|
C-SECTION
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
C-SECTION
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
IP
|
$3,193.00
|
|
| Hospital Charge Code |
76102549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.90 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
OP
|
$3,193.00
|
|
| Hospital Charge Code |
76102549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.90 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem Medicaid |
$1,098.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Humana KY Medicaid |
$1,098.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,120.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
IP
|
$3,329.00
|
|
| Hospital Charge Code |
45000319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$998.70 |
| Max. Negotiated Rate |
$3,195.84 |
| Rate for Payer: Aetna Commercial |
$2,563.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.62
|
| Rate for Payer: Cash Price |
$1,664.50
|
| Rate for Payer: Cigna Commercial |
$2,763.07
|
| Rate for Payer: First Health Commercial |
$3,162.55
|
| Rate for Payer: Humana Commercial |
$2,829.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,297.01
|
| Rate for Payer: PHCS Commercial |
$3,195.84
|
| Rate for Payer: United Healthcare All Payer |
$2,929.52
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
OP
|
$3,329.00
|
|
| Hospital Charge Code |
45000319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$998.70 |
| Max. Negotiated Rate |
$3,195.84 |
| Rate for Payer: Aetna Commercial |
$2,563.33
|
| Rate for Payer: Anthem Medicaid |
$1,144.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.62
|
| Rate for Payer: Cash Price |
$1,664.50
|
| Rate for Payer: Cigna Commercial |
$2,763.07
|
| Rate for Payer: First Health Commercial |
$3,162.55
|
| Rate for Payer: Humana Commercial |
$2,829.65
|
| Rate for Payer: Humana KY Medicaid |
$1,144.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,156.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,896.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,297.01
|
| Rate for Payer: PHCS Commercial |
$3,195.84
|
| Rate for Payer: United Healthcare All Payer |
$2,929.52
|
|
|
C-SECTION(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
720P0023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,537.35 |
| Rate for Payer: Aetna Commercial |
$1,537.35
|
| Rate for Payer: Ambetter Exchange |
$867.00
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$867.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$867.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,040.40
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,417.36
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,417.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,127.10
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$867.00
|
|
|
C-SECTION W/PRENATAL CARE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
C-SECTION W/PRENATAL CARE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
C-SECTION W/PRENATAL CARE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,315.45 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Ambetter Exchange |
$2,550.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,550.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,060.42
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,974.03
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,550.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,550.35
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,315.45
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,550.35
|
|
|
C-SECTION W/PRENATAL CARE(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
720P0022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,315.45 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Ambetter Exchange |
$2,550.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,550.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,060.42
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,974.03
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,550.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,550.35
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,315.45
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,550.35
|
|
|
[C]SERAX (OXAZEPAM) 10MG/1CAP
|
Facility
|
OP
|
$60.96
|
|
|
Service Code
|
NDC 228206710
|
| Hospital Charge Code |
25000121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.55
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: First Health Commercial |
$57.91
|
| Rate for Payer: Humana Commercial |
$51.82
|
| Rate for Payer: Humana KY Medicaid |
$20.96
|
| Rate for Payer: Kentucky WC Medicaid |
$21.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.64
|
| Rate for Payer: Ohio Health Group HMO |
$45.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.06
|
| Rate for Payer: PHCS Commercial |
$58.52
|
| Rate for Payer: United Healthcare All Payer |
$53.64
|
|
|
[C]SERAX (OXAZEPAM) 10MG/1CAP
|
Facility
|
IP
|
$60.96
|
|
|
Service Code
|
NDC 228206710
|
| Hospital Charge Code |
25000121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.55
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: First Health Commercial |
$57.91
|
| Rate for Payer: Humana Commercial |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.64
|
| Rate for Payer: Ohio Health Group HMO |
$45.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.06
|
| Rate for Payer: PHCS Commercial |
$58.52
|
| Rate for Payer: United Healthcare All Payer |
$53.64
|
|
|
[C]SERAX (OXAZEPAM) 15MG/1CAP
|
Facility
|
IP
|
$61.21
|
|
|
Service Code
|
NDC 228206910
|
| Hospital Charge Code |
25000122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$50.80
|
| Rate for Payer: First Health Commercial |
$58.15
|
| Rate for Payer: Humana Commercial |
$52.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.23
|
| Rate for Payer: PHCS Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Payer |
$53.86
|
|
|
[C]SERAX (OXAZEPAM) 15MG/1CAP
|
Facility
|
OP
|
$61.21
|
|
|
Service Code
|
NDC 228206910
|
| Hospital Charge Code |
25000122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Anthem Medicaid |
$21.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$50.80
|
| Rate for Payer: First Health Commercial |
$58.15
|
| Rate for Payer: Humana Commercial |
$52.03
|
| Rate for Payer: Humana KY Medicaid |
$21.05
|
| Rate for Payer: Kentucky WC Medicaid |
$21.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.23
|
| Rate for Payer: PHCS Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Payer |
$53.86
|
|
|
CSF CELL COUNT W DIFF ADD TUBE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
CSF CELL COUNT W DIFF ADD TUBE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$342.60 |
| Max. Negotiated Rate |
$1,096.32 |
| Rate for Payer: Aetna Commercial |
$879.34
|
| Rate for Payer: Anthem Medicaid |
$392.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$890.76
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$947.86
|
| Rate for Payer: First Health Commercial |
$1,084.90
|
| Rate for Payer: Humana Commercial |
$970.70
|
| Rate for Payer: Humana KY Medicaid |
$392.73
|
| Rate for Payer: Kentucky WC Medicaid |
$396.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.96
|
| Rate for Payer: Ohio Health Group HMO |
$856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.98
|
| Rate for Payer: PHCS Commercial |
$1,096.32
|
| Rate for Payer: United Healthcare All Payer |
$1,004.96
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$685.20 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$72.64
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.17
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$685.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.43
|
| Rate for Payer: UHCCP Medicaid |
$399.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.64
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$342.60 |
| Max. Negotiated Rate |
$1,096.32 |
| Rate for Payer: Aetna Commercial |
$879.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$890.76
|
| Rate for Payer: Cash Price |
$571.00
|
| Rate for Payer: Cigna Commercial |
$947.86
|
| Rate for Payer: First Health Commercial |
$1,084.90
|
| Rate for Payer: Humana Commercial |
$970.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$842.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,004.96
|
| Rate for Payer: Ohio Health Group HMO |
$856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$787.98
|
| Rate for Payer: PHCS Commercial |
$1,096.32
|
| Rate for Payer: United Healthcare All Payer |
$1,004.96
|
|
|
CT 3D STUDY WITH WORKSTATION(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Ambetter Exchange |
$72.64
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.17
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.43
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.64
|
|
|
CT 3D STUDY WITH WORKSTATION(T
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
CT 3D STUDY WITH WORKSTATION(T
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
CT ABD & PELV 1/> REGNS
|
Professional
|
Both
|
$5,796.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
35000064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$3,477.60 |
| Rate for Payer: Aetna Commercial |
$668.41
|
| Rate for Payer: Ambetter Exchange |
$309.52
|
| Rate for Payer: Anthem Medicaid |
$375.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.42
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cigna Commercial |
$706.69
|
| Rate for Payer: Healthspan PPO |
$346.20
|
| Rate for Payer: Humana Medicaid |
$375.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$383.44
|
| Rate for Payer: Molina Healthcare Passport |
$375.92
|
| Rate for Payer: Multiplan PHCS |
$3,477.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.38
|
| Rate for Payer: UHCCP Medicaid |
$2,028.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$379.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.52
|
|
|
CT ABD & PELV 1/> REGNS
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
35000064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,738.80 |
| Max. Negotiated Rate |
$5,564.16 |
| Rate for Payer: Aetna Commercial |
$4,462.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,520.88
|
| Rate for Payer: Cash Price |
$2,898.00
|
| Rate for Payer: Cigna Commercial |
$4,810.68
|
| Rate for Payer: First Health Commercial |
$5,506.20
|
| Rate for Payer: Humana Commercial |
$4,926.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,752.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,277.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,738.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,100.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,347.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,042.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,999.24
|
| Rate for Payer: PHCS Commercial |
$5,564.16
|
| Rate for Payer: United Healthcare All Payer |
$5,100.48
|
|
