|
CR FLX ART SUR C-H/5 6 GRN 17M
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CR FLX ART SUR C-H/5 6 GRN 20M
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CR FLX ART SUR C-H/5 6 GRN 20M
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CRICOTHYROID INCISION
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
45000217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$630.72 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$512.46
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna Commercial |
$545.31
|
| Rate for Payer: First Health Commercial |
$624.15
|
| Rate for Payer: Humana Commercial |
$558.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$538.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$484.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$578.16
|
| Rate for Payer: Ohio Health Group HMO |
$492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.67
|
| Rate for Payer: PHCS Commercial |
$630.72
|
| Rate for Payer: United Healthcare All Payer |
$578.16
|
|
|
CRICOTHYROID INCISION
|
Professional
|
Both
|
$2,454.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
76101167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.58 |
| Max. Negotiated Rate |
$2,454.00 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Anthem Medicaid |
$229.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,454.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$279.96
|
| Rate for Payer: Healthspan PPO |
$241.15
|
| Rate for Payer: Humana Medicaid |
$229.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.17
|
| Rate for Payer: Molina Healthcare Passport |
$229.58
|
| Rate for Payer: Multiplan PHCS |
$1,472.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,717.80
|
| Rate for Payer: UHCCP Medicaid |
$858.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.88
|
|
|
CRICOTHYROID INCISION
|
Facility
|
IP
|
$2,454.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
76101167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.02 |
| Max. Negotiated Rate |
$2,355.84 |
| Rate for Payer: Aetna Commercial |
$1,889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,914.12
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$2,036.82
|
| Rate for Payer: First Health Commercial |
$2,331.30
|
| Rate for Payer: Humana Commercial |
$2,085.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,012.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,811.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$736.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,159.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,840.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$760.74
|
| Rate for Payer: PHCS Commercial |
$2,355.84
|
| Rate for Payer: United Healthcare All Payer |
$2,159.52
|
|
|
CRICOTHYROID INCISION
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
45000217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$630.72 |
| Rate for Payer: Aetna Commercial |
$505.89
|
| Rate for Payer: Anthem Medicaid |
$225.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$512.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna Commercial |
$545.31
|
| Rate for Payer: First Health Commercial |
$624.15
|
| Rate for Payer: Humana Commercial |
$558.45
|
| Rate for Payer: Humana KY Medicaid |
$225.94
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$228.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$538.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$484.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$230.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$578.16
|
| Rate for Payer: Ohio Health Group HMO |
$492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.67
|
| Rate for Payer: PHCS Commercial |
$630.72
|
| Rate for Payer: United Healthcare All Payer |
$578.16
|
|
|
CRICOTHYROID INCISION
|
Facility
|
OP
|
$2,454.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
76101167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$2,355.84 |
| Rate for Payer: Aetna Commercial |
$1,889.58
|
| Rate for Payer: Anthem Medicaid |
$843.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,914.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$2,036.82
|
| Rate for Payer: First Health Commercial |
$2,331.30
|
| Rate for Payer: Humana Commercial |
$2,085.90
|
| Rate for Payer: Humana KY Medicaid |
$843.93
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$852.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,012.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,811.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$860.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,159.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,840.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$319.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$760.74
|
| Rate for Payer: PHCS Commercial |
$2,355.84
|
| Rate for Payer: United Healthcare All Payer |
$2,159.52
|
|
|
CRICOTHYROID INCISION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
761P1167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.58 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Anthem Medicaid |
$229.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$279.96
|
| Rate for Payer: Healthspan PPO |
$241.15
|
| Rate for Payer: Humana Medicaid |
$229.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.17
|
| Rate for Payer: Molina Healthcare Passport |
$229.58
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.88
|
|
|
CRICOTHYROID INCISION(T
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
761T1167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$1,539.84 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem Medicaid |
$551.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Humana KY Medicaid |
$551.62
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$557.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$562.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRICOTHYROID INCISION(T
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
761T1167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$1,539.84 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRISIS MANAGEMENT
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna Commercial |
$218.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$107.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$107.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.51
|
| Rate for Payer: Molina Healthcare Passport |
$107.36
|
| Rate for Payer: Multiplan PHCS |
$463.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$540.40
|
| Rate for Payer: UHCCP Medicaid |
$102.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.43
|
|
|
CRISIS MANAGEMENT
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.32
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
CRISIS MANAGEMENT
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem Medicaid |
$265.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Humana KY Medicaid |
$265.49
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$268.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.32
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$358.05
|
| Rate for Payer: Anthem Medicaid |
$159.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.70
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$385.95
|
| Rate for Payer: First Health Commercial |
$441.75
|
| Rate for Payer: Humana Commercial |
$395.25
|
| Rate for Payer: Humana KY Medicaid |
$159.91
|
| Rate for Payer: Kentucky WC Medicaid |
$161.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.20
|
| Rate for Payer: Ohio Health Group HMO |
$348.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.15
|
| Rate for Payer: PHCS Commercial |
$446.40
|
| Rate for Payer: United Healthcare All Payer |
$409.20
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
900T0003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$67.06
|
| Rate for Payer: Kentucky WC Medicaid |
$67.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$358.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$362.70
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$385.95
|
| Rate for Payer: First Health Commercial |
$441.75
|
| Rate for Payer: Humana Commercial |
$395.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.20
|
| Rate for Payer: Ohio Health Group HMO |
$348.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.15
|
| Rate for Payer: PHCS Commercial |
$446.40
|
| Rate for Payer: United Healthcare All Payer |
$409.20
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
900P0003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.85
|
| Rate for Payer: Anthem Medicaid |
$51.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$51.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.66
|
| Rate for Payer: Molina Healthcare Passport |
$51.63
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$49.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.15
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
900T0003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.85
|
| Rate for Payer: Anthem Medicaid |
$51.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$465.00
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$51.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.66
|
| Rate for Payer: Molina Healthcare Passport |
$51.63
|
| Rate for Payer: Multiplan PHCS |
$279.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$325.50
|
| Rate for Payer: UHCCP Medicaid |
$49.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.15
|
|
|
CRISIS MANAGEMENT(P
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
900P0002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna Commercial |
$218.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$107.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$772.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$107.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.51
|
| Rate for Payer: Molina Healthcare Passport |
$107.36
|
| Rate for Payer: Multiplan PHCS |
$463.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$540.40
|
| Rate for Payer: UHCCP Medicaid |
$102.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.43
|
|
|
[C]RITALIN(METHYLPHEN 5MG/1TAB
|
Facility
|
OP
|
$60.16
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
25000118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.93
|
| Rate for Payer: First Health Commercial |
$57.15
|
| Rate for Payer: Humana Commercial |
$51.14
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.94
|
| Rate for Payer: Ohio Health Group HMO |
$45.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Payer |
$52.94
|
|
|
[C]RITALIN(METHYLPHEN 5MG/1TAB
|
Facility
|
IP
|
$60.16
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
25000118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.93
|
| Rate for Payer: First Health Commercial |
$57.15
|
| Rate for Payer: Humana Commercial |
$51.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.94
|
| Rate for Payer: Ohio Health Group HMO |
$45.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Payer |
$52.94
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem Medicaid |
$324.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Humana KY Medicaid |
$324.99
|
| Rate for Payer: Kentucky WC Medicaid |
$328.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$331.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
