|
THER/PROPH/DIAG IV INF ADDON
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
26000021
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
THER/PROPH/DIAG IV INF ADDON
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$29.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$29.23
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$29.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
THER/PROPH/DIAG IV INF ADDON
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
THER/PROPH/DIAG IV INF ADDON
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
26000021
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000020
|
|
Hospital Revenue Code
|
260
|
| 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 |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| 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 |
$194.67
|
| 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 |
$233.60
|
| 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
|
|
|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000020
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
761P2628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.28 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Ambetter Exchange |
$98.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.28
|
| Rate for Payer: Anthem Medicaid |
$244.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.36
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$244.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.30
|
| Rate for Payer: Molina Healthcare Passport |
$244.41
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.22
|
| Rate for Payer: UHCCP Medicaid |
$96.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.63
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.28 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Ambetter Exchange |
$98.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.28
|
| Rate for Payer: Anthem Medicaid |
$244.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.36
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$244.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.30
|
| Rate for Payer: Molina Healthcare Passport |
$244.41
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.22
|
| Rate for Payer: UHCCP Medicaid |
$96.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.63
|
|
|
TH FAMILY THERAPY
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90000028
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna Commercial |
$161.69
|
| Rate for Payer: Ambetter Exchange |
$101.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.71
|
| Rate for Payer: Anthem Medicaid |
$78.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.85
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$142.98
|
| Rate for Payer: Healthspan PPO |
$130.54
|
| Rate for Payer: Humana Medicaid |
$78.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.22
|
| Rate for Payer: Molina Healthcare Passport |
$78.65
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.00
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.54
|
|
|
THIAMINE 100 MG/1 ML 100MG/1ML
|
Facility
|
IP
|
$116.95
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
25002424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.70
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
THIAMINE 100 MG/1 ML 100MG/1ML
|
Facility
|
OP
|
$116.95
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
25002424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem Medicaid |
$40.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Humana KY Medicaid |
$40.22
|
| Rate for Payer: Kentucky WC Medicaid |
$40.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.70
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
THIAMINE 100 MG TAB 100MG/1TAB
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 904719106
|
| Hospital Charge Code |
25001526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
THIAMINE 100 MG TAB 100MG/1TAB
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 904719106
|
| Hospital Charge Code |
25001526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
THIGH LIFT
|
Facility
|
OP
|
$1,505.00
|
|
| Hospital Charge Code |
22200058
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,444.80 |
| Rate for Payer: Aetna Commercial |
$1,158.85
|
| Rate for Payer: Anthem Medicaid |
$517.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.90
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cigna Commercial |
$1,249.15
|
| Rate for Payer: First Health Commercial |
$1,429.75
|
| Rate for Payer: Humana Commercial |
$1,279.25
|
| Rate for Payer: Humana KY Medicaid |
$517.57
|
| Rate for Payer: Kentucky WC Medicaid |
$522.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,234.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,110.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,324.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,309.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.45
|
| Rate for Payer: PHCS Commercial |
$1,444.80
|
| Rate for Payer: United Healthcare All Payer |
$1,324.40
|
|
|
THIGH LIFT
|
Professional
|
Both
|
$1,505.00
|
|
| Hospital Charge Code |
22200058
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$1,053.50 |
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Multiplan PHCS |
$903.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,053.50
|
| Rate for Payer: UHCCP Medicaid |
$526.75
|
|
|
THIGH LIFT
|
Facility
|
IP
|
$1,505.00
|
|
| Hospital Charge Code |
22200058
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,444.80 |
| Rate for Payer: Aetna Commercial |
$1,158.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.90
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Cigna Commercial |
$1,249.15
|
| Rate for Payer: First Health Commercial |
$1,429.75
|
| Rate for Payer: Humana Commercial |
$1,279.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,234.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,110.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,324.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,309.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.45
|
| Rate for Payer: PHCS Commercial |
$1,444.80
|
| Rate for Payer: United Healthcare All Payer |
$1,324.40
|
|
|
THIGH LIFT -80
|
Facility
|
OP
|
$752.50
|
|
| Hospital Charge Code |
22200381
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$579.42
|
| Rate for Payer: Anthem Medicaid |
$258.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.95
|
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Cigna Commercial |
$624.58
|
| Rate for Payer: First Health Commercial |
$714.88
|
| Rate for Payer: Humana Commercial |
$639.62
|
| Rate for Payer: Humana KY Medicaid |
$258.78
|
| Rate for Payer: Kentucky WC Medicaid |
$261.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.20
|
| Rate for Payer: Ohio Health Group HMO |
$564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.23
|
| Rate for Payer: PHCS Commercial |
$722.40
|
| Rate for Payer: United Healthcare All Payer |
$662.20
|
|
|
THIGH LIFT -80
|
Professional
|
Both
|
$752.50
|
|
| Hospital Charge Code |
22200381
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$263.38 |
| Max. Negotiated Rate |
$526.75 |
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Multiplan PHCS |
$451.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$526.75
|
| Rate for Payer: UHCCP Medicaid |
$263.38
|
|
|
THIGH LIFT -80
|
Facility
|
IP
|
$752.50
|
|
| Hospital Charge Code |
22200381
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$722.40 |
| Rate for Payer: Aetna Commercial |
$579.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.95
|
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Cigna Commercial |
$624.58
|
| Rate for Payer: First Health Commercial |
$714.88
|
| Rate for Payer: Humana Commercial |
$639.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.20
|
| Rate for Payer: Ohio Health Group HMO |
$564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$602.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.23
|
| Rate for Payer: PHCS Commercial |
$722.40
|
| Rate for Payer: United Healthcare All Payer |
$662.20
|
|
|
TH INIT PM E/M NEW PAT INFANT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$78.58
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.37
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$260.16 |
| Rate for Payer: Aetna Commercial |
$208.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$217.61
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$224.93
|
| Rate for Payer: First Health Commercial |
$257.45
|
| Rate for Payer: Humana Commercial |
$230.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$222.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$238.48
|
| Rate for Payer: Ohio Health Group HMO |
$203.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.99
|
| Rate for Payer: PHCS Commercial |
$260.16
|
| Rate for Payer: United Healthcare All Payer |
$238.48
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$260.16 |
| Rate for Payer: Aetna Commercial |
$208.67
|
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$217.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.61
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$224.93
|
| Rate for Payer: First Health Commercial |
$257.45
|
| Rate for Payer: Humana Commercial |
$230.35
|
| Rate for Payer: Humana KY Medicaid |
$26.61
|
| Rate for Payer: Humana Medicare Advantage |
$26.61
|
| Rate for Payer: Kentucky WC Medicaid |
$26.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$222.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$238.48
|
| Rate for Payer: Ohio Health Group HMO |
$203.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.99
|
| Rate for Payer: PHCS Commercial |
$260.16
|
| Rate for Payer: United Healthcare All Payer |
$238.48
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$162.60 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Ambetter Exchange |
$26.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.93
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cash Price |
$135.50
|
| Rate for Payer: Cigna Commercial |
$23.48
|
| Rate for Payer: Healthspan PPO |
$38.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.61
|
| Rate for Payer: Multiplan PHCS |
$162.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.59
|
| Rate for Payer: UHCCP Medicaid |
$94.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.61
|
|
