|
OCULAR INSTRUMNT SCREEN BIL
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 99177
|
| Hospital Charge Code |
51000354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
OCULAR INSTRUMNT SCREEN BIL
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 99177
|
| Hospital Charge Code |
51000354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
OCUPRESS(CARTEOLOL) 1% OP 5ML
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 61314023805
|
| Hospital Charge Code |
25001119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Anthem Medicaid |
$0.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.73
|
| Rate for Payer: First Health Commercial |
$0.84
|
| Rate for Payer: Humana Commercial |
$0.75
|
| Rate for Payer: Humana KY Medicaid |
$0.30
|
| Rate for Payer: Kentucky WC Medicaid |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.61
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
OCUPRESS(CARTEOLOL) 1% OP 5ML
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 61314023805
|
| Hospital Charge Code |
25001119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.73
|
| Rate for Payer: First Health Commercial |
$0.84
|
| Rate for Payer: Humana Commercial |
$0.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.61
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
OCU ROOM RATE
|
Facility
|
IP
|
$1,790.00
|
|
| Hospital Charge Code |
11000008
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
OFFICE CONSULT - COSMETIC
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
22200031
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
OFFICE CONSULT - COSMETIC
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
22200031
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
OFFICE CONSULT - COSMETIC
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200031
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.76
|
| Rate for Payer: Anthem Medicaid |
$90.43
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Healthspan PPO |
$145.25
|
| Rate for Payer: Humana Medicaid |
$90.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.24
|
| Rate for Payer: Molina Healthcare Passport |
$90.43
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$50.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.33
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(P
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510P0330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$184.90 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.76
|
| Rate for Payer: Anthem Medicaid |
$90.43
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Healthspan PPO |
$145.25
|
| Rate for Payer: Humana Medicaid |
$90.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.24
|
| Rate for Payer: Molina Healthcare Passport |
$90.43
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.50
|
| Rate for Payer: UHCCP Medicaid |
$50.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.33
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(T
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510T0330
|
|
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
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(T
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510T0330
|
|
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
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$116.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$116.93
|
| Rate for Payer: Kentucky WC Medicaid |
$118.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$272.23 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$128.22
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$272.23
|
| Rate for Payer: Healthspan PPO |
$214.87
|
| Rate for Payer: Humana Medicaid |
$128.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.78
|
| Rate for Payer: Molina Healthcare Passport |
$128.22
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: United Healthcare Non-Options |
$199.07
|
| Rate for Payer: United Healthcare Options |
$137.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.50
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510P0331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$272.23 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$128.22
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$272.23
|
| Rate for Payer: Healthspan PPO |
$214.87
|
| Rate for Payer: Humana Medicaid |
$128.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.78
|
| Rate for Payer: Molina Healthcare Passport |
$128.22
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: United Healthcare Non-Options |
$199.07
|
| Rate for Payer: United Healthcare Options |
$137.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.50
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(T
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510T0331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| 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: Humana KY Medicaid |
$55.02
|
| 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 |
$48.00
|
| 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
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(T
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510T0331
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$304.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.48
|
| Rate for Payer: Anthem Medicaid |
$166.18
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$337.77
|
| Rate for Payer: Healthspan PPO |
$264.42
|
| Rate for Payer: Humana Medicaid |
$166.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare Passport |
$166.18
|
| Rate for Payer: Multiplan PHCS |
$342.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.00
|
| Rate for Payer: UHCCP Medicaid |
$99.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.84
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.60
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: First Health Commercial |
$541.50
|
| Rate for Payer: Humana Commercial |
$484.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.60
|
| Rate for Payer: Ohio Health Group HMO |
$427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.30
|
| Rate for Payer: PHCS Commercial |
$547.20
|
| Rate for Payer: United Healthcare All Payer |
$501.60
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem Medicaid |
$196.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.60
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: First Health Commercial |
$541.50
|
| Rate for Payer: Humana Commercial |
$484.50
|
| Rate for Payer: Humana KY Medicaid |
$196.02
|
| Rate for Payer: Kentucky WC Medicaid |
$198.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.60
|
| Rate for Payer: Ohio Health Group HMO |
$427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.30
|
| Rate for Payer: PHCS Commercial |
$547.20
|
| Rate for Payer: United Healthcare All Payer |
$501.60
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
510P0332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$337.77 |
| Rate for Payer: Aetna Commercial |
$304.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.48
|
| Rate for Payer: Anthem Medicaid |
$166.18
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$337.77
|
| Rate for Payer: Healthspan PPO |
$264.42
|
| Rate for Payer: Humana Medicaid |
$166.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.50
|
| Rate for Payer: Molina Healthcare Passport |
$166.18
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$99.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.84
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55(T
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
510T0332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
