|
SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$9,618.25
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$6,526.67 |
| Max. Negotiated Rate |
$9,618.25 |
| Rate for Payer: Anthem Medicaid |
$6,526.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,870.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,618.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,274.74
|
| Rate for Payer: Humana KY Medicaid |
$6,526.67
|
| Rate for Payer: Humana Medicare Advantage |
$6,870.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,591.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,657.20
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$15,518.85
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$10,530.65 |
| Max. Negotiated Rate |
$15,518.85 |
| Rate for Payer: Anthem Medicaid |
$10,530.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,084.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,518.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,964.60
|
| Rate for Payer: Humana KY Medicaid |
$10,530.65
|
| Rate for Payer: Humana Medicare Advantage |
$11,084.89
|
| Rate for Payer: Kentucky WC Medicaid |
$10,635.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,301.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,741.26
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
|
IP
|
$7,318.39
|
|
|
Service Code
|
MSDRG 195
|
| Min. Negotiated Rate |
$4,966.05 |
| Max. Negotiated Rate |
$7,318.39 |
| Rate for Payer: Anthem Medicaid |
$4,966.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,227.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,318.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,057.02
|
| Rate for Payer: Humana KY Medicaid |
$4,966.05
|
| Rate for Payer: Humana Medicare Advantage |
$5,227.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,015.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,272.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,065.37
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
SIMPONI ARIA 1MG(50MG/4ML VL)
|
Facility
|
OP
|
$3,749.19
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
25002118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$3,599.22 |
| Rate for Payer: Aetna Commercial |
$2,886.88
|
| Rate for Payer: Anthem Medicaid |
$1,289.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,924.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.66
|
| Rate for Payer: Cash Price |
$1,874.60
|
| Rate for Payer: Cash Price |
$1,874.60
|
| Rate for Payer: Cigna Commercial |
$3,111.83
|
| Rate for Payer: First Health Commercial |
$3,561.73
|
| Rate for Payer: Humana Commercial |
$3,186.81
|
| Rate for Payer: Humana KY Medicaid |
$1,289.35
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,302.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,074.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,766.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,315.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,299.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,811.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,162.25
|
| Rate for Payer: PHCS Commercial |
$3,599.22
|
| Rate for Payer: United Healthcare All Payer |
$3,299.29
|
|
|
SIMPONI ARIA 1MG(50MG/4ML VL)
|
Facility
|
IP
|
$3,749.19
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
25002118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$487.39 |
| Max. Negotiated Rate |
$3,599.22 |
| Rate for Payer: Aetna Commercial |
$2,886.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,924.37
|
| Rate for Payer: Cash Price |
$1,874.60
|
| Rate for Payer: Cigna Commercial |
$3,111.83
|
| Rate for Payer: First Health Commercial |
$3,561.73
|
| Rate for Payer: Humana Commercial |
$3,186.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,074.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,766.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,124.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,299.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,811.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,162.25
|
| Rate for Payer: PHCS Commercial |
$3,599.22
|
| Rate for Payer: United Healthcare All Payer |
$3,299.29
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
761T0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
76100132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$1,294.08 |
| Rate for Payer: Aetna Commercial |
$1,037.96
|
| Rate for Payer: Anthem Medicaid |
$463.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Cigna Commercial |
$1,118.84
|
| Rate for Payer: First Health Commercial |
$1,280.60
|
| Rate for Payer: Humana Commercial |
$1,145.80
|
| Rate for Payer: Humana KY Medicaid |
$463.58
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$468.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$472.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.88
|
| Rate for Payer: PHCS Commercial |
$1,294.08
|
| Rate for Payer: United Healthcare All Payer |
$1,186.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
761T0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem Medicaid |
$231.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Humana KY Medicaid |
$231.44
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$233.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem Medicaid |
$231.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Humana KY Medicaid |
$231.44
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$233.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
76100132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.24 |
| Max. Negotiated Rate |
$1,294.08 |
| Rate for Payer: Aetna Commercial |
$1,037.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.44
|
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Cigna Commercial |
$1,118.84
|
| Rate for Payer: First Health Commercial |
$1,280.60
|
| Rate for Payer: Humana Commercial |
$1,145.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.88
|
| Rate for Payer: PHCS Commercial |
$1,294.08
|
| Rate for Payer: United Healthcare All Payer |
$1,186.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
76100132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.55 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna Commercial |
$484.73
|
| Rate for Payer: Anthem Medicaid |
$310.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,348.00
|
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Cash Price |
$674.00
|
| Rate for Payer: Cigna Commercial |
$451.05
|
| Rate for Payer: Healthspan PPO |
$387.58
|
| Rate for Payer: Humana Medicaid |
$310.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.81
|
| Rate for Payer: Molina Healthcare Passport |
$310.60
|
| Rate for Payer: Multiplan PHCS |
$808.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$943.60
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.71
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
761P0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$484.73
|
| Rate for Payer: Anthem Medicaid |
$310.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$451.05
|
| Rate for Payer: Healthspan PPO |
$387.58
|
| Rate for Payer: Humana Medicaid |
$310.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.81
|
| Rate for Payer: Molina Healthcare Passport |
$310.60
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.71
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
761T0129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.52
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
761P0129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.78
|
| Rate for Payer: Anthem Medicaid |
$138.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$254.35
|
| Rate for Payer: Healthspan PPO |
$285.80
|
| Rate for Payer: Humana Medicaid |
$138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.77
|
| Rate for Payer: Molina Healthcare Passport |
$138.99
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$75.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.38
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
45000050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.79 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem Medicaid |
$131.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$298.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Humana KY Medicaid |
$131.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$133.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.52
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem Medicaid |
$341.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Humana KY Medicaid |
$341.15
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$344.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.52
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
45000050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.79 |
| Max. Negotiated Rate |
$367.68 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$298.74
|
| Rate for Payer: Cash Price |
$191.50
|
| Rate for Payer: Cigna Commercial |
$317.89
|
| Rate for Payer: First Health Commercial |
$363.85
|
| Rate for Payer: Humana Commercial |
$325.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$314.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$282.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$337.04
|
| Rate for Payer: Ohio Health Group HMO |
$287.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.73
|
| Rate for Payer: PHCS Commercial |
$367.68
|
| Rate for Payer: United Healthcare All Payer |
$337.04
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.78
|
| Rate for Payer: Anthem Medicaid |
$138.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$992.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$254.35
|
| Rate for Payer: Healthspan PPO |
$285.80
|
| Rate for Payer: Humana Medicaid |
$138.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.77
|
| Rate for Payer: Molina Healthcare Passport |
$138.99
|
| Rate for Payer: Multiplan PHCS |
$595.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$694.40
|
| Rate for Payer: UHCCP Medicaid |
$75.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.38
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
761T0129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem Medicaid |
$203.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Humana KY Medicaid |
$203.59
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$205.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.52
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$623.04 |
| Rate for Payer: Aetna Commercial |
$499.73
|
| Rate for Payer: Anthem Medicaid |
$223.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$538.67
|
| Rate for Payer: First Health Commercial |
$616.55
|
| Rate for Payer: Humana Commercial |
$551.65
|
| Rate for Payer: Humana KY Medicaid |
$223.19
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$225.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$532.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$571.12
|
| Rate for Payer: Ohio Health Group HMO |
$486.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.19
|
| Rate for Payer: PHCS Commercial |
$623.04
|
| Rate for Payer: United Healthcare All Payer |
$571.12
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
45000049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna Commercial |
$213.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.08
|
| Rate for Payer: Anthem Medicaid |
$105.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.00
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$202.06
|
| Rate for Payer: Healthspan PPO |
$227.29
|
| Rate for Payer: Humana Medicaid |
$105.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.17
|
| Rate for Payer: Molina Healthcare Passport |
$105.07
|
| Rate for Payer: Multiplan PHCS |
$389.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$454.30
|
| Rate for Payer: UHCCP Medicaid |
$56.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.12
|
|
