|
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 |
$1,124.76 |
| 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 |
$2,999.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,261.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.94
|
| 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
|
OP
|
$3,749.19
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
25002118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.03 |
| 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 |
$11.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,924.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.89
|
| 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 |
$11.03
|
| 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 |
$13.24
|
| 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 |
$2,999.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,261.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.94
|
| Rate for Payer: PHCS Commercial |
$3,599.22
|
| Rate for Payer: United Healthcare All Payer |
$3,299.29
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
761T0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
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 |
$166.96 |
| Max. Negotiated Rate |
$808.80 |
| Rate for Payer: Aetna Commercial |
$484.73
|
| Rate for Payer: Ambetter Exchange |
$166.96
|
| Rate for Payer: Anthem Medicaid |
$310.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$166.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$166.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$166.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.96
|
| 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 |
$217.05
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$166.96
|
|
|
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 |
$404.40 |
| 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 |
$1,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,172.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.12
|
| 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
|
$675.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
761P0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$484.73 |
| Rate for Payer: Aetna Commercial |
$484.73
|
| Rate for Payer: Ambetter Exchange |
$166.96
|
| Rate for Payer: Anthem Medicaid |
$310.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$166.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$166.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$166.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.96
|
| 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 |
$217.05
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$166.96
|
|
|
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 |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$1,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,172.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.12
|
| Rate for Payer: PHCS Commercial |
$1,294.08
|
| Rate for Payer: United Healthcare All Payer |
$1,186.24
|
|
|
SIM RPR >30.0 FACEARLIDSLIPMUC
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
45000053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.90 |
| 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 |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| 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 |
761T0132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.90 |
| 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 |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| 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 |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
761T0129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.60 |
| 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 |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
45000050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
761T0129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| 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 |
$285.80 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Ambetter Exchange |
$90.08
|
| 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 Individual/Medicaid |
$90.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$90.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.08
|
| 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 |
$117.10
|
| Rate for Payer: UHCCP Medicaid |
$75.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.08
|
|
|
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 |
$595.20 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Ambetter Exchange |
$90.08
|
| 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 Individual/Medicaid |
$90.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$90.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.08
|
| 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 |
$117.10
|
| Rate for Payer: UHCCP Medicaid |
$75.37
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.08
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
45000050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.60 |
| 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 |
$473.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.48
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
SIMRPR7.6>12.5FCEEARLIDLIPMUCM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.60 |
| 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 |
$793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.48
|
| 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 |
$183.59 |
| 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 |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| 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 |
$183.59
|
| 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 |
$220.31
|
| 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 |
$793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.48
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$402.60 |
| Rate for Payer: Aetna Commercial |
$213.07
|
| Rate for Payer: Ambetter Exchange |
$71.12
|
| 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 Individual/Medicaid |
$71.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.34
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$71.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.17
|
| Rate for Payer: Molina Healthcare Passport |
$105.07
|
| Rate for Payer: Multiplan PHCS |
$402.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.46
|
| Rate for Payer: UHCCP Medicaid |
$56.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.12
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem Medicaid |
$230.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Humana KY Medicaid |
$230.76
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$233.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
45000049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
45000049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$127.59
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$128.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
SIM RPR FACE - EENL5.1-7.5 CM
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
SIM RPR FACE - EENL5.1-7.5 C(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
761P0128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$227.29 |
| Rate for Payer: Aetna Commercial |
$213.07
|
| Rate for Payer: Ambetter Exchange |
$71.12
|
| 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 Individual/Medicaid |
$71.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.34
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$71.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.17
|
| Rate for Payer: Molina Healthcare Passport |
$105.07
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.46
|
| Rate for Payer: UHCCP Medicaid |
$56.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.12
|
|
|
SIM RPR FACE - EENL5.1-7.5 C(T
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
761T0128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
