|
CLOZAPINE
|
Facility
|
IP
|
$9.67
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
25000437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
|
|
CLOZARIL 25MG TABLET
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
25000438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
CLOZARIL 25MG TABLET
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
25000438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
76100737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
45000144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
761P0737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$417.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.50
|
| Rate for Payer: Anthem Medicaid |
$119.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$524.26
|
| Rate for Payer: Healthspan PPO |
$417.47
|
| Rate for Payer: Humana Medicaid |
$119.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.94
|
| Rate for Payer: Molina Healthcare Passport |
$119.55
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$166.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.75
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
761T0737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
76100737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: UHCCP Medicaid |
$166.42
|
| Rate for Payer: Aetna Commercial |
$417.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.50
|
| Rate for Payer: Anthem Medicaid |
$119.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,530.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$524.26
|
| Rate for Payer: Healthspan PPO |
$417.47
|
| Rate for Payer: Humana Medicaid |
$119.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.94
|
| Rate for Payer: Molina Healthcare Passport |
$119.55
|
| Rate for Payer: Multiplan PHCS |
$918.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,071.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.75
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
76100737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
761T0737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
45000144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CL RESERVOIR 75CC
|
Facility
|
IP
|
$13,238.95
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.06 |
| Max. Negotiated Rate |
$12,709.39 |
| Rate for Payer: Aetna Commercial |
$10,193.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,326.38
|
| Rate for Payer: Cash Price |
$6,619.48
|
| Rate for Payer: Cigna Commercial |
$10,988.33
|
| Rate for Payer: First Health Commercial |
$12,577.00
|
| Rate for Payer: Humana Commercial |
$11,253.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,855.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,770.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,971.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,650.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,929.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,647.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,104.07
|
| Rate for Payer: PHCS Commercial |
$12,709.39
|
| Rate for Payer: United Healthcare All Payer |
$11,650.28
|
|
|
CL RESERVOIR 75CC
|
Facility
|
OP
|
$13,238.95
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.06 |
| Max. Negotiated Rate |
$12,709.39 |
| Rate for Payer: Aetna Commercial |
$10,193.99
|
| Rate for Payer: Anthem Medicaid |
$4,552.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,326.38
|
| Rate for Payer: Cash Price |
$6,619.48
|
| Rate for Payer: Cigna Commercial |
$10,988.33
|
| Rate for Payer: First Health Commercial |
$12,577.00
|
| Rate for Payer: Humana Commercial |
$11,253.11
|
| Rate for Payer: Humana KY Medicaid |
$4,552.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,599.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,855.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,770.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,971.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,644.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,650.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,929.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,647.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,104.07
|
| Rate for Payer: PHCS Commercial |
$12,709.39
|
| Rate for Payer: United Healthcare All Payer |
$11,650.28
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
76100729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
76100729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
45000141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
45000141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
76100726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
45000140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
45000140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
76100726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
76100733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
45000142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
45000142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
76100733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
