|
DTAP .5ML
|
Professional
|
Both
|
$234.50
|
|
|
Service Code
|
HCPCS 90749
|
| Hospital Charge Code |
77000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$234.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$234.50
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$140.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.15
|
| Rate for Payer: UHCCP Medicaid |
$82.08
|
|
|
DTAP .5ML
|
Facility
|
IP
|
$234.50
|
|
|
Service Code
|
HCPCS 90749
|
| Hospital Charge Code |
77000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$180.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.91
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: First Health Commercial |
$222.78
|
| Rate for Payer: Humana Commercial |
$199.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.36
|
| Rate for Payer: Ohio Health Group HMO |
$175.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.70
|
| Rate for Payer: PHCS Commercial |
$225.12
|
| Rate for Payer: United Healthcare All Payer |
$206.36
|
|
|
DTAP .5ML(T
|
Facility
|
OP
|
$234.50
|
|
|
Service Code
|
HCPCS 90749
|
| Hospital Charge Code |
770T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$180.56
|
| Rate for Payer: Anthem Medicaid |
$80.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.91
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: First Health Commercial |
$222.78
|
| Rate for Payer: Humana Commercial |
$199.32
|
| Rate for Payer: Humana KY Medicaid |
$80.64
|
| Rate for Payer: Kentucky WC Medicaid |
$81.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.36
|
| Rate for Payer: Ohio Health Group HMO |
$175.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.70
|
| Rate for Payer: PHCS Commercial |
$225.12
|
| Rate for Payer: United Healthcare All Payer |
$206.36
|
|
|
DTAP .5ML(T
|
Facility
|
IP
|
$234.50
|
|
|
Service Code
|
HCPCS 90749
|
| Hospital Charge Code |
770T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$180.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.91
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: First Health Commercial |
$222.78
|
| Rate for Payer: Humana Commercial |
$199.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.36
|
| Rate for Payer: Ohio Health Group HMO |
$175.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.70
|
| Rate for Payer: PHCS Commercial |
$225.12
|
| Rate for Payer: United Healthcare All Payer |
$206.36
|
|
|
DTAP/HEPB/IPV VACCINE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
77000045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Humana KY Medicaid |
$101.11
|
| Rate for Payer: Kentucky WC Medicaid |
$102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.14
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
DTAP/HEPB/IPV VACCINE
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
77000045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.14
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
DTAP/HEPB/IPV VACCINE
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
77000045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$294.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Healthspan PPO |
$70.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.16
|
| Rate for Payer: Multiplan PHCS |
$176.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.80
|
| Rate for Payer: UHCCP Medicaid |
$102.90
|
|
|
DTAP/HEPB/IPV VACCINE(T
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
770T0045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.14
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
DTAP/HEPB/IPV VACCINE(T
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
770T0045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Humana KY Medicaid |
$101.11
|
| Rate for Payer: Kentucky WC Medicaid |
$102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.14
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
DTAP - HIB - IPV
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
77000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
DTAP - HIB - IPV
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
77000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$327.00
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Healthspan PPO |
$50.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.16
|
| Rate for Payer: Multiplan PHCS |
$196.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.90
|
| Rate for Payer: UHCCP Medicaid |
$114.45
|
|
|
DTAP - HIB - IPV
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
77000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
DTAP - HIB - IPV(T
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
770T0037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
DTAP - HIB - IPV(T
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
770T0037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
DTAP-IPV
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
77000036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.15
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
DTAP-IPV
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
77000036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
DTAP-IPV
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
77000036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
DTAP-IPV(T
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
770T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
DTAP-IPV(T
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
770T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
DTAP VAC
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
77000038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$53.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$53.65
|
| Rate for Payer: Kentucky WC Medicaid |
$54.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
DTAP VAC
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
77000038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
DTAP VAC
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
77000038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.86 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$156.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.86
|
| Rate for Payer: Multiplan PHCS |
$93.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$109.20
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
|
|
DTAP VAC(T
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
770T0038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$53.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$53.65
|
| Rate for Payer: Kentucky WC Medicaid |
$54.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
DTAP VAC(T
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 90700
|
| Hospital Charge Code |
770T0038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.68
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
DUCK FEATHERS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000712
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
