|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$314.37 |
| Rate for Payer: Aetna Commercial |
$314.37
|
| Rate for Payer: Ambetter Exchange |
$179.58
|
| Rate for Payer: Anthem Medicaid |
$262.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$179.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$179.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$215.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$283.40
|
| Rate for Payer: Healthspan PPO |
$265.11
|
| Rate for Payer: Humana Medicaid |
$262.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$179.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.93
|
| Rate for Payer: Molina Healthcare Passport |
$262.68
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$233.45
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$179.58
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
942P0010
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$37.60
|
| Rate for Payer: Ambetter Exchange |
$23.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.48
|
| Rate for Payer: Anthem Medicaid |
$21.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.08
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$36.48
|
| Rate for Payer: Healthspan PPO |
$30.62
|
| Rate for Payer: Humana Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.39
|
| Rate for Payer: Molina Healthcare Passport |
$21.95
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.42
|
| Rate for Payer: UHCCP Medicaid |
$30.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.40
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$37.60
|
| Rate for Payer: Ambetter Exchange |
$23.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.48
|
| Rate for Payer: Anthem Medicaid |
$21.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.08
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$36.48
|
| Rate for Payer: Healthspan PPO |
$30.62
|
| Rate for Payer: Humana Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.39
|
| Rate for Payer: Molina Healthcare Passport |
$21.95
|
| Rate for Payer: Multiplan PHCS |
$55.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.42
|
| Rate for Payer: UHCCP Medicaid |
$30.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.40
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
942P0009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$11.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.97
|
| Rate for Payer: Humana Medicaid |
$11.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.57
|
| Rate for Payer: Molina Healthcare Passport |
$11.34
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
942T0009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
942T0009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 4-10 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 4-10 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 4-10 MIN
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$11.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.97
|
| Rate for Payer: Humana Medicaid |
$11.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.57
|
| Rate for Payer: Molina Healthcare Passport |
$11.34
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
|
SMOKING CESS 4-10 MIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$22.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$22.70
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
SMOKING CESS 4-10 MIN
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$11.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.97
|
| Rate for Payer: Humana Medicaid |
$11.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.57
|
| Rate for Payer: Molina Healthcare Passport |
$11.34
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
|
SMOKING CESS 4-10 MIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
SOALR OFFSET HUM HEAD 50*15
|
Facility
|
OP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem Medicaid |
$2,776.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Humana KY Medicaid |
$2,776.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,832.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOALR OFFSET HUM HEAD 50*15
|
Facility
|
IP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
SOD BICARB4.2%0.5MEQ/ML
|
Facility
|
OP
|
$114.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003448
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$110.15 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Anthem Medicaid |
$39.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.50
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cigna Commercial |
$95.23
|
| Rate for Payer: First Health Commercial |
$109.00
|
| Rate for Payer: Humana Commercial |
$97.53
|
| Rate for Payer: Humana KY Medicaid |
$39.46
|
| Rate for Payer: Kentucky WC Medicaid |
$39.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.97
|
| Rate for Payer: Ohio Health Group HMO |
$86.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.17
|
| Rate for Payer: PHCS Commercial |
$110.15
|
| Rate for Payer: United Healthcare All Payer |
$100.97
|
|
|
SOD BICARB4.2%0.5MEQ/ML
|
Facility
|
IP
|
$114.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003448
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$110.15 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.50
|
| Rate for Payer: Cash Price |
$57.37
|
| Rate for Payer: Cigna Commercial |
$95.23
|
| Rate for Payer: First Health Commercial |
$109.00
|
| Rate for Payer: Humana Commercial |
$97.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.97
|
| Rate for Payer: Ohio Health Group HMO |
$86.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.17
|
| Rate for Payer: PHCS Commercial |
$110.15
|
| Rate for Payer: United Healthcare All Payer |
$100.97
|
|
|
SOD CHLORIDE 0.9%IRRIG 1000ML
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25003463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
SOD CHLORIDE 0.9%IRRIG 1000ML
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25003463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
SOD CHLORIDE 23.4% SOLU 250ML
|
Facility
|
IP
|
$114.65
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.06 |
| Rate for Payer: Aetna Commercial |
$88.28
|
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.88
|
| Rate for Payer: Cash Price |
$57.33
|
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Cigna Commercial |
$95.16
|
| Rate for Payer: Cigna Commercial |
$66.91
|
| Rate for Payer: First Health Commercial |
$76.59
|
| Rate for Payer: First Health Commercial |
$108.92
|
| Rate for Payer: Humana Commercial |
$68.53
|
| Rate for Payer: Humana Commercial |
$97.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.95
|
| Rate for Payer: Ohio Health Group HMO |
$85.99
|
| Rate for Payer: Ohio Health Group HMO |
$60.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.11
|
| Rate for Payer: PHCS Commercial |
$110.06
|
| Rate for Payer: PHCS Commercial |
$77.40
|
| Rate for Payer: United Healthcare All Payer |
$100.89
|
| Rate for Payer: United Healthcare All Payer |
$70.95
|
|
|
SOD CHLORIDE 23.4% SOLU 250ML
|
Facility
|
OP
|
$114.65
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.06 |
| Rate for Payer: Aetna Commercial |
$88.28
|
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: Anthem Medicaid |
$39.43
|
| Rate for Payer: Anthem Medicaid |
$27.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.88
|
| Rate for Payer: Cash Price |
$57.33
|
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Cigna Commercial |
$66.91
|
| Rate for Payer: Cigna Commercial |
$95.16
|
| Rate for Payer: First Health Commercial |
$76.59
|
| Rate for Payer: First Health Commercial |
$108.92
|
| Rate for Payer: Humana Commercial |
$97.45
|
| Rate for Payer: Humana Commercial |
$68.53
|
| Rate for Payer: Humana KY Medicaid |
$39.43
|
| Rate for Payer: Humana KY Medicaid |
$27.73
|
| Rate for Payer: Kentucky WC Medicaid |
$28.01
|
| Rate for Payer: Kentucky WC Medicaid |
$39.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.95
|
| Rate for Payer: Ohio Health Group HMO |
$85.99
|
| Rate for Payer: Ohio Health Group HMO |
$60.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.63
|
| Rate for Payer: PHCS Commercial |
$77.40
|
| Rate for Payer: PHCS Commercial |
$110.06
|
| Rate for Payer: United Healthcare All Payer |
$70.95
|
| Rate for Payer: United Healthcare All Payer |
$100.89
|
|
|
SODIUM ACETATE 40MEQ/20ML
|
Facility
|
OP
|
$118.19
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003447
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Anthem Medicaid |
$40.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.19
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cigna Commercial |
$98.10
|
| Rate for Payer: First Health Commercial |
$112.28
|
| Rate for Payer: Humana Commercial |
$100.46
|
| Rate for Payer: Humana KY Medicaid |
$40.65
|
| Rate for Payer: Kentucky WC Medicaid |
$41.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.01
|
| Rate for Payer: Ohio Health Group HMO |
$88.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.55
|
| Rate for Payer: PHCS Commercial |
$113.46
|
| Rate for Payer: United Healthcare All Payer |
$104.01
|
|
