|
RESOLUTE ONYX 5.0*22
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
RESOLUTE ONYX 5.0*26
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
RESOLUTE ONYX 5.0*26
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
RESOLUTE ONYX 5.0*30
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
RESOLUTE ONYX 5.0*30
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
RESOURCE 7 GRAM (PER SCOOP)
|
Facility
|
OP
|
$4.84
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
25001318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem Medicaid |
$1.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.02
|
| Rate for Payer: First Health Commercial |
$4.60
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Humana KY Medicaid |
$1.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.26
|
| Rate for Payer: Ohio Health Group HMO |
$3.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.50
|
| Rate for Payer: PHCS Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Payer |
$4.26
|
|
|
RESOURCE 7 GRAM (PER SCOOP)
|
Facility
|
IP
|
$4.84
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
25001318
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.02
|
| Rate for Payer: First Health Commercial |
$4.60
|
| Rate for Payer: Humana Commercial |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.26
|
| Rate for Payer: Ohio Health Group HMO |
$3.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.50
|
| Rate for Payer: PHCS Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Payer |
$4.26
|
|
|
RESPIRATORY FLOW VOLUME
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
41000103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$477.12 |
| Rate for Payer: Aetna Commercial |
$382.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.66
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$412.51
|
| Rate for Payer: First Health Commercial |
$472.15
|
| Rate for Payer: Humana Commercial |
$422.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.36
|
| Rate for Payer: Ohio Health Group HMO |
$372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.07
|
| Rate for Payer: PHCS Commercial |
$477.12
|
| Rate for Payer: United Healthcare All Payer |
$437.36
|
|
|
RESPIRATORY FLOW VOLUME
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
41000103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$477.12 |
| Rate for Payer: Aetna Commercial |
$382.69
|
| Rate for Payer: Anthem Medicaid |
$170.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$412.51
|
| Rate for Payer: First Health Commercial |
$472.15
|
| Rate for Payer: Humana Commercial |
$422.45
|
| Rate for Payer: Humana KY Medicaid |
$170.92
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$172.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.36
|
| Rate for Payer: Ohio Health Group HMO |
$372.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.07
|
| Rate for Payer: PHCS Commercial |
$477.12
|
| Rate for Payer: United Healthcare All Payer |
$437.36
|
|
|
RESPIRATORY FLOW VOLUME
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
41000103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: Aetna Commercial |
$56.43
|
| Rate for Payer: Anthem Medicaid |
$28.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$497.00
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Cigna Commercial |
$52.98
|
| Rate for Payer: Healthspan PPO |
$43.71
|
| Rate for Payer: Humana Medicaid |
$28.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.60
|
| Rate for Payer: Molina Healthcare Passport |
$28.04
|
| Rate for Payer: Multiplan PHCS |
$298.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$347.90
|
| Rate for Payer: UHCCP Medicaid |
$173.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.32
|
|
|
RESPIRATORY FLOW VOLUME(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
410P0103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$56.43
|
| Rate for Payer: Anthem Medicaid |
$28.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$52.98
|
| Rate for Payer: Healthspan PPO |
$43.71
|
| Rate for Payer: Humana Medicaid |
$28.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.60
|
| Rate for Payer: Molina Healthcare Passport |
$28.04
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.32
|
|
|
RESPIRATORY FLOW VOLUME(T
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
410T0103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$381.12 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem Medicaid |
$136.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$309.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Humana KY Medicaid |
$136.53
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$137.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.07
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
RESPIRATORY FLOW VOLUME(T
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
410T0103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$381.12 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$309.66
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.07
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$11,542.61
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$7,832.48 |
| Max. Negotiated Rate |
$11,542.61 |
| Rate for Payer: Anthem Medicaid |
$7,832.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,244.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,542.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,130.37
|
| Rate for Payer: Humana KY Medicaid |
$7,832.48
|
| Rate for Payer: Humana Medicare Advantage |
$8,244.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7,910.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,893.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,989.13
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$19,844.83
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$13,466.14 |
| Max. Negotiated Rate |
$19,844.83 |
| Rate for Payer: Anthem Medicaid |
$13,466.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,174.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,844.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,136.09
|
| Rate for Payer: Humana KY Medicaid |
$13,466.14
|
| Rate for Payer: Humana Medicare Advantage |
$14,174.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13,600.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,009.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,735.46
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,929.24
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$6,059.13 |
| Max. Negotiated Rate |
$8,929.24 |
| Rate for Payer: Anthem Medicaid |
$6,059.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,378.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,929.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,610.34
|
| Rate for Payer: Humana KY Medicaid |
$6,059.13
|
| Rate for Payer: Humana Medicare Advantage |
$6,378.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,119.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,653.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,180.31
|
|
|
RESPIRATORY MOTION MANAGEMEN(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
333P0004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$671.71 |
| Rate for Payer: Anthem Medicaid |
$319.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$671.71
|
| Rate for Payer: Healthspan PPO |
$547.25
|
| Rate for Payer: Humana Medicaid |
$319.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$325.94
|
| Rate for Payer: Molina Healthcare Passport |
$319.55
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$322.75
|
|
|
RESPIRATORY MOTION MANAGEMEN(T
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
333T0004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.81
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
RESPIRATORY MOTION MANAGEMEN(T
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
333T0004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$624.96 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem Medicaid |
$223.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Humana KY Medicaid |
$223.88
|
| Rate for Payer: Kentucky WC Medicaid |
$226.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.81
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
RESPIRATORY MOTION MANAGEMENT
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$866.00 |
| Rate for Payer: Anthem Medicaid |
$319.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$866.00
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cigna Commercial |
$671.71
|
| Rate for Payer: Healthspan PPO |
$547.25
|
| Rate for Payer: Humana Medicaid |
$319.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$325.94
|
| Rate for Payer: Molina Healthcare Passport |
$319.55
|
| Rate for Payer: Multiplan PHCS |
$519.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$606.20
|
| Rate for Payer: UHCCP Medicaid |
$303.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$322.75
|
|
|
RESPIRATORY MOTION MANAGEMENT
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$831.36 |
| Rate for Payer: Aetna Commercial |
$666.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.48
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cigna Commercial |
$718.78
|
| Rate for Payer: First Health Commercial |
$822.70
|
| Rate for Payer: Humana Commercial |
$736.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.08
|
| Rate for Payer: Ohio Health Group HMO |
$649.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.46
|
| Rate for Payer: PHCS Commercial |
$831.36
|
| Rate for Payer: United Healthcare All Payer |
$762.08
|
|
|
RESPIRATORY MOTION MANAGEMENT
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$831.36 |
| Rate for Payer: Aetna Commercial |
$666.82
|
| Rate for Payer: Anthem Medicaid |
$297.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.48
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cigna Commercial |
$718.78
|
| Rate for Payer: First Health Commercial |
$822.70
|
| Rate for Payer: Humana Commercial |
$736.10
|
| Rate for Payer: Humana KY Medicaid |
$297.82
|
| Rate for Payer: Kentucky WC Medicaid |
$300.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.08
|
| Rate for Payer: Ohio Health Group HMO |
$649.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.46
|
| Rate for Payer: PHCS Commercial |
$831.36
|
| Rate for Payer: United Healthcare All Payer |
$762.08
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$12,880.88
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$8,740.60 |
| Max. Negotiated Rate |
$12,880.88 |
| Rate for Payer: Anthem Medicaid |
$8,740.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,200.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,880.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,420.85
|
| Rate for Payer: Humana KY Medicaid |
$8,740.60
|
| Rate for Payer: Humana Medicare Advantage |
$9,200.63
|
| Rate for Payer: Kentucky WC Medicaid |
$8,828.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,040.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,915.41
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$20,333.82
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$13,797.95 |
| Max. Negotiated Rate |
$20,333.82 |
| Rate for Payer: Anthem Medicaid |
$13,797.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,524.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,333.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,607.62
|
| Rate for Payer: Humana KY Medicaid |
$13,797.95
|
| Rate for Payer: Humana Medicare Advantage |
$14,524.16
|
| Rate for Payer: Kentucky WC Medicaid |
$13,935.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,428.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,073.91
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,344.54
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$6,340.94 |
| Max. Negotiated Rate |
$9,344.54 |
| Rate for Payer: Anthem Medicaid |
$6,340.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,674.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,344.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,010.80
|
| Rate for Payer: Humana KY Medicaid |
$6,340.94
|
| Rate for Payer: Humana Medicare Advantage |
$6,674.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,404.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,009.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,467.76
|
|
