|
CONSULTATION WITH FAMILY(T
|
Facility
|
OP
|
$204.50
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
900T0013
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$196.32 |
| Rate for Payer: Aetna Commercial |
$157.47
|
| Rate for Payer: Anthem Medicaid |
$70.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.51
|
| Rate for Payer: Cash Price |
$102.25
|
| Rate for Payer: Cigna Commercial |
$169.74
|
| Rate for Payer: First Health Commercial |
$194.28
|
| Rate for Payer: Humana Commercial |
$173.82
|
| Rate for Payer: Humana KY Medicaid |
$70.33
|
| Rate for Payer: Kentucky WC Medicaid |
$71.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.96
|
| Rate for Payer: Ohio Health Group HMO |
$153.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.10
|
| Rate for Payer: PHCS Commercial |
$196.32
|
| Rate for Payer: United Healthcare All Payer |
$179.96
|
|
|
CONSULTATION WITH FAMILY(T
|
Facility
|
IP
|
$204.50
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
900T0013
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$196.32 |
| Rate for Payer: Aetna Commercial |
$157.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.51
|
| Rate for Payer: Cash Price |
$102.25
|
| Rate for Payer: Cigna Commercial |
$169.74
|
| Rate for Payer: First Health Commercial |
$194.28
|
| Rate for Payer: Humana Commercial |
$173.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.96
|
| Rate for Payer: Ohio Health Group HMO |
$153.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.10
|
| Rate for Payer: PHCS Commercial |
$196.32
|
| Rate for Payer: United Healthcare All Payer |
$179.96
|
|
|
CONTACT 8 EXT KIT 25CM
|
Facility
|
IP
|
$4,495.21
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.56 |
| Max. Negotiated Rate |
$4,315.40 |
| Rate for Payer: Aetna Commercial |
$3,461.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.26
|
| Rate for Payer: Cash Price |
$2,247.61
|
| Rate for Payer: Cigna Commercial |
$3,731.02
|
| Rate for Payer: First Health Commercial |
$4,270.45
|
| Rate for Payer: Humana Commercial |
$3,820.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,686.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.69
|
| Rate for Payer: PHCS Commercial |
$4,315.40
|
| Rate for Payer: United Healthcare All Payer |
$3,955.78
|
|
|
CONTACT 8 EXT KIT 25CM
|
Facility
|
OP
|
$4,495.21
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.56 |
| Max. Negotiated Rate |
$4,315.40 |
| Rate for Payer: Aetna Commercial |
$3,461.31
|
| Rate for Payer: Anthem Medicaid |
$1,545.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.26
|
| Rate for Payer: Cash Price |
$2,247.61
|
| Rate for Payer: Cigna Commercial |
$3,731.02
|
| Rate for Payer: First Health Commercial |
$4,270.45
|
| Rate for Payer: Humana Commercial |
$3,820.93
|
| Rate for Payer: Humana KY Medicaid |
$1,545.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,561.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,686.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.69
|
| Rate for Payer: PHCS Commercial |
$4,315.40
|
| Rate for Payer: United Healthcare All Payer |
$3,955.78
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem Medicaid |
$67.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Humana KY Medicaid |
$67.40
|
| Rate for Payer: Kentucky WC Medicaid |
$68.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.24
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.24
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
51000034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Ambetter Exchange |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$20.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.02
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: Healthspan PPO |
$54.94
|
| Rate for Payer: Humana Medicaid |
$20.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.21
|
| Rate for Payer: Molina Healthcare Passport |
$20.79
|
| Rate for Payer: Multiplan PHCS |
$117.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.28
|
| Rate for Payer: UHCCP Medicaid |
$68.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.52
|
|
|
CONT GLUC MNTR ANALYSIS I&R(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510P0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$62.82 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Ambetter Exchange |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$20.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.02
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: Healthspan PPO |
$54.94
|
| Rate for Payer: Humana Medicaid |
$20.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.21
|
| Rate for Payer: Molina Healthcare Passport |
$20.79
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.28
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.52
|
|
|
CONT GLUC MNTR ANALYSIS I&R(T
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510T0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CONT GLUC MNTR ANALYSIS I&R(T
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 95251
|
| Hospital Charge Code |
510T0034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$147.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$190.71
|
| Rate for Payer: Ambetter Exchange |
$127.16
|
| Rate for Payer: Anthem Medicaid |
$37.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.59
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$189.89
|
| Rate for Payer: Healthspan PPO |
$166.78
|
| Rate for Payer: Humana Medicaid |
$37.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.17
|
| Rate for Payer: Molina Healthcare Passport |
$37.42
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.31
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.16
|
|
|
CONT GLUC MNTR PHYS/QHP EQP
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
51000033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP(T
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
510T0033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$146.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$146.16
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$147.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PHYS/QHP EQP(T
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 95250
|
| Hospital Charge Code |
510T0033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.25
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Ambetter Exchange |
$58.50
|
| Rate for Payer: Anthem Medicaid |
$40.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$74.76
|
| Rate for Payer: Humana Medicaid |
$40.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.49
|
| Rate for Payer: Molina Healthcare Passport |
$40.68
|
| Rate for Payer: Multiplan PHCS |
$163.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.05
|
| Rate for Payer: UHCCP Medicaid |
$95.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.50
|
|
|
CONT GLUC MNTR PT PROV EQP
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
51000032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem Medicaid |
$93.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Humana KY Medicaid |
$93.88
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$94.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
CONT GLUC MNTR PT PROV EQP(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510P0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$76.05 |
| Rate for Payer: Ambetter Exchange |
$58.50
|
| Rate for Payer: Anthem Medicaid |
$40.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.76
|
| Rate for Payer: Humana Medicaid |
$40.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.49
|
| Rate for Payer: Molina Healthcare Passport |
$40.68
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.05
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.50
|
|
|
CONT GLUC MNTR PT PROV EQP(T
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510T0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
CONT GLUC MNTR PT PROV EQP(T
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 95249
|
| Hospital Charge Code |
510T0032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
CONTIN RENAL REPLAC THERAPY
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$393.45 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem Medicaid |
$435.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$393.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$550.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$531.16
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Humana KY Medicaid |
$435.38
|
| Rate for Payer: Humana Medicare Advantage |
$393.45
|
| Rate for Payer: Kentucky WC Medicaid |
$439.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$444.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.54
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
CONTIN RENAL REPLAC THERAPY
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$73.57 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Aetna Commercial |
$108.33
|
| Rate for Payer: Ambetter Exchange |
$80.62
|
| Rate for Payer: Anthem Medicaid |
$73.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.74
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: Healthspan PPO |
$88.65
|
| Rate for Payer: Humana Medicaid |
$73.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.04
|
| Rate for Payer: Molina Healthcare Passport |
$73.57
|
| Rate for Payer: Multiplan PHCS |
$759.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.81
|
| Rate for Payer: UHCCP Medicaid |
$443.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.62
|
|
|
CONTIN RENAL REPLAC THERAPY
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
880
|
| Min. Negotiated Rate |
$379.80 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.54
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
CONTINUOUS NEB 1ST HR
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
41000078
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
