|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$1,079.04 |
| Rate for Payer: Aetna Commercial |
$865.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.72
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$932.92
|
| Rate for Payer: First Health Commercial |
$1,067.80
|
| Rate for Payer: Humana Commercial |
$955.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.12
|
| Rate for Payer: Ohio Health Group HMO |
$843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.44
|
| Rate for Payer: PHCS Commercial |
$1,079.04
|
| Rate for Payer: United Healthcare All Payer |
$989.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$1,124.00 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.50
|
| Rate for Payer: Anthem Medicaid |
$46.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,124.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$247.63
|
| Rate for Payer: Healthspan PPO |
$219.11
|
| Rate for Payer: Humana Medicaid |
$46.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.43
|
| Rate for Payer: Molina Healthcare Passport |
$46.50
|
| Rate for Payer: Multiplan PHCS |
$674.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$786.80
|
| Rate for Payer: UHCCP Medicaid |
$66.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.96
|
|
|
DRN EXTRN EARABSCESHEMATSIMPL
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
76102401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$1,079.04 |
| Rate for Payer: Aetna Commercial |
$865.48
|
| Rate for Payer: Anthem Medicaid |
$386.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cash Price |
$562.00
|
| Rate for Payer: Cigna Commercial |
$932.92
|
| Rate for Payer: First Health Commercial |
$1,067.80
|
| Rate for Payer: Humana Commercial |
$955.40
|
| Rate for Payer: Humana KY Medicaid |
$386.54
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$390.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.12
|
| Rate for Payer: Ohio Health Group HMO |
$843.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.44
|
| Rate for Payer: PHCS Commercial |
$1,079.04
|
| Rate for Payer: United Healthcare All Payer |
$989.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761P2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.50
|
| Rate for Payer: Anthem Medicaid |
$46.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$247.63
|
| Rate for Payer: Healthspan PPO |
$219.11
|
| Rate for Payer: Humana Medicaid |
$46.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$150.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.43
|
| Rate for Payer: Molina Healthcare Passport |
$46.50
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$66.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.96
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(T
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761T2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DRN EXTRN EARABSCESHEMATSIMP(T
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
761T2401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
DROPERIDOL 5mg SDV
|
Facility
|
IP
|
$24.42
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.05
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna Commercial |
$20.27
|
| Rate for Payer: First Health Commercial |
$23.20
|
| Rate for Payer: Humana Commercial |
$20.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.49
|
| Rate for Payer: Ohio Health Group HMO |
$18.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.57
|
| Rate for Payer: PHCS Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Payer |
$21.49
|
|
|
DROPERIDOL 5mg SDV
|
Facility
|
OP
|
$24.42
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
25004419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Anthem Medicaid |
$8.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.05
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cigna Commercial |
$20.27
|
| Rate for Payer: First Health Commercial |
$23.20
|
| Rate for Payer: Humana Commercial |
$20.76
|
| Rate for Payer: Humana KY Medicaid |
$8.40
|
| Rate for Payer: Kentucky WC Medicaid |
$8.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.49
|
| Rate for Payer: Ohio Health Group HMO |
$18.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.57
|
| Rate for Payer: PHCS Commercial |
$23.44
|
| Rate for Payer: United Healthcare All Payer |
$21.49
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761T0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem Medicaid |
$260.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Humana KY Medicaid |
$260.68
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$758.00 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$758.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$240.92
|
| Rate for Payer: Healthspan PPO |
$198.68
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$454.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$530.60
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761T0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.98
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761P0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.97
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$240.92
|
| Rate for Payer: Healthspan PPO |
$198.68
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$70.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem Medicaid |
$158.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Humana KY Medicaid |
$158.88
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$160.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761T0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$61.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$462.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$203.63
|
| Rate for Payer: Healthspan PPO |
$165.96
|
| Rate for Payer: Humana Medicaid |
$61.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.77
|
| Rate for Payer: Molina Healthcare Passport |
$61.54
|
| Rate for Payer: Multiplan PHCS |
$277.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$323.40
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.16
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
45000079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761P0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$203.63 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$61.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$167.00
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$203.63
|
| Rate for Payer: Healthspan PPO |
$165.96
|
| Rate for Payer: Humana Medicaid |
$61.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.77
|
| Rate for Payer: Molina Healthcare Passport |
$61.54
|
| Rate for Payer: Multiplan PHCS |
$100.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.90
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.16
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$443.52 |
| Rate for Payer: Aetna Commercial |
$355.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.36
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$383.46
|
| Rate for Payer: First Health Commercial |
$438.90
|
| Rate for Payer: Humana Commercial |
$392.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$406.56
|
| Rate for Payer: Ohio Health Group HMO |
$346.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.22
|
| Rate for Payer: PHCS Commercial |
$443.52
|
| Rate for Payer: United Healthcare All Payer |
$406.56
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761T0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$101.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$101.45
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$102.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
45000079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$101.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$101.45
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$102.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
DRUG ASSAY POSACONAZOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 80187
|
| Hospital Charge Code |
30001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
