|
RAPID CROSS 2*80*170
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
RAPID CROSS 3*150*170
|
Facility
|
OP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem Medicaid |
$1,282.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Humana KY Medicaid |
$1,282.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 3*150*170
|
Facility
|
IP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 3*20*170
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 3*20*170
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 3*40*170
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 3*40*170
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 3*80*170
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 3*80*170
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 4*150*170
|
Facility
|
IP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 4*150*170
|
Facility
|
OP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem Medicaid |
$1,282.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Humana KY Medicaid |
$1,282.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 4*40*170
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 4*40*170
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 4*80*170
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID CROSS 4*80*170
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
RAPID FLU SCREEN
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem Medicaid |
$16.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.55
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| 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 |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
RAPID FLU SCREEN
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
RAPID FLU SCREEN
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
30001410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Ambetter Exchange |
$16.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.86
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.55
|
| Rate for Payer: Multiplan PHCS |
$19.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.52
|
| Rate for Payer: UHCCP Medicaid |
$11.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.55
|
|
|
RAPID HIV
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
30001178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.20 |
| 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 |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| 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 |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.02
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Aetna Commercial |
$198.66
|
| Rate for Payer: Anthem Medicaid |
$95.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$134.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$95.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$214.14
|
| Rate for Payer: First Health Commercial |
$245.10
|
| Rate for Payer: Humana Commercial |
$219.30
|
| 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 |
$211.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$190.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.04
|
| Rate for Payer: Ohio Health Group HMO |
$193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.02
|
| Rate for Payer: PHCS Commercial |
$247.68
|
| Rate for Payer: United Healthcare All Payer |
$227.04
|
|
|
RAPID INFLUENZA DNA AMP PROBE
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30001927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Ambetter Exchange |
$95.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.96
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$84.41
|
| Rate for Payer: Healthspan PPO |
$89.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.80
|
| Rate for Payer: Multiplan PHCS |
$154.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.54
|
| Rate for Payer: UHCCP Medicaid |
$90.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.80
|
|
|
RAPID STREP A POC
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
RAPID STREP A POC
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
30001939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.16
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
