|
PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
94000008
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem Medicaid |
$54.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Humana KY Medicaid |
$54.34
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$54.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.02
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
94000008
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$151.68 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.24
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.02
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
PH MONITOR
|
Professional
|
Both
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$684.78 |
| Rate for Payer: Aetna Commercial |
$684.78
|
| Rate for Payer: Ambetter Exchange |
$391.49
|
| Rate for Payer: Anthem Medicaid |
$325.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.79
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$602.95
|
| Rate for Payer: Healthspan PPO |
$560.38
|
| Rate for Payer: Humana Medicaid |
$325.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.38
|
| Rate for Payer: Molina Healthcare Passport |
$325.86
|
| Rate for Payer: Multiplan PHCS |
$615.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$508.94
|
| Rate for Payer: UHCCP Medicaid |
$359.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.49
|
|
|
PH MONITOR
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$352.84 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna Commercial |
$790.02
|
| Rate for Payer: Anthem Medicaid |
$352.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$800.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$851.58
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Humana Commercial |
$872.10
|
| Rate for Payer: Humana KY Medicaid |
$352.84
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$356.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$841.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$757.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.88
|
| Rate for Payer: Ohio Health Group HMO |
$769.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.94
|
| Rate for Payer: PHCS Commercial |
$984.96
|
| Rate for Payer: United Healthcare All Payer |
$902.88
|
|
|
PH MONITOR
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$307.80 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna Commercial |
$790.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$800.28
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$851.58
|
| Rate for Payer: First Health Commercial |
$974.70
|
| Rate for Payer: Humana Commercial |
$872.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$841.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$757.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.88
|
| Rate for Payer: Ohio Health Group HMO |
$769.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.94
|
| Rate for Payer: PHCS Commercial |
$984.96
|
| Rate for Payer: United Healthcare All Payer |
$902.88
|
|
|
PH MONITOR(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 91035
|
| Hospital Charge Code |
750P0002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$684.78 |
| Rate for Payer: Aetna Commercial |
$684.78
|
| Rate for Payer: Ambetter Exchange |
$391.49
|
| Rate for Payer: Anthem Medicaid |
$325.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.79
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$602.95
|
| Rate for Payer: Healthspan PPO |
$560.38
|
| Rate for Payer: Humana Medicaid |
$325.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.38
|
| Rate for Payer: Molina Healthcare Passport |
$325.86
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$508.94
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.49
|
|
|
PH MONITOR(T
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 91034
|
| Hospital Charge Code |
750T0002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$249.67 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem Medicaid |
$249.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Humana KY Medicaid |
$249.67
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$252.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.94
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
PH MONITOR(T
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 91034
|
| Hospital Charge Code |
750T0002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.94
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
PHOENIX 1.8 5F
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX 1.8 5F
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX 2.2 149CM 6F
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX 2.2 149CM 6F
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX 2.4MM 127CM 7F
|
Facility
|
OP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem Medicaid |
$4,926.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Humana KY Medicaid |
$4,926.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,977.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX 2.4MM 127CM 7F
|
Facility
|
IP
|
$14,326.50
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.95 |
| Max. Negotiated Rate |
$13,753.44 |
| Rate for Payer: Aetna Commercial |
$11,031.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,174.67
|
| Rate for Payer: Cash Price |
$7,163.25
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: First Health Commercial |
$13,610.17
|
| Rate for Payer: Humana Commercial |
$12,177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,747.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,572.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,297.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,607.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,744.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,461.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,464.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,885.28
|
| Rate for Payer: PHCS Commercial |
$13,753.44
|
| Rate for Payer: United Healthcare All Payer |
$12,607.32
|
|
|
PHOENIX LIGHT SUPPORT GUIDWIRE
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
PHOENIX LIGHT SUPPORT GUIDWIRE
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
PHOSLO (23mg) 667M CAP
|
Facility
|
OP
|
$9.40
|
|
|
Service Code
|
HCPCS J0615
|
| Hospital Charge Code |
25001185
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$7.24
|
| Rate for Payer: Anthem Medicaid |
$3.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.33
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.80
|
| Rate for Payer: First Health Commercial |
$8.93
|
| Rate for Payer: Humana Commercial |
$7.99
|
| Rate for Payer: Humana KY Medicaid |
$3.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.27
|
| Rate for Payer: Ohio Health Group HMO |
$7.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Payer |
$8.27
|
|
|
PHOSLO (23mg) 667M CAP
|
Facility
|
IP
|
$9.40
|
|
|
Service Code
|
HCPCS J0615
|
| Hospital Charge Code |
25001185
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$7.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.33
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cigna Commercial |
$7.80
|
| Rate for Payer: First Health Commercial |
$8.93
|
| Rate for Payer: Humana Commercial |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.27
|
| Rate for Payer: Ohio Health Group HMO |
$7.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Payer |
$8.27
|
|
|
PHOSPHATIDYL GLYCEROL
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 84081
|
| Hospital Charge Code |
30000473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
PHOSPHATIDYL GLYCEROL
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 84081
|
| Hospital Charge Code |
30000473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$16.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.52
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Humana KY Medicaid |
$16.52
|
| Rate for Payer: Humana Medicare Advantage |
$16.52
|
| Rate for Payer: Kentucky WC Medicaid |
$16.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
PHOSPHORUS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
30000475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
PHOSPHORUS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
30000475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$4.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.74
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$4.74
|
| Rate for Payer: Humana Medicare Advantage |
$4.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.33
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
PHOSPHORUS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
30000475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Ambetter Exchange |
$4.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.69
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: Healthspan PPO |
$4.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.74
|
| Rate for Payer: Multiplan PHCS |
$34.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.16
|
| Rate for Payer: UHCCP Medicaid |
$19.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.74
|
|
|
PHOTOCHEMOTHERAPY WITH UV-B
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 96910
|
| Hospital Charge Code |
76102704
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Aetna Commercial |
$93.82
|
| Rate for Payer: Ambetter Exchange |
$103.51
|
| Rate for Payer: Anthem Medicaid |
$15.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$103.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$103.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$124.21
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Cigna Commercial |
$85.25
|
| Rate for Payer: Humana Medicaid |
$15.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$103.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.03
|
| Rate for Payer: Molina Healthcare Passport |
$15.72
|
| Rate for Payer: Multiplan PHCS |
$118.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.56
|
| Rate for Payer: UHCCP Medicaid |
$68.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$103.51
|
|
|
PHOTOFIX BOVNE PERCRDM 0.8*8CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
