|
NXGN RH KNE FBTIB AGMT 10M SZ6
|
Facility
|
IP
|
$3,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$3,014.40 |
| Rate for Payer: Aetna Commercial |
$2,417.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.20
|
| Rate for Payer: Cash Price |
$1,570.00
|
| Rate for Payer: Cigna Commercial |
$2,606.20
|
| Rate for Payer: First Health Commercial |
$2,983.00
|
| Rate for Payer: Humana Commercial |
$2,669.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,574.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.60
|
| Rate for Payer: PHCS Commercial |
$3,014.40
|
| Rate for Payer: United Healthcare All Payer |
$2,763.20
|
|
|
NXGN RH KNE FBTIB AGMT 10M SZ6
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$3,014.40 |
| Rate for Payer: Aetna Commercial |
$2,417.80
|
| Rate for Payer: Anthem Medicaid |
$1,079.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.20
|
| Rate for Payer: Cash Price |
$1,570.00
|
| Rate for Payer: Cigna Commercial |
$2,606.20
|
| Rate for Payer: First Health Commercial |
$2,983.00
|
| Rate for Payer: Humana Commercial |
$2,669.00
|
| Rate for Payer: Humana KY Medicaid |
$1,079.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,090.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,574.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,101.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.60
|
| Rate for Payer: PHCS Commercial |
$3,014.40
|
| Rate for Payer: United Healthcare All Payer |
$2,763.20
|
|
|
NXGN RHKNE OFSET REV TIB BM 0^
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
NXGN RHKNE OFSET REV TIB BM 0^
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
NXGN TRAB MTAL AUG DST C 10MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN TRAB MTAL AUG DST C 10MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN TRAB MTAL AUG DST C 15MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN TRAB MTAL AUG DST C 15MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN TRAB MTAL AUG DST C 20MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NXGN TRAB MTAL AUG DST C 20MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NYSTAGMUS TESTING:SPONTANEOUS
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 92541
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
NYSTAGMUS TESTING:SPONTANEOUS
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 92541
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
NYSTATIN CREAM (30GM)
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
NDC 51672128902
|
| Hospital Charge Code |
25003310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.29
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cigna Commercial |
$2.44
|
| Rate for Payer: First Health Commercial |
$2.79
|
| Rate for Payer: Humana Commercial |
$2.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.59
|
| Rate for Payer: Ohio Health Group HMO |
$2.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.03
|
| Rate for Payer: PHCS Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Payer |
$2.59
|
|
|
NYSTATIN CREAM (30GM)
|
Facility
|
OP
|
$2.94
|
|
|
Service Code
|
NDC 51672128902
|
| Hospital Charge Code |
25003310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Anthem Medicaid |
$1.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.29
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: Cigna Commercial |
$2.44
|
| Rate for Payer: First Health Commercial |
$2.79
|
| Rate for Payer: Humana Commercial |
$2.50
|
| Rate for Payer: Humana KY Medicaid |
$1.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.59
|
| Rate for Payer: Ohio Health Group HMO |
$2.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.03
|
| Rate for Payer: PHCS Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Payer |
$2.59
|
|
|
NYSTATIN ORAL SUSP 5ML500000U
|
Facility
|
IP
|
$9.89
|
|
|
Service Code
|
NDC 121086800
|
| Hospital Charge Code |
25001116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$7.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.71
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Cigna Commercial |
$8.21
|
| Rate for Payer: First Health Commercial |
$9.40
|
| Rate for Payer: Humana Commercial |
$8.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.70
|
| Rate for Payer: Ohio Health Group HMO |
$7.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$9.49
|
| Rate for Payer: United Healthcare All Payer |
$8.70
|
|
|
NYSTATIN ORAL SUSP 5ML500000U
|
Facility
|
OP
|
$9.89
|
|
|
Service Code
|
NDC 121086800
|
| Hospital Charge Code |
25001116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.49 |
| Rate for Payer: Aetna Commercial |
$7.62
|
| Rate for Payer: Anthem Medicaid |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.71
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Cigna Commercial |
$8.21
|
| Rate for Payer: First Health Commercial |
$9.40
|
| Rate for Payer: Humana Commercial |
$8.41
|
| Rate for Payer: Humana KY Medicaid |
$3.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.70
|
| Rate for Payer: Ohio Health Group HMO |
$7.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$9.49
|
| Rate for Payer: United Healthcare All Payer |
$8.70
|
|
|
O2 SATURATION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 82810
|
| Hospital Charge Code |
30000335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
O2 SATURATION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 82810
|
| Hospital Charge Code |
30000335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$9.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$9.77
|
| Rate for Payer: Humana Medicare Advantage |
$9.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OAK TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000923
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OAK TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000923
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OB GROWTH
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$457.80 |
| Rate for Payer: Aetna Commercial |
$160.39
|
| Rate for Payer: Ambetter Exchange |
$98.34
|
| Rate for Payer: Anthem Medicaid |
$80.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.01
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$142.08
|
| Rate for Payer: Healthspan PPO |
$150.28
|
| Rate for Payer: Humana Medicaid |
$80.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.73
|
| Rate for Payer: Molina Healthcare Passport |
$80.13
|
| Rate for Payer: Multiplan PHCS |
$457.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.84
|
| Rate for Payer: UHCCP Medicaid |
$267.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.34
|
|
|
OB GROWTH
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
OB GROWTH
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.90 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$526.47
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
OB GROWTH(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
402P0038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$160.39 |
| Rate for Payer: Aetna Commercial |
$160.39
|
| Rate for Payer: Ambetter Exchange |
$98.34
|
| Rate for Payer: Anthem Medicaid |
$80.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.01
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$142.08
|
| Rate for Payer: Healthspan PPO |
$150.28
|
| Rate for Payer: Humana Medicaid |
$80.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.73
|
| Rate for Payer: Molina Healthcare Passport |
$80.13
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.84
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$80.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.34
|
|
|
OB GROWTH(T
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
402T0038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$617.28 |
| Rate for Payer: Aetna Commercial |
$495.11
|
| Rate for Payer: Anthem Medicaid |
$221.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cigna Commercial |
$533.69
|
| Rate for Payer: First Health Commercial |
$610.85
|
| Rate for Payer: Humana Commercial |
$546.55
|
| Rate for Payer: Humana KY Medicaid |
$221.13
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$223.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$527.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$474.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$225.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$565.84
|
| Rate for Payer: Ohio Health Group HMO |
$482.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$443.67
|
| Rate for Payer: PHCS Commercial |
$617.28
|
| Rate for Payer: United Healthcare All Payer |
$565.84
|
|
