|
PATIENT PROGRAMMER 3037
|
Facility
|
OP
|
$10,117.50
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.25 |
| Max. Negotiated Rate |
$9,712.80 |
| Rate for Payer: Aetna Commercial |
$7,790.48
|
| Rate for Payer: Anthem Medicaid |
$3,479.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,891.65
|
| Rate for Payer: Cash Price |
$5,058.75
|
| Rate for Payer: Cigna Commercial |
$8,397.52
|
| Rate for Payer: First Health Commercial |
$9,611.62
|
| Rate for Payer: Humana Commercial |
$8,599.88
|
| Rate for Payer: Humana KY Medicaid |
$3,479.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,514.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,296.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,466.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,035.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,903.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,588.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,094.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,802.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,981.07
|
| Rate for Payer: PHCS Commercial |
$9,712.80
|
| Rate for Payer: United Healthcare All Payer |
$8,903.40
|
|
|
PATIENT REMOTE CONTROL
|
Facility
|
OP
|
$5,003.75
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.12 |
| Max. Negotiated Rate |
$4,803.60 |
| Rate for Payer: Aetna Commercial |
$3,852.89
|
| Rate for Payer: Anthem Medicaid |
$1,720.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.93
|
| Rate for Payer: Cash Price |
$2,501.88
|
| Rate for Payer: Cigna Commercial |
$4,153.11
|
| Rate for Payer: First Health Commercial |
$4,753.56
|
| Rate for Payer: Humana Commercial |
$4,253.19
|
| Rate for Payer: Humana KY Medicaid |
$1,720.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,738.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,692.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,755.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,403.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,752.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,353.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,452.59
|
| Rate for Payer: PHCS Commercial |
$4,803.60
|
| Rate for Payer: United Healthcare All Payer |
$4,403.30
|
|
|
PATIENT REMOTE CONTROL
|
Facility
|
IP
|
$5,003.75
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
27000083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.12 |
| Max. Negotiated Rate |
$4,803.60 |
| Rate for Payer: Aetna Commercial |
$3,852.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,902.93
|
| Rate for Payer: Cash Price |
$2,501.88
|
| Rate for Payer: Cigna Commercial |
$4,153.11
|
| Rate for Payer: First Health Commercial |
$4,753.56
|
| Rate for Payer: Humana Commercial |
$4,253.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,692.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,403.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,752.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,353.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,452.59
|
| Rate for Payer: PHCS Commercial |
$4,803.60
|
| Rate for Payer: United Healthcare All Payer |
$4,403.30
|
|
|
PAXIL 10MG TAB
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 50268064015
|
| Hospital Charge Code |
25001163
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| 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 |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PAXIL (PAROXETINE) 2 20MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
25001162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.34 |
| 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
|
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PAXIL (PAROXETINE) 2 20MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68084004501
|
| Hospital Charge Code |
25001162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PC HYBRID GLEN POST-POLY
|
Facility
|
IP
|
$2,227.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.16 |
| Max. Negotiated Rate |
$2,138.11 |
| Rate for Payer: Aetna Commercial |
$1,714.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.22
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cigna Commercial |
$1,848.58
|
| Rate for Payer: First Health Commercial |
$2,115.84
|
| Rate for Payer: Humana Commercial |
$1,893.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.77
|
| Rate for Payer: PHCS Commercial |
$2,138.11
|
| Rate for Payer: United Healthcare All Payer |
$1,959.94
|
|
|
PC HYBRID GLEN POST-POLY
|
Facility
|
OP
|
$2,227.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.16 |
| Max. Negotiated Rate |
$2,138.11 |
| Rate for Payer: Aetna Commercial |
$1,714.94
|
| Rate for Payer: Anthem Medicaid |
$765.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.22
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cigna Commercial |
$1,848.58
|
| Rate for Payer: First Health Commercial |
$2,115.84
|
| Rate for Payer: Humana Commercial |
$1,893.12
|
| Rate for Payer: Humana KY Medicaid |
$765.93
|
| Rate for Payer: Kentucky WC Medicaid |
$773.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.77
|
| Rate for Payer: PHCS Commercial |
$2,138.11
|
| Rate for Payer: United Healthcare All Payer |
$1,959.94
|
|
|
PCU ROOM RATE
|
Facility
|
IP
|
$3,234.00
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
PCV13 VACCINE IM
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem Medicaid |
$284.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Humana KY Medicaid |
$284.75
|
| Rate for Payer: Kentucky WC Medicaid |
$287.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
PCV13 VACCINE IM
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
PCV13 VACCINE IM
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
77000025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Ambetter Exchange |
$257.99
|
| Rate for Payer: Anthem Medicaid |
$257.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$257.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.59
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$257.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$257.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.15
|
| Rate for Payer: Molina Healthcare Passport |
$257.99
|
| Rate for Payer: Multiplan PHCS |
$496.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.39
|
| Rate for Payer: UHCCP Medicaid |
$289.80
|
| Rate for Payer: United Healthcare Non-Options |
$315.28
|
| Rate for Payer: United Healthcare Options |
$315.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$260.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.99
|
|
|
PCV13 VACCINE IM(T
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
770T0025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
PCV13 VACCINE IM(T
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
770T0025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem Medicaid |
$284.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Humana KY Medicaid |
$284.75
|
| Rate for Payer: Kentucky WC Medicaid |
$287.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.32
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
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 |
$8.34 |
| 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 |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.18
|
| 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 |
$8.34 |
| 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 |
$22.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.18
|
| Rate for Payer: PHCS Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Payer |
$24.46
|
|
|
PEANUT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000895
|
|
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
|
|
|
PEANUT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000895
|
|
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
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$6,196.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.15 |
| Max. Negotiated Rate |
$3,717.60 |
| Rate for Payer: Aetna Commercial |
$1,097.89
|
| Rate for Payer: Ambetter Exchange |
$681.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$376.34
|
| Rate for Payer: Anthem Medicaid |
$298.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.75
|
| Rate for Payer: Cash Price |
$3,098.00
|
| Rate for Payer: Cash Price |
$3,098.00
|
| Rate for Payer: Cigna Commercial |
$1,045.61
|
| Rate for Payer: Healthspan PPO |
$1,013.11
|
| Rate for Payer: Humana Medicaid |
$298.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$681.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.11
|
| Rate for Payer: Molina Healthcare Passport |
$298.15
|
| Rate for Payer: Multiplan PHCS |
$3,717.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.90
|
| Rate for Payer: UHCCP Medicaid |
$395.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.46
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
Facility
|
OP
|
$6,196.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$5,948.16 |
| Rate for Payer: Aetna Commercial |
$4,770.92
|
| Rate for Payer: Anthem Medicaid |
$2,130.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,832.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$3,098.00
|
| Rate for Payer: Cash Price |
$3,098.00
|
| Rate for Payer: Cigna Commercial |
$5,142.68
|
| Rate for Payer: First Health Commercial |
$5,886.20
|
| Rate for Payer: Humana Commercial |
$5,266.60
|
| Rate for Payer: Humana KY Medicaid |
$2,130.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,152.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,080.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,572.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,173.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,452.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,647.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,390.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,275.24
|
| Rate for Payer: PHCS Commercial |
$5,948.16
|
| Rate for Payer: United Healthcare All Payer |
$5,452.48
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
Facility
|
IP
|
$6,196.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,858.80 |
| Max. Negotiated Rate |
$5,948.16 |
| Rate for Payer: Aetna Commercial |
$4,770.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,832.88
|
| Rate for Payer: Cash Price |
$3,098.00
|
| Rate for Payer: Cigna Commercial |
$5,142.68
|
| Rate for Payer: First Health Commercial |
$5,886.20
|
| Rate for Payer: Humana Commercial |
$5,266.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,080.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,572.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,858.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,452.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,647.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,390.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,275.24
|
| Rate for Payer: PHCS Commercial |
$5,948.16
|
| Rate for Payer: United Healthcare All Payer |
$5,452.48
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/(P
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
761P0199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.15 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$1,097.89
|
| Rate for Payer: Ambetter Exchange |
$681.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$376.34
|
| Rate for Payer: Anthem Medicaid |
$298.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.75
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$1,045.61
|
| Rate for Payer: Healthspan PPO |
$1,013.11
|
| Rate for Payer: Humana Medicaid |
$298.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$681.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.11
|
| Rate for Payer: Molina Healthcare Passport |
$298.15
|
| Rate for Payer: Multiplan PHCS |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.90
|
| Rate for Payer: UHCCP Medicaid |
$395.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.46
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/(T
|
Facility
|
OP
|
$4,221.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
761T0199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,451.60 |
| Max. Negotiated Rate |
$4,052.16 |
| Rate for Payer: Aetna Commercial |
$3,250.17
|
| Rate for Payer: Anthem Medicaid |
$1,451.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,292.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cigna Commercial |
$3,503.43
|
| Rate for Payer: First Health Commercial |
$4,009.95
|
| Rate for Payer: Humana Commercial |
$3,587.85
|
| Rate for Payer: Humana KY Medicaid |
$1,451.60
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,466.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,461.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,115.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,480.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,714.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,672.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,912.49
|
| Rate for Payer: PHCS Commercial |
$4,052.16
|
| Rate for Payer: United Healthcare All Payer |
$3,714.48
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/(T
|
Facility
|
IP
|
$4,221.00
|
|
|
Service Code
|
HCPCS 15574
|
| Hospital Charge Code |
761T0199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,266.30 |
| Max. Negotiated Rate |
$4,052.16 |
| Rate for Payer: Aetna Commercial |
$3,250.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,292.38
|
| Rate for Payer: Cash Price |
$2,110.50
|
| Rate for Payer: Cigna Commercial |
$3,503.43
|
| Rate for Payer: First Health Commercial |
$4,009.95
|
| Rate for Payer: Humana Commercial |
$3,587.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,461.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,115.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,714.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,165.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,672.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,912.49
|
| Rate for Payer: PHCS Commercial |
$4,052.16
|
| Rate for Payer: United Healthcare All Payer |
$3,714.48
|
|
