|
RAPID CROSS 2*40*170
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
RAPID CROSS 2*80*170
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
RAPID CROSS 2*80*170
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
RAPID CROSS 3*150*170
|
Facility
|
OP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem Medicaid |
$1,311.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Humana KY Medicaid |
$1,311.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 3*150*170
|
Facility
|
IP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 3*20*170
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 3*20*170
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 3*40*170
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 3*40*170
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 3*80*170
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 3*80*170
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 4*150*170
|
Facility
|
OP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem Medicaid |
$1,311.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Humana KY Medicaid |
$1,311.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 4*150*170
|
Facility
|
IP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 4*40*170
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 4*40*170
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 4*80*170
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID CROSS 4*80*170
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
RAPID FLU SCREEN
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem Medicaid |
$16.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.55
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Humana KY Medicaid |
$16.55
|
| Rate for Payer: Humana Medicare Advantage |
$16.55
|
| Rate for Payer: Kentucky WC Medicaid |
$16.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
RAPID FLU SCREEN
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
RAPID FLU SCREEN
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Multiplan PHCS |
$19.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.40
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.93
|
|
|
RAPID HIV
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
RAPID HIV
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$8.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.89
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$8.89
|
| Rate for Payer: Humana Medicare Advantage |
$8.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.81
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$95.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$134.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.80
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$95.80
|
| Rate for Payer: Humana Medicare Advantage |
$95.80
|
| Rate for Payer: Kentucky WC Medicaid |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.81
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$251.00
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$84.41
|
| Rate for Payer: Healthspan PPO |
$89.81
|
| Rate for Payer: Multiplan PHCS |
$150.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.70
|
| Rate for Payer: UHCCP Medicaid |
$87.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.48
|
|
