|
PATIENT EVAL/DEMO RESP DEVICES
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$258.22 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
PATIENT EXCISION THYROID
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
76102271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.78 |
| Max. Negotiated Rate |
$1,061.76 |
| Rate for Payer: Aetna Commercial |
$851.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$862.68
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$917.98
|
| Rate for Payer: First Health Commercial |
$1,050.70
|
| Rate for Payer: Humana Commercial |
$940.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$906.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$816.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$973.28
|
| Rate for Payer: Ohio Health Group HMO |
$829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.86
|
| Rate for Payer: PHCS Commercial |
$1,061.76
|
| Rate for Payer: United Healthcare All Payer |
$973.28
|
|
|
PATIENT EXCISION THYROID
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
76102271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$1,106.00 |
| Rate for Payer: Aetna Commercial |
$1,025.08
|
| Rate for Payer: Anthem Medicaid |
$581.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,106.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$964.60
|
| Rate for Payer: Healthspan PPO |
$864.47
|
| Rate for Payer: Humana Medicaid |
$581.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$906.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$592.94
|
| Rate for Payer: Molina Healthcare Passport |
$581.31
|
| Rate for Payer: Multiplan PHCS |
$663.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$774.20
|
| Rate for Payer: UHCCP Medicaid |
$387.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.12
|
|
|
PATIENT EXCISION THYROID
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
76102271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.78 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$851.62
|
| Rate for Payer: Anthem Medicaid |
$380.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$862.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$917.98
|
| Rate for Payer: First Health Commercial |
$1,050.70
|
| Rate for Payer: Humana Commercial |
$940.10
|
| Rate for Payer: Humana KY Medicaid |
$380.35
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$384.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$906.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$816.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$973.28
|
| Rate for Payer: Ohio Health Group HMO |
$829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.86
|
| Rate for Payer: PHCS Commercial |
$1,061.76
|
| Rate for Payer: United Healthcare All Payer |
$973.28
|
|
|
PATIENT EXCISION THYROID(P
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
HCPCS 60210
|
| Hospital Charge Code |
761P2271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$1,106.00 |
| Rate for Payer: Aetna Commercial |
$1,025.08
|
| Rate for Payer: Anthem Medicaid |
$581.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,106.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cash Price |
$553.00
|
| Rate for Payer: Cigna Commercial |
$964.60
|
| Rate for Payer: Healthspan PPO |
$864.47
|
| Rate for Payer: Humana Medicaid |
$581.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$906.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$592.94
|
| Rate for Payer: Molina Healthcare Passport |
$581.31
|
| Rate for Payer: Multiplan PHCS |
$663.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$774.20
|
| Rate for Payer: UHCCP Medicaid |
$387.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.12
|
|
|
PATIENT PROGRAMMER
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
PATIENT PROGRAMMER
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
PATIENT PROGRAMMER 3037
|
Facility
|
IP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
PATIENT PROGRAMMER 3037
|
Facility
|
OP
|
$9,917.50
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
PAXIL 10MG TAB
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 50268064015
|
| Hospital Charge Code |
25001163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PAXIL 10MG TAB
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 50268064015
|
| Hospital Charge Code |
25001163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PAXIL (PAROXETINE) 2 20MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
25001162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PAXIL (PAROXETINE) 2 20MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
25001162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
|
|
PC HYBRID GLEN POST-POLY
|
Facility
|
OP
|
$2,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$2,115.84 |
| Rate for Payer: Aetna Commercial |
$1,697.08
|
| Rate for Payer: Anthem Medicaid |
$757.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,719.12
|
| Rate for Payer: Cash Price |
$1,102.00
|
| Rate for Payer: Cigna Commercial |
$1,829.32
|
| Rate for Payer: First Health Commercial |
$2,093.80
|
| Rate for Payer: Humana Commercial |
$1,873.40
|
| Rate for Payer: Humana KY Medicaid |
$757.96
|
| Rate for Payer: Kentucky WC Medicaid |
$765.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.24
|
| Rate for Payer: PHCS Commercial |
$2,115.84
|
| Rate for Payer: United Healthcare All Payer |
$1,939.52
|
|
|
PC HYBRID GLEN POST-POLY
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$2,115.84 |
| Rate for Payer: Aetna Commercial |
$1,697.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,719.12
|
| Rate for Payer: Cash Price |
$1,102.00
|
| Rate for Payer: Cigna Commercial |
$1,829.32
|
| Rate for Payer: First Health Commercial |
$2,093.80
|
| Rate for Payer: Humana Commercial |
$1,873.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.24
|
| Rate for Payer: PHCS Commercial |
$2,115.84
|
| Rate for Payer: United Healthcare All Payer |
$1,939.52
|
|
|
PCU ROOM RATE
|
Facility
|
IP
|
$3,034.00
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$394.42 |
| Max. Negotiated Rate |
$2,912.64 |
| Rate for Payer: Aetna Commercial |
$2,336.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.52
|
| Rate for Payer: Cash Price |
$1,517.00
|
| Rate for Payer: Cigna Commercial |
$2,518.22
|
| Rate for Payer: First Health Commercial |
$2,882.30
|
| Rate for Payer: Humana Commercial |
$2,578.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,239.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.54
|
| Rate for Payer: PHCS Commercial |
$2,912.64
|
| Rate for Payer: United Healthcare All Payer |
$2,669.92
|
|
|
PCV13 VACCINE IM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PCV13 VACCINE IM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PCV13 VACCINE IM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.00
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: United Healthcare Non-Options |
$315.28
|
| Rate for Payer: United Healthcare Options |
$315.28
|
|
|
PCV13 VACCINE IM(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
770T0025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PCV13 VACCINE IM(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
770T0025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
PD 2500ML 1.5%D LMG LCA
|
Facility
|
OP
|
$27.80
|
|
|
Service Code
|
NDC 941042453
|
| Hospital Charge Code |
25003341
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$26.69 |
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$9.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.68
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: First Health Commercial |
$26.41
|
| Rate for Payer: Humana Commercial |
$23.63
|
| Rate for Payer: Humana KY Medicaid |
$9.56
|
| Rate for Payer: Kentucky WC Medicaid |
$9.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.46
|
| Rate for Payer: Ohio Health Group HMO |
$20.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.62
|
| Rate for Payer: PHCS Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Payer |
$24.46
|
|
|
PD 2500ML 1.5%D LMG LCA
|
Facility
|
IP
|
$27.80
|
|
|
Service Code
|
NDC 941042453
|
| Hospital Charge Code |
25003341
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$26.69 |
| Rate for Payer: Aetna Commercial |
$21.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.68
|
| Rate for Payer: Cash Price |
$13.90
|
| Rate for Payer: Cigna Commercial |
$23.07
|
| Rate for Payer: First Health Commercial |
$26.41
|
| Rate for Payer: Humana Commercial |
$23.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.46
|
| Rate for Payer: Ohio Health Group HMO |
$20.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.62
|
| Rate for Payer: PHCS Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Payer |
$24.46
|
|
|
PEANUT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
PEANUT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000895
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
