial |
$1,796.45
|
| Rate for Payer: Humana Commercial |
$1,607.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,550.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,395.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,664.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,418.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.21
|
| Rate for Payer: PHCS Commercial |
$1,815.36
|
| Rate for Payer: United Healthcare All Payer |
$1,664.08
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
761T2290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$1,143.36 |
| Rate for Payer: Aetna Commercial |
$917.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.98
|
| Rate for Payer: Cash Price |
$595.50
|
| Rate for Payer: Cigna Commercial |
$988.53
|
| Rate for Payer: First Health Commercial |
$1,131.45
|
| Rate for Payer: Humana Commercial |
$1,012.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$976.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,048.08
|
| Rate for Payer: Ohio Health Group HMO |
$893.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.21
|
| Rate for Payer: PHCS Commercial |
$1,143.36
|
| Rate for Payer: United Healthcare All Payer |
$1,048.08
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
76102290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.83 |
| Max. Negotiated Rate |
$1,815.36 |
| Rate for Payer: Aetna Commercial |
$1,456.07
|
| Rate for Payer: Anthem Medicaid |
$650.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,474.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$945.50
|
| Rate for Payer: Cash Price |
$945.50
|
| Rate for Payer: Cigna Commercial |
$1,569.53
|
| Rate for Payer: First Health Commercial |
$1,796.45
|
| Rate for Payer: Humana Commercial |
$1,607.35
|
| Rate for Payer: Humana KY Medicaid |
$650.31
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$656.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,550.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,395.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,664.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,418.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.21
|
| Rate for Payer: PHCS Commercial |
$1,815.36
|
| Rate for Payer: United Healthcare All Payer |
$1,664.08
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Professional
|
Both
|
$1,891.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
76102290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$1,891.00 |
| Rate for Payer: Aetna Commercial |
$271.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.57
|
| Rate for Payer: Anthem Medicaid |
$129.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,891.00
|
| Rate for Payer: Cash Price |
$945.50
|
| Rate for Payer: Cash Price |
$945.50
|
| Rate for Payer: Cigna Commercial |
$264.59
|
| Rate for Payer: Healthspan PPO |
$312.43
|
| Rate for Payer: Humana Medicaid |
$129.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.55
|
| Rate for Payer: Molina Healthcare Passport |
$129.95
|
| Rate for Payer: Multiplan PHCS |
$1,134.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,323.70
|
| Rate for Payer: UHCCP Medicaid |
$112.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.25
|
|
|
NBX INTRA PARAVERTEB DISC TISS
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 62267
|
| Hospital Charge Code |
761P2290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$271.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.57
|
| Rate for Payer: Anthem Medicaid |
$129.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$264.59
|
| Rate for Payer: Healthspan PPO |
$312.43
|
| Rate for Payer: Humana Medicaid |
$129.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.55
|
| Rate for Payer: Molina Healthcare Passport |
$129.95
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$112.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.25
|
|
|
NBX RENAL KIDNEY
|
Professional
|
Both
|
$2,811.03
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
76102045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.48 |
| Max. Negotiated Rate |
$2,811.03 |
| Rate for Payer: Aetna Commercial |
$231.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.48
|
| Rate for Payer: Anthem Medicaid |
$152.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,811.03
|
| Rate for Payer: Cash Price |
$1,405.52
|
| Rate for Payer: Cash Price |
$1,405.52
|
| Rate for Payer: Cigna Commercial |
$217.37
|
| Rate for Payer: Healthspan PPO |
$184.87
|
| Rate for Payer: Humana Medicaid |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.57
|
| Rate for Payer: Molina Healthcare Passport |
$152.52
|
| Rate for Payer: Multiplan PHCS |
$1,686.62
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,967.72
|
| Rate for Payer: UHCCP Medicaid |
$106.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.05
|
|
|
NBX RENAL KIDNEY
|
Facility
|
IP
|
$2,811.03
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
76102045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.43 |
| Max. Negotiated Rate |
$2,698.59 |
| Rate for Payer: Aetna Commercial |
$2,164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,192.60
|
| Rate for Payer: Cash Price |
$1,405.52
|
| Rate for Payer: Cigna Commercial |
$2,333.15
|
| Rate for Payer: First Health Commercial |
$2,670.48
|
| Rate for Payer: Humana Commercial |
$2,389.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,074.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,473.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,108.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.42
|
| Rate for Payer: PHCS Commercial |
$2,698.59
|
| Rate for Payer: United Healthcare All Payer |
$2,473.71
|
|
|
NBX RENAL KIDNEY
|
Facility
|
OP
|
$2,811.03
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
76102045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.43 |
| Max. Negotiated Rate |
$2,698.59 |
| Rate for Payer: Aetna Commercial |
$2,164.49
|
| Rate for Payer: Anthem Medicaid |
$966.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,192.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,405.52
|
| Rate for Payer: Cash Price |
$1,405.52
|
| Rate for Payer: Cigna Commercial |
$2,333.15
|
| Rate for Payer: First Health Commercial |
$2,670.48
|
| Rate for Payer: Humana Commercial |
$2,389.38
|
| Rate for Payer: Humana KY Medicaid |
$966.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$976.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,074.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$986.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,473.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,108.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.42
|
| Rate for Payer: PHCS Commercial |
$2,698.59
|
| Rate for Payer: United Healthcare All Payer |
$2,473.71
|
|
|
NBX RENAL KIDNEY(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
761P2045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.48 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$231.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.48
|
| Rate for Payer: Anthem Medicaid |
$152.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$217.37
|
| Rate for Payer: Healthspan PPO |
$184.87
|
| Rate for Payer: Humana Medicaid |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.57
|
| Rate for Payer: Molina Healthcare Passport |
$152.52
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$106.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.05
|
|
|
NBX RENAL KIDNEY(T
|
Facility
|
IP
|
$2,036.03
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
761T2045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.68 |
| Max. Negotiated Rate |
$1,954.59 |
| Rate for Payer: Aetna Commercial |
$1,567.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.10
|
| Rate for Payer: Cash Price |
$1,018.02
|
| Rate for Payer: Cigna Commercial |
$1,689.90
|
| Rate for Payer: First Health Commercial |
$1,934.23
|
| Rate for Payer: Humana Commercial |
$1,730.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,669.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,502.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,791.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.17
|
| Rate for Payer: PHCS Commercial |
$1,954.59
|
| Rate for Payer: United Healthcare All Payer |
$1,791.71
|
|
|
NBX RENAL KIDNEY(T
|
Facility
|
OP
|
$2,036.03
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
761T2045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.68 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,567.74
|
| Rate for Payer: Anthem Medicaid |
$700.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,018.02
|
| Rate for Payer: Cash Price |
$1,018.02
|
| Rate for Payer: Cigna Commercial |
$1,689.90
|
| Rate for Payer: First Health Commercial |
$1,934.23
|
| Rate for Payer: Humana Commercial |
$1,730.63
|
| Rate for Payer: Humana KY Medicaid |
$700.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$707.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,669.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,502.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,791.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.17
|
| Rate for Payer: PHCS Commercial |
$1,954.59
|
| Rate for Payer: United Healthcare All Payer |
$1,791.71
|
|
|
NC EUPHORA 3.0*12
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 3.0*12
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 3.5*12
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 3.5*12
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 3.5*20
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 3.5*20
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 4.0*12
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
NC EUPHORA 4.0*12
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
NC EUPHORA 4.0*15
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 4.0*15
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 4.5*12
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
NC EUPHORA 4.5*12
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
