|
[C]MS CONTIN (MORP 200MG/1TAB
|
Facility
|
OP
|
$66.74
|
|
|
Service Code
|
NDC 406832001
|
| Hospital Charge Code |
25000077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$64.07 |
| Rate for Payer: Aetna Commercial |
$51.39
|
| Rate for Payer: Anthem Medicaid |
$22.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.06
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.40
|
| Rate for Payer: Humana Commercial |
$56.73
|
| Rate for Payer: Humana KY Medicaid |
$22.95
|
| Rate for Payer: Kentucky WC Medicaid |
$23.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.73
|
| Rate for Payer: Ohio Health Group HMO |
$50.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.07
|
| Rate for Payer: United Healthcare All Payer |
$58.73
|
|
|
[C]MS CONTIN (MORP 200MG/1TAB
|
Facility
|
IP
|
$66.74
|
|
|
Service Code
|
NDC 406832001
|
| Hospital Charge Code |
25000077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$64.07 |
| Rate for Payer: Aetna Commercial |
$51.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.06
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.40
|
| Rate for Payer: Humana Commercial |
$56.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.73
|
| Rate for Payer: Ohio Health Group HMO |
$50.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.07
|
| Rate for Payer: United Healthcare All Payer |
$58.73
|
|
|
[C]MS CONTIN (MORPH 100MG/1TAB
|
Facility
|
IP
|
$63.68
|
|
|
Service Code
|
NDC 406839001
|
| Hospital Charge Code |
25000109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.67
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cigna Commercial |
$52.85
|
| Rate for Payer: First Health Commercial |
$60.50
|
| Rate for Payer: Humana Commercial |
$54.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.04
|
| Rate for Payer: Ohio Health Group HMO |
$47.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.74
|
| Rate for Payer: PHCS Commercial |
$61.13
|
| Rate for Payer: United Healthcare All Payer |
$56.04
|
|
|
[C]MS CONTIN (MORPH 100MG/1TAB
|
Facility
|
OP
|
$63.68
|
|
|
Service Code
|
NDC 406839001
|
| Hospital Charge Code |
25000109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$49.03
|
| Rate for Payer: Anthem Medicaid |
$21.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.67
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cigna Commercial |
$52.85
|
| Rate for Payer: First Health Commercial |
$60.50
|
| Rate for Payer: Humana Commercial |
$54.13
|
| Rate for Payer: Humana KY Medicaid |
$21.90
|
| Rate for Payer: Kentucky WC Medicaid |
$22.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.04
|
| Rate for Payer: Ohio Health Group HMO |
$47.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.74
|
| Rate for Payer: PHCS Commercial |
$61.13
|
| Rate for Payer: United Healthcare All Payer |
$56.04
|
|
|
[C]MS CONTIN(MORPHIN 15MG/1TAB
|
Facility
|
IP
|
$60.67
|
|
|
Service Code
|
NDC 406831501
|
| Hospital Charge Code |
25000110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Aetna Commercial |
$46.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.32
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Cigna Commercial |
$50.36
|
| Rate for Payer: First Health Commercial |
$57.64
|
| Rate for Payer: Humana Commercial |
$51.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.39
|
| Rate for Payer: Ohio Health Group HMO |
$45.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.81
|
| Rate for Payer: PHCS Commercial |
$58.24
|
| Rate for Payer: United Healthcare All Payer |
$53.39
|
|
|
[C]MS CONTIN(MORPHIN 15MG/1TAB
|
Facility
|
OP
|
$60.67
|
|
|
Service Code
|
NDC 406831501
|
| Hospital Charge Code |
25000110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Anthem Medicaid |
$20.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.32
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Cigna Commercial |
$50.36
|
| Rate for Payer: First Health Commercial |
$57.64
|
| Rate for Payer: Humana Commercial |
$51.57
|
| Rate for Payer: Humana KY Medicaid |
$20.86
|
| Rate for Payer: Kentucky WC Medicaid |
$21.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.75
|
| Rate for Payer: Aetna Commercial |
$46.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.39
|
| Rate for Payer: Ohio Health Group HMO |
$45.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.81
|
| Rate for Payer: PHCS Commercial |
$58.24
|
| Rate for Payer: United Healthcare All Payer |
$53.39
|
|
|
[C]MS CONTIN(MORPHIN 30MG/1TAB
|
Facility
|
IP
|
$61.27
|
|
|
Service Code
|
NDC 406833001
|
| Hospital Charge Code |
25000111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.99
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
[C]MS CONTIN(MORPHIN 30MG/1TAB
|
Facility
|
OP
|
$61.27
|
|
|
Service Code
|
NDC 406833001
|
| Hospital Charge Code |
25000111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem Medicaid |
$21.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Humana KY Medicaid |
$21.07
|
| Rate for Payer: Kentucky WC Medicaid |
$21.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.99
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
[C]MS CONTIN(MORPHIN 60MG/1TAB
|
Facility
|
IP
|
$60.87
|
|
|
Service Code
|
NDC 42858080301
|
| Hospital Charge Code |
25000112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$58.44 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.48
|
| Rate for Payer: Cash Price |
$30.43
|
| Rate for Payer: Cigna Commercial |
$50.52
|
| Rate for Payer: First Health Commercial |
$57.83
|
| Rate for Payer: Humana Commercial |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.57
|
| Rate for Payer: Ohio Health Group HMO |
$45.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.87
|
| Rate for Payer: PHCS Commercial |
$58.44
|
| Rate for Payer: United Healthcare All Payer |
$53.57
|
|
|
[C]MS CONTIN(MORPHIN 60MG/1TAB
|
Facility
|
OP
|
$60.87
|
|
|
Service Code
|
NDC 42858080301
|
| Hospital Charge Code |
25000112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$58.44 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Anthem Medicaid |
$20.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.48
|
| Rate for Payer: Cash Price |
$30.43
|
| Rate for Payer: Cigna Commercial |
$50.52
|
| Rate for Payer: First Health Commercial |
$57.83
|
| Rate for Payer: Humana Commercial |
$51.74
|
| Rate for Payer: Humana KY Medicaid |
$20.93
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.57
|
| Rate for Payer: Ohio Health Group HMO |
$45.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.87
|
| Rate for Payer: PHCS Commercial |
$58.44
|
| Rate for Payer: United Healthcare All Payer |
$53.57
|
|
|
[C]MSIR (MORPHINE S 15MG/TAB0
|
Facility
|
IP
|
$60.43
|
|
|
Service Code
|
NDC 54023525
|
| Hospital Charge Code |
25000078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna Commercial |
$50.16
|
| Rate for Payer: First Health Commercial |
$57.41
|
| Rate for Payer: Humana Commercial |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.18
|
| Rate for Payer: Ohio Health Group HMO |
$45.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.73
|
| Rate for Payer: PHCS Commercial |
$58.01
|
| Rate for Payer: United Healthcare All Payer |
$53.18
|
|
|
[C]MSIR (MORPHINE S 15MG/TAB0
|
Facility
|
OP
|
$60.43
|
|
|
Service Code
|
NDC 54023525
|
| Hospital Charge Code |
25000078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Anthem Medicaid |
$20.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna Commercial |
$50.16
|
| Rate for Payer: First Health Commercial |
$57.41
|
| Rate for Payer: Humana Commercial |
$51.37
|
| Rate for Payer: Humana KY Medicaid |
$20.78
|
| Rate for Payer: Kentucky WC Medicaid |
$20.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.18
|
| Rate for Payer: Ohio Health Group HMO |
$45.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.73
|
| Rate for Payer: PHCS Commercial |
$58.01
|
| Rate for Payer: United Healthcare All Payer |
$53.18
|
|
|
CMT SPINAL 3-4 REGIONS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 98941
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
CMT SPINAL 3-4 REGIONS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 98941
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
CNTRL OROPHNGL HEMORHG SIMPLE
|
Professional
|
Both
|
$4,699.23
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
76101714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.79 |
| Max. Negotiated Rate |
$4,699.23 |
| Rate for Payer: Aetna Commercial |
$246.06
|
| Rate for Payer: Anthem Medicaid |
$98.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,699.23
|
| Rate for Payer: Cash Price |
$2,349.61
|
| Rate for Payer: Cash Price |
$2,349.61
|
| Rate for Payer: Cigna Commercial |
$244.68
|
| Rate for Payer: Healthspan PPO |
$207.51
|
| Rate for Payer: Humana Medicaid |
$98.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.77
|
| Rate for Payer: Molina Healthcare Passport |
$98.79
|
| Rate for Payer: Multiplan PHCS |
$2,819.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,289.46
|
| Rate for Payer: UHCCP Medicaid |
$1,644.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.78
|
|
|
CNTRL OROPHNGL HEMORHG SIMPLE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
45000264
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
CNTRL OROPHNGL HEMORHG SIMPLE
|
Facility
|
IP
|
$4,699.23
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
76101714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.90 |
| Max. Negotiated Rate |
$4,511.26 |
| Rate for Payer: Aetna Commercial |
$3,618.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,665.40
|
| Rate for Payer: Cash Price |
$2,349.61
|
| Rate for Payer: Cigna Commercial |
$3,900.36
|
| Rate for Payer: First Health Commercial |
$4,464.27
|
| Rate for Payer: Humana Commercial |
$3,994.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,853.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,524.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.76
|
| Rate for Payer: PHCS Commercial |
$4,511.26
|
| Rate for Payer: United Healthcare All Payer |
$4,135.32
|
|
|
CNTRL OROPHNGL HEMORHG SIMPLE
|
Facility
|
OP
|
$4,699.23
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
76101714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.79 |
| Max. Negotiated Rate |
$4,511.26 |
| Rate for Payer: Aetna Commercial |
$3,618.41
|
| Rate for Payer: Anthem Medicaid |
$1,616.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,665.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$2,349.61
|
| Rate for Payer: Cash Price |
$2,349.61
|
| Rate for Payer: Cigna Commercial |
$3,900.36
|
| Rate for Payer: First Health Commercial |
$4,464.27
|
| Rate for Payer: Humana Commercial |
$3,994.35
|
| Rate for Payer: Humana KY Medicaid |
$1,616.07
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,853.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,524.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.76
|
| Rate for Payer: PHCS Commercial |
$4,511.26
|
| Rate for Payer: United Healthcare All Payer |
$4,135.32
|
|
|
CNTRL OROPHNGL HEMORHG SIMPLE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
45000264
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
CNTRL OROPHNGL HEMORHG SIMPL(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
761P1714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$246.06
|
| Rate for Payer: Anthem Medicaid |
$98.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$244.68
|
| Rate for Payer: Healthspan PPO |
$207.51
|
| Rate for Payer: Humana Medicaid |
$98.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.77
|
| Rate for Payer: Molina Healthcare Passport |
$98.79
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.78
|
|
|
CNTRL OROPHNGL HEMORHG SIMPL(T
|
Facility
|
OP
|
$4,449.23
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
761T1714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.79 |
| Max. Negotiated Rate |
$4,271.26 |
| Rate for Payer: Aetna Commercial |
$3,425.91
|
| Rate for Payer: Anthem Medicaid |
$1,530.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,470.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$2,224.61
|
| Rate for Payer: Cash Price |
$2,224.61
|
| Rate for Payer: Cigna Commercial |
$3,692.86
|
| Rate for Payer: First Health Commercial |
$4,226.77
|
| Rate for Payer: Humana Commercial |
$3,781.85
|
| Rate for Payer: Humana KY Medicaid |
$1,530.09
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,648.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,915.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$889.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.26
|
| Rate for Payer: PHCS Commercial |
$4,271.26
|
| Rate for Payer: United Healthcare All Payer |
$3,915.32
|
|
|
CNTRL OROPHNGL HEMORHG SIMPL(T
|
Facility
|
IP
|
$4,449.23
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
761T1714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$4,271.26 |
| Rate for Payer: Aetna Commercial |
$3,425.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,470.40
|
| Rate for Payer: Cash Price |
$2,224.61
|
| Rate for Payer: Cigna Commercial |
$3,692.86
|
| Rate for Payer: First Health Commercial |
$4,226.77
|
| Rate for Payer: Humana Commercial |
$3,781.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,648.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,283.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,915.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$889.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.26
|
| Rate for Payer: PHCS Commercial |
$4,271.26
|
| Rate for Payer: United Healthcare All Payer |
$3,915.32
|
|
|
CO2 TOTAL
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
30000263
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
CO2 TOTAL
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
30000263
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$4.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.88
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$4.88
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$18,249.20
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$12,383.38 |
| Max. Negotiated Rate |
$18,249.20 |
| Rate for Payer: Anthem Medicaid |
$12,383.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,035.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,249.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,597.44
|
| Rate for Payer: Humana KY Medicaid |
$12,383.38
|
| Rate for Payer: Humana Medicare Advantage |
$13,035.14
|
| Rate for Payer: Kentucky WC Medicaid |
$12,507.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,642.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,631.05
|
|
