|
AFLURIA PFS 24-25
|
Facility
|
IP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
636T0244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
|
AFLURIA PFS 24-25
|
Professional
|
Both
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$72.15 |
| Rate for Payer: Ambetter Exchange |
$22.35
|
| Rate for Payer: Anthem Medicaid |
$23.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.82
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Healthspan PPO |
$23.44
|
| Rate for Payer: Humana Medicaid |
$23.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.68
|
| Rate for Payer: Molina Healthcare Passport |
$23.22
|
| Rate for Payer: Multiplan PHCS |
$72.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$42.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.35
|
|
|
AFLURIA PFS 24-25
|
Facility
|
IP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
|
AFLURIA PFS 24-25
|
Facility
|
OP
|
$120.25
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
636T0244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$115.44 |
| Rate for Payer: Aetna Commercial |
$92.59
|
| Rate for Payer: Anthem Medicaid |
$41.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.80
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna Commercial |
$99.81
|
| Rate for Payer: First Health Commercial |
$114.24
|
| Rate for Payer: Humana Commercial |
$102.21
|
| Rate for Payer: Humana KY Medicaid |
$41.35
|
| Rate for Payer: Kentucky WC Medicaid |
$41.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.82
|
| Rate for Payer: Ohio Health Group HMO |
$90.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.97
|
| Rate for Payer: PHCS Commercial |
$115.44
|
| Rate for Payer: United Healthcare All Payer |
$105.82
|
|
|
AFLURIA PFS 24-25 (T
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
770T0020
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
AFLURIA PFS 24-25 (T
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
770T0020
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
AFLURIA QUAD (3YR & UP)
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
770T0033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
AFLURIA QUAD (3YR & UP)
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
770T0033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
AFLURIA QUAD (3YR & UP)
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
77000033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
AFLURIA QUAD (3YR & UP)
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
77000033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$22.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.80
|
| Rate for Payer: Molina Healthcare Passport |
$22.35
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.57
|
|
|
AFLURIA QUAD (3YR & UP)
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
77000033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
AFRIN(OXYMETAZOLINE) 15ML SPRY
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 37000080301
|
| Hospital Charge Code |
25000172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
AFRIN(OXYMETAZOLINE) 15ML SPRY
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 37000080301
|
| Hospital Charge Code |
25000172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
AFTER CARE
|
Professional
|
Both
|
$175.00
|
|
| Hospital Charge Code |
22200207
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
AFX 2 BFMN BDY BEA22-60/I16-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-60/I16-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-70/I20-30
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-70/I20-30
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-80/I20-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-80/I20-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-90/I16-30
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-90/I16-30
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-90/I20-30
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA22-90/I20-30
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BDY BEA25-60/I16-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
