|
CR FLX ART SUR C-H/5 6 GRN 20M
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
CR FLX ART SUR C-H/5 6 GRN 20M
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
CRICOTHYROID INCISION
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
45000217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.20 |
| 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 |
$1,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,395.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.76
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRICOTHYROID INCISION
|
Facility
|
IP
|
$2,454.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
76101167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.20 |
| 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 |
$1,963.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,693.26
|
| Rate for Payer: PHCS Commercial |
$2,355.84
|
| Rate for Payer: United Healthcare All Payer |
$2,159.52
|
|
|
CRICOTHYROID INCISION
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
45000217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$1,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,395.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.76
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRICOTHYROID INCISION
|
Facility
|
OP
|
$2,454.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
76101167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,914.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$1,963.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,693.26
|
| Rate for Payer: PHCS Commercial |
$2,355.84
|
| Rate for Payer: United Healthcare All Payer |
$2,159.52
|
|
|
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 |
$1,472.40 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Ambetter Exchange |
$314.43
|
| Rate for Payer: Anthem Medicaid |
$229.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.43
|
| 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 |
$408.76
|
| Rate for Payer: UHCCP Medicaid |
$858.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.43
|
|
|
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 |
$510.00 |
| Rate for Payer: Aetna Commercial |
$308.86
|
| Rate for Payer: Ambetter Exchange |
$314.43
|
| Rate for Payer: Anthem Medicaid |
$229.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.43
|
| 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 |
$408.76
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.43
|
|
|
CRICOTHYROID INCISION(T
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
761T1167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.20 |
| 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 |
$1,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,395.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.76
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRICOTHYROID INCISION(T
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
761T1167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| 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 |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| 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 |
$214.57
|
| 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 |
$257.48
|
| 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 |
$1,283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,395.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.76
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
CRISIS MANAGEMENT
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.86
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
CRISIS MANAGEMENT
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$476.40 |
| Rate for Payer: Aetna Commercial |
$218.31
|
| Rate for Payer: Ambetter Exchange |
$129.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$108.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.82
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$108.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.30
|
| Rate for Payer: Molina Healthcare Passport |
$108.14
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.73
|
| Rate for Payer: UHCCP Medicaid |
$102.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.02
|
|
|
CRISIS MANAGEMENT
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
90000002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem Medicaid |
$273.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Humana KY Medicaid |
$273.06
|
| Rate for Payer: Humana Medicare Advantage |
$148.46
|
| Rate for Payer: Kentucky WC Medicaid |
$275.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.86
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$143.40 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.82
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
900T0003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$199.68 |
| Rate for Payer: Aetna Commercial |
$160.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.24
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$172.64
|
| Rate for Payer: First Health Commercial |
$197.60
|
| Rate for Payer: Humana Commercial |
$176.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$153.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.04
|
| Rate for Payer: Ohio Health Group HMO |
$156.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.52
|
| Rate for Payer: PHCS Commercial |
$199.68
|
| Rate for Payer: United Healthcare All Payer |
$183.04
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
90000003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$286.80 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Ambetter Exchange |
$63.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.85
|
| Rate for Payer: Anthem Medicaid |
$51.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.67
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$51.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.41
|
| Rate for Payer: Molina Healthcare Passport |
$51.38
|
| Rate for Payer: Multiplan PHCS |
$286.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.06
|
| Rate for Payer: UHCCP Medicaid |
$49.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.89
|
|
|
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 |
$162.00 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Ambetter Exchange |
$63.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.85
|
| Rate for Payer: Anthem Medicaid |
$51.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.67
|
| 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 |
$51.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.41
|
| Rate for Payer: Molina Healthcare Passport |
$51.38
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.06
|
| Rate for Payer: UHCCP Medicaid |
$49.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.89
|
|
|
CRISIS MANAGEMENT ADDL 30 MINS
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
900T0003
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$199.68 |
| Rate for Payer: Aetna Commercial |
$160.16
|
| Rate for Payer: Anthem Medicaid |
$71.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$162.24
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cigna Commercial |
$172.64
|
| Rate for Payer: First Health Commercial |
$197.60
|
| Rate for Payer: Humana Commercial |
$176.80
|
| Rate for Payer: Humana KY Medicaid |
$71.53
|
| Rate for Payer: Kentucky WC Medicaid |
$72.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$153.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.04
|
| Rate for Payer: Ohio Health Group HMO |
$156.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.52
|
| Rate for Payer: PHCS Commercial |
$199.68
|
| Rate for Payer: United Healthcare All Payer |
$183.04
|
|
|
CRISIS MANAGEMENT(P
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
900P0002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$476.40 |
| Rate for Payer: Aetna Commercial |
$218.31
|
| Rate for Payer: Ambetter Exchange |
$129.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$108.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.82
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$108.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$157.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.30
|
| Rate for Payer: Molina Healthcare Passport |
$108.14
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.73
|
| Rate for Payer: UHCCP Medicaid |
$102.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.02
|
|
|
[C]RITALIN(METHYLPHEN 5MG/1TAB
|
Facility
|
IP
|
$60.16
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
25000118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.05 |
| 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 |
$48.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.51
|
| Rate for Payer: PHCS Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Payer |
$52.94
|
|
|
[C]RITALIN(METHYLPHEN 5MG/1TAB
|
Facility
|
OP
|
$60.16
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
25000118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.05 |
| 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 |
$48.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.51
|
| Rate for Payer: PHCS Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Payer |
$52.94
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.80 |
| Max. Negotiated Rate |
$965.76 |
| Rate for Payer: Aetna Commercial |
$774.62
|
| Rate for Payer: Anthem Medicaid |
$345.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.68
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$834.98
|
| Rate for Payer: First Health Commercial |
$955.70
|
| Rate for Payer: Humana Commercial |
$855.10
|
| Rate for Payer: Humana KY Medicaid |
$345.96
|
| Rate for Payer: Kentucky WC Medicaid |
$349.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.28
|
| Rate for Payer: Ohio Health Group HMO |
$754.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.14
|
| Rate for Payer: PHCS Commercial |
$965.76
|
| Rate for Payer: United Healthcare All Payer |
$885.28
|
|
|
CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.80 |
| Max. Negotiated Rate |
$965.76 |
| Rate for Payer: Aetna Commercial |
$774.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.68
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$834.98
|
| Rate for Payer: First Health Commercial |
$955.70
|
| Rate for Payer: Humana Commercial |
$855.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.28
|
| Rate for Payer: Ohio Health Group HMO |
$754.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.14
|
| Rate for Payer: PHCS Commercial |
$965.76
|
| Rate for Payer: United Healthcare All Payer |
$885.28
|
|
|
CRITICAL CARE ADDL 30MIN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
51000167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.50 |
| 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 |
$756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$822.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.05
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
