|
ADM FEE VAC 2+ SHOTS
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.66
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
ADMIN HEP B VACCINE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77000057
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN HEP B VACCINE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77000057
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN HEP B VACCINE (T
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
770T0057
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN HEP B VACCINE (T
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
770T0057
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN INFLUENZA VIRUS VAC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77000004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Ambetter Exchange |
$18.80
|
| Rate for Payer: Anthem Medicaid |
$27.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.56
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$28.79
|
| Rate for Payer: Healthspan PPO |
$23.94
|
| Rate for Payer: Humana Medicaid |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.04
|
| Rate for Payer: Molina Healthcare Passport |
$27.49
|
| Rate for Payer: Multiplan PHCS |
$50.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.44
|
| Rate for Payer: UHCCP Medicaid |
$29.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.80
|
|
|
ADMIN INFLUENZA VIRUS VAC
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN INFLUENZA VIRUS VAC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$92.06 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN INFLUENZA VIRUS VAC
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77000004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN INFLUENZA VIRUS VAC(T
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
770T0004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN INFLUENZA VIRUS VAC(T
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
770T0004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
ADMIN PNEMONIA VACCINE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77000056
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN PNEMONIA VACCINE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77000056
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
ADMIN PNEMONIA VACCINE(T
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
770T0056
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
ADMIN PNEMONIA VACCINE(T
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
770T0056
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$8.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$8.60
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$8.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
77000093
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
770T0093
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.79
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$38.36
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
77000093
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Anthem Medicaid |
$40.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Humana Medicaid |
$40.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.80
|
| Rate for Payer: Molina Healthcare Passport |
$40.00
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.40
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
770T0093
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
77000093
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.79
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$38.36
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ADM OF SOC DTR ASSESS 5-15M
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ADM OF SOC DTR ASSESS 5-15M
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ADM OF SOC DTR ASSESS 5-15M
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Ambetter Exchange |
$8.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.21
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.51
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.06
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.51
|
|
|
A + D ORIGINAL OINTMENT(42.5GM
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
25003730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
