|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$34.73 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
CARE PLAN OVERSIGHT < 60 MIN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 99378
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$55.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.36
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$55.71
|
| Rate for Payer: Kentucky WC Medicaid |
$56.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
CARE PLAN OVERSIGHT < 60 MIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 99378
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.36
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
CARE PLAN OVERSIGHT < 60 MIN
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99378
|
| Hospital Charge Code |
51000095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$186.51 |
| Rate for Payer: Aetna Commercial |
$154.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$186.51
|
| Rate for Payer: Healthspan PPO |
$116.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$128.86
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.40
|
| Rate for Payer: UHCCP Medicaid |
$56.70
|
|
|
CARE PLAN OVERSIGHT < 60MIN
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99375
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$170.50
|
| Rate for Payer: Healthspan PPO |
$116.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.18
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
CARE PLAN OVERSIGHT < 60MIN
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99375
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
CARE PLAN OVERSIGHT < 60MIN
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99375
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
CARE PLAN OVERSIGHT < 60 MIN(P
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99378
|
| Hospital Charge Code |
510P0095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$186.51 |
| Rate for Payer: Aetna Commercial |
$154.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$186.51
|
| Rate for Payer: Healthspan PPO |
$116.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$128.86
|
| Rate for Payer: Multiplan PHCS |
$97.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.40
|
| Rate for Payer: UHCCP Medicaid |
$56.70
|
|
|
CARE PLAN OVERSIGHT < 60MIN(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99375
|
| Hospital Charge Code |
510P0093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$170.50
|
| Rate for Payer: Healthspan PPO |
$116.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.18
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
CARE PLAN OVERSIGHT/COMMERCIAL
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 99374
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$97.67
|
| Rate for Payer: Healthspan PPO |
$77.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.22
|
| Rate for Payer: Multiplan PHCS |
$88.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.90
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
|
|
CARE PLAN OVERSIGHT/COMMERCIAL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 99374
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$50.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.66
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$50.55
|
| Rate for Payer: Kentucky WC Medicaid |
$51.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
CARE PLAN OVERSIGHT/COMMERCIAL
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 99374
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.66
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.57
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
CARE PLAN OVERSIGHT/COMM(P
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 99374
|
| Hospital Charge Code |
510P0092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$97.67
|
| Rate for Payer: Healthspan PPO |
$77.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.22
|
| Rate for Payer: Multiplan PHCS |
$88.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.90
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
|
|
CARMOL 20% CREAM 3 OZ
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 536110945
|
| Hospital Charge Code |
25002933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna Commercial |
$0.07
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.09
|
| Rate for Payer: Humana Commercial |
$0.08
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.08
|
| Rate for Payer: Ohio Health Group HMO |
$0.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Payer |
$0.08
|
|
|
CARMOL 20% CREAM 3 OZ
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 536110945
|
| Hospital Charge Code |
25002933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna Commercial |
$0.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.09
|
| Rate for Payer: Humana Commercial |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.08
|
| Rate for Payer: Ohio Health Group HMO |
$0.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Payer |
$0.08
|
|
|
CARNITOR(LEVOCARNIT) 500MG/5ML
|
Facility
|
OP
|
$9.47
|
|
|
Service Code
|
NDC 70954013910
|
| Hospital Charge Code |
25000391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Anthem Medicaid |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.39
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.86
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: Humana Commercial |
$8.05
|
| Rate for Payer: Humana KY Medicaid |
$3.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.09
|
| Rate for Payer: United Healthcare All Payer |
$8.33
|
|
|
CARNITOR(LEVOCARNIT) 500MG/5ML
|
Facility
|
IP
|
$9.47
|
|
|
Service Code
|
NDC 70954013910
|
| Hospital Charge Code |
25000391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.39
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cigna Commercial |
$7.86
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: Humana Commercial |
$8.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.33
|
| Rate for Payer: Ohio Health Group HMO |
$7.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.09
|
| Rate for Payer: United Healthcare All Payer |
$8.33
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$26,900.02
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$18,253.58 |
| Max. Negotiated Rate |
$26,900.02 |
| Rate for Payer: Anthem Medicaid |
$18,253.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,214.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,900.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,939.30
|
| Rate for Payer: Humana KY Medicaid |
$18,253.58
|
| Rate for Payer: Humana Medicare Advantage |
$19,214.30
|
| Rate for Payer: Kentucky WC Medicaid |
$18,436.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,057.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,618.66
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,639.40
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$30,969.59 |
| Max. Negotiated Rate |
$45,639.40 |
| Rate for Payer: Anthem Medicaid |
$30,969.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32,599.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45,639.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$44,009.42
|
| Rate for Payer: Humana KY Medicaid |
$30,969.59
|
| Rate for Payer: Humana Medicare Advantage |
$32,599.57
|
| Rate for Payer: Kentucky WC Medicaid |
$31,279.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39,119.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,588.98
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,152.70
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$14,353.62 |
| Max. Negotiated Rate |
$21,152.70 |
| Rate for Payer: Anthem Medicaid |
$14,353.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,109.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,152.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,397.24
|
| Rate for Payer: Humana KY Medicaid |
$14,353.62
|
| Rate for Payer: Humana Medicare Advantage |
$15,109.07
|
| Rate for Payer: Kentucky WC Medicaid |
$14,497.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,130.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,640.69
|
|
|
CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
76101379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CAROTID ENDARTERECTOMY
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
76101379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,851.59
|
| Rate for Payer: Anthem Medicaid |
$924.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: Healthspan PPO |
$1,820.48
|
| Rate for Payer: Humana Medicaid |
$924.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,438.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$942.63
|
| Rate for Payer: Molina Healthcare Passport |
$924.15
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$933.39
|
|
|
CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
76101379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CAROTID ENDARTERECTOMY(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
761P1379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,851.59
|
| Rate for Payer: Anthem Medicaid |
$924.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,774.54
|
| Rate for Payer: Healthspan PPO |
$1,820.48
|
| Rate for Payer: Humana Medicaid |
$924.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,438.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$942.63
|
| Rate for Payer: Molina Healthcare Passport |
$924.15
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$933.39
|
|
