|
NUCALA 1 MG (100 MG VIAL)
|
Facility
|
IP
|
$5,282.18
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
25002225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,584.65 |
| Max. Negotiated Rate |
$5,070.89 |
| Rate for Payer: Aetna Commercial |
$4,067.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,120.10
|
| Rate for Payer: Cash Price |
$2,641.09
|
| Rate for Payer: Cigna Commercial |
$4,384.21
|
| Rate for Payer: First Health Commercial |
$5,018.07
|
| Rate for Payer: Humana Commercial |
$4,489.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,331.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,898.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,648.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,961.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,595.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.70
|
| Rate for Payer: PHCS Commercial |
$5,070.89
|
| Rate for Payer: United Healthcare All Payer |
$4,648.32
|
|
|
NUCALA 1 MG (100 MG VIAL)
|
Facility
|
OP
|
$5,282.18
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
25002225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$5,070.89 |
| Rate for Payer: Aetna Commercial |
$4,067.28
|
| Rate for Payer: Anthem Medicaid |
$1,816.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,120.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.30
|
| Rate for Payer: Cash Price |
$2,641.09
|
| Rate for Payer: Cash Price |
$2,641.09
|
| Rate for Payer: Cigna Commercial |
$4,384.21
|
| Rate for Payer: First Health Commercial |
$5,018.07
|
| Rate for Payer: Humana Commercial |
$4,489.85
|
| Rate for Payer: Humana KY Medicaid |
$1,816.54
|
| Rate for Payer: Humana Medicare Advantage |
$31.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,835.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,331.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,898.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,648.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,961.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,595.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.70
|
| Rate for Payer: PHCS Commercial |
$5,070.89
|
| Rate for Payer: United Healthcare All Payer |
$4,648.32
|
|
|
NUCYNTA 100MG TABLET PO
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
NDC 24510010010
|
| Hospital Charge Code |
25001109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$75.80 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.59
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.54
|
| Rate for Payer: First Health Commercial |
$75.01
|
| Rate for Payer: Humana Commercial |
$67.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.48
|
| Rate for Payer: PHCS Commercial |
$75.80
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
NUCYNTA 100MG TABLET PO
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 24510010010
|
| Hospital Charge Code |
25001109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$75.80 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Anthem Medicaid |
$27.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.59
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.54
|
| Rate for Payer: First Health Commercial |
$75.01
|
| Rate for Payer: Humana Commercial |
$67.12
|
| Rate for Payer: Humana KY Medicaid |
$27.15
|
| Rate for Payer: Kentucky WC Medicaid |
$27.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.48
|
| Rate for Payer: PHCS Commercial |
$75.80
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
NUCYNTA 50MG TABLET PO
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
NDC 24510005010
|
| Hospital Charge Code |
25001110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Aetna Commercial |
$55.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.29
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$59.90
|
| Rate for Payer: First Health Commercial |
$68.56
|
| Rate for Payer: Humana Commercial |
$61.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.51
|
| Rate for Payer: Ohio Health Group HMO |
$54.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.80
|
| Rate for Payer: PHCS Commercial |
$69.28
|
| Rate for Payer: United Healthcare All Payer |
$63.51
|
|
|
NUCYNTA 50MG TABLET PO
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
NDC 24510005010
|
| Hospital Charge Code |
25001110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: Aetna Commercial |
$55.57
|
| Rate for Payer: Anthem Medicaid |
$24.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.29
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna Commercial |
$59.90
|
| Rate for Payer: First Health Commercial |
$68.56
|
| Rate for Payer: Humana Commercial |
$61.34
|
| Rate for Payer: Humana KY Medicaid |
$24.82
|
| Rate for Payer: Kentucky WC Medicaid |
$25.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.51
|
| Rate for Payer: Ohio Health Group HMO |
$54.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.80
|
| Rate for Payer: PHCS Commercial |
$69.28
|
| Rate for Payer: United Healthcare All Payer |
$63.51
|
|
|
NUCYNTA 75MG TABLET PO
|
Facility
|
OP
|
$74.22
|
|
|
Service Code
|
NDC 24510007510
|
| Hospital Charge Code |
25001111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$57.15
|
| Rate for Payer: Anthem Medicaid |
$25.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.89
|
| Rate for Payer: Cash Price |
$37.11
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: First Health Commercial |
$70.51
|
| Rate for Payer: Humana Commercial |
$63.09
|
| Rate for Payer: Humana KY Medicaid |
$25.52
|
| Rate for Payer: Kentucky WC Medicaid |
$25.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.31
|
| Rate for Payer: Ohio Health Group HMO |
$55.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.21
|
| Rate for Payer: PHCS Commercial |
$71.25
|
| Rate for Payer: United Healthcare All Payer |
$65.31
|
|
|
NUCYNTA 75MG TABLET PO
|
Facility
|
IP
|
$74.22
|
|
|
Service Code
|
NDC 24510007510
|
| Hospital Charge Code |
25001111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$57.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.89
|
| Rate for Payer: Cash Price |
$37.11
|
| Rate for Payer: Cigna Commercial |
$61.60
|
| Rate for Payer: First Health Commercial |
$70.51
|
| Rate for Payer: Humana Commercial |
$63.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.31
|
| Rate for Payer: Ohio Health Group HMO |
$55.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.21
|
| Rate for Payer: PHCS Commercial |
$71.25
|
| Rate for Payer: United Healthcare All Payer |
$65.31
|
|
|
NUCYNTA ER 50 MG TABLET
|
Facility
|
OP
|
$83.56
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
25003307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$80.22 |
| Rate for Payer: Aetna Commercial |
$64.34
|
| Rate for Payer: Anthem Medicaid |
$28.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.18
|
| Rate for Payer: Cash Price |
$41.78
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: First Health Commercial |
$79.38
|
| Rate for Payer: Humana Commercial |
$71.03
|
| Rate for Payer: Humana KY Medicaid |
$28.74
|
| Rate for Payer: Kentucky WC Medicaid |
$29.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.53
|
| Rate for Payer: Ohio Health Group HMO |
$62.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$80.22
|
| Rate for Payer: United Healthcare All Payer |
$73.53
|
|
|
NUCYNTA ER 50 MG TABLET
|
Facility
|
IP
|
$83.56
|
|
|
Service Code
|
NDC 24510011660
|
| Hospital Charge Code |
25003307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$80.22 |
| Rate for Payer: Aetna Commercial |
$64.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.18
|
| Rate for Payer: Cash Price |
$41.78
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: First Health Commercial |
$79.38
|
| Rate for Payer: Humana Commercial |
$71.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.53
|
| Rate for Payer: Ohio Health Group HMO |
$62.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$80.22
|
| Rate for Payer: United Healthcare All Payer |
$73.53
|
|
|
NUPERCAINAL(DIBUCAINE) 1% 1OZ
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 536121195
|
| Hospital Charge Code |
25003308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
NUPERCAINAL(DIBUCAINE) 1% 1OZ
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 536121195
|
| Hospital Charge Code |
25003308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
NURSE MAID ELBOW
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
45000125
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
NURSE MAID ELBOW
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
45000125
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.50 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
51000062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$439.80 |
| Max. Negotiated Rate |
$1,407.36 |
| Rate for Payer: Aetna Commercial |
$1,128.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,143.48
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,216.78
|
| Rate for Payer: First Health Commercial |
$1,392.70
|
| Rate for Payer: Humana Commercial |
$1,246.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,081.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$439.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,099.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.54
|
| Rate for Payer: PHCS Commercial |
$1,407.36
|
| Rate for Payer: United Healthcare All Payer |
$1,290.08
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99305
|
| Hospital Charge Code |
51000061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
NURSING FACILITY CARE INITIAL
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99304
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$126.48 |
| Rate for Payer: Aetna Commercial |
$126.48
|
| Rate for Payer: Ambetter Exchange |
$75.51
|
| Rate for Payer: Anthem Medicaid |
$49.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.61
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$93.07
|
| Rate for Payer: Healthspan PPO |
$94.02
|
| Rate for Payer: Humana Medicaid |
$49.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.39
|
| Rate for Payer: Molina Healthcare Passport |
$49.40
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.16
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.51
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 99304
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
NURSING FACILITY CARE INITIAL
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
51000062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$879.60 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Ambetter Exchange |
$170.66
|
| Rate for Payer: Anthem Medicaid |
$130.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.79
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$152.21
|
| Rate for Payer: Healthspan PPO |
$168.92
|
| Rate for Payer: Humana Medicaid |
$130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$215.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.11
|
| Rate for Payer: Molina Healthcare Passport |
$130.50
|
| Rate for Payer: Multiplan PHCS |
$879.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.86
|
| Rate for Payer: UHCCP Medicaid |
$513.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.66
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
51000062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$439.80 |
| Max. Negotiated Rate |
$1,407.36 |
| Rate for Payer: Aetna Commercial |
$1,128.82
|
| Rate for Payer: Anthem Medicaid |
$504.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,143.48
|
| Rate for Payer: Cash Price |
$733.00
|
| Rate for Payer: Cigna Commercial |
$1,216.78
|
| Rate for Payer: First Health Commercial |
$1,392.70
|
| Rate for Payer: Humana Commercial |
$1,246.10
|
| Rate for Payer: Humana KY Medicaid |
$504.16
|
| Rate for Payer: Kentucky WC Medicaid |
$509.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,202.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,081.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$439.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,290.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,099.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.54
|
| Rate for Payer: PHCS Commercial |
$1,407.36
|
| Rate for Payer: United Healthcare All Payer |
$1,290.08
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99305
|
| Hospital Charge Code |
51000061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
NURSING FACILITY CARE INITIAL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 99304
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
NURSING FACILITY CARE INITIAL
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99305
|
| Hospital Charge Code |
51000061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$176.84 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Ambetter Exchange |
$124.82
|
| Rate for Payer: Anthem Medicaid |
$65.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.78
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$123.78
|
| Rate for Payer: Healthspan PPO |
$131.46
|
| Rate for Payer: Humana Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.97
|
| Rate for Payer: Molina Healthcare Passport |
$65.66
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.27
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.82
|
|
|
NURSING FACILITY CARE INITIA(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99305
|
| Hospital Charge Code |
510P0061
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$176.84 |
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Ambetter Exchange |
$124.82
|
| Rate for Payer: Anthem Medicaid |
$65.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.78
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$123.78
|
| Rate for Payer: Healthspan PPO |
$131.46
|
| Rate for Payer: Humana Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.97
|
| Rate for Payer: Molina Healthcare Passport |
$65.66
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.27
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.82
|
|
|
NURSING FACILITY CARE INITIA(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99304
|
| Hospital Charge Code |
510P0060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$126.48 |
| Rate for Payer: Aetna Commercial |
$126.48
|
| Rate for Payer: Ambetter Exchange |
$75.51
|
| Rate for Payer: Anthem Medicaid |
$49.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.61
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$93.07
|
| Rate for Payer: Healthspan PPO |
$94.02
|
| Rate for Payer: Humana Medicaid |
$49.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.39
|
| Rate for Payer: Molina Healthcare Passport |
$49.40
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.16
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.51
|
|
