|
ED ARTERIAL BLOOD GAS STICK
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ED ARTERIAL BLOOD GAS STICK
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
EDECRIN 25MG TAB
|
Facility
|
OP
|
$41.44
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
25000594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: Anthem Medicaid |
$14.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.32
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: First Health Commercial |
$39.37
|
| Rate for Payer: Humana Commercial |
$35.22
|
| Rate for Payer: Humana KY Medicaid |
$14.25
|
| Rate for Payer: Kentucky WC Medicaid |
$14.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.47
|
| Rate for Payer: Ohio Health Group HMO |
$31.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.85
|
| Rate for Payer: PHCS Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Payer |
$36.47
|
|
|
EDECRIN 25MG TAB
|
Facility
|
IP
|
$41.44
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
25000594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.32
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cigna Commercial |
$34.40
|
| Rate for Payer: First Health Commercial |
$39.37
|
| Rate for Payer: Humana Commercial |
$35.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.47
|
| Rate for Payer: Ohio Health Group HMO |
$31.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.85
|
| Rate for Payer: PHCS Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Payer |
$36.47
|
|
|
EDECRIN (ETHACRYNATE 50MG/50ML
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
NDC 67457029750
|
| Hospital Charge Code |
25003818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
|
|
EDECRIN (ETHACRYNATE 50MG/50ML
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
NDC 67457029750
|
| Hospital Charge Code |
25003818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Humana KY Medicaid |
$1,255.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
EDEX 1.25mcg (40MCG SDV)
|
Facility
|
IP
|
$1,639.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.13 |
| Max. Negotiated Rate |
$1,573.89 |
| Rate for Payer: Aetna Commercial |
$1,262.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,278.79
|
| Rate for Payer: Cash Price |
$819.74
|
| Rate for Payer: Cigna Commercial |
$1,360.76
|
| Rate for Payer: First Health Commercial |
$1,557.50
|
| Rate for Payer: Humana Commercial |
$1,393.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,209.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,442.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,229.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.24
|
| Rate for Payer: PHCS Commercial |
$1,573.89
|
| Rate for Payer: United Healthcare All Payer |
$1,442.73
|
|
|
EDEX 1.25mcg (40MCG SDV)
|
Facility
|
OP
|
$1,639.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.13 |
| Max. Negotiated Rate |
$1,573.89 |
| Rate for Payer: Aetna Commercial |
$1,262.39
|
| Rate for Payer: Anthem Medicaid |
$563.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,278.79
|
| Rate for Payer: Cash Price |
$819.74
|
| Rate for Payer: Cigna Commercial |
$1,360.76
|
| Rate for Payer: First Health Commercial |
$1,557.50
|
| Rate for Payer: Humana Commercial |
$1,393.55
|
| Rate for Payer: Humana KY Medicaid |
$563.81
|
| Rate for Payer: Kentucky WC Medicaid |
$569.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,209.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,442.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,229.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.24
|
| Rate for Payer: PHCS Commercial |
$1,573.89
|
| Rate for Payer: United Healthcare All Payer |
$1,442.73
|
|
|
ED HIGH LEVEL IV
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.86 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$709.94
|
| Rate for Payer: Anthem Medicaid |
$317.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$383.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$536.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.06
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cigna Commercial |
$765.26
|
| Rate for Payer: First Health Commercial |
$875.90
|
| Rate for Payer: Humana Commercial |
$783.70
|
| Rate for Payer: Humana KY Medicaid |
$317.08
|
| Rate for Payer: Humana Medicare Advantage |
$383.01
|
| Rate for Payer: Kentucky WC Medicaid |
$320.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$680.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$323.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$811.36
|
| Rate for Payer: Ohio Health Group HMO |
$691.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.82
|
| Rate for Payer: PHCS Commercial |
$885.12
|
| Rate for Payer: United Healthcare All Payer |
$811.36
|
|
|
ED HIGH LEVEL IV
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.86 |
| Max. Negotiated Rate |
$885.12 |
| Rate for Payer: Aetna Commercial |
$709.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.16
|
| Rate for Payer: Cash Price |
$461.00
|
| Rate for Payer: Cigna Commercial |
$765.26
|
| Rate for Payer: First Health Commercial |
$875.90
|
| Rate for Payer: Humana Commercial |
$783.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$680.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$811.36
|
| Rate for Payer: Ohio Health Group HMO |
$691.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.82
|
| Rate for Payer: PHCS Commercial |
$885.12
|
| Rate for Payer: United Healthcare All Payer |
$811.36
|
|
|
ED HIGH LEVEL V
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
ED HIGH LEVEL V
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem Medicaid |
$375.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$555.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$777.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$749.84
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Humana KY Medicaid |
$375.19
|
| Rate for Payer: Humana Medicare Advantage |
$555.44
|
| Rate for Payer: Kentucky WC Medicaid |
$379.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.21
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
ED LOW LEVEL I
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
45000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.62
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.99
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
ED LOW LEVEL I
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
45000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$253.33
|
| Rate for Payer: Anthem Medicaid |
$113.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$76.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.64
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cigna Commercial |
$273.07
|
| Rate for Payer: First Health Commercial |
$312.55
|
| Rate for Payer: Humana Commercial |
$279.65
|
| Rate for Payer: Humana KY Medicaid |
$113.14
|
| Rate for Payer: Humana Medicare Advantage |
$76.77
|
| Rate for Payer: Kentucky WC Medicaid |
$114.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$269.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.52
|
| Rate for Payer: Ohio Health Group HMO |
$246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.99
|
| Rate for Payer: PHCS Commercial |
$315.84
|
| Rate for Payer: United Healthcare All Payer |
$289.52
|
|
|
ED LOW LEVEL II
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
ED LOW LEVEL II
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem Medicaid |
$161.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$141.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$198.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.93
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Humana KY Medicaid |
$161.63
|
| Rate for Payer: Humana Medicare Advantage |
$141.43
|
| Rate for Payer: Kentucky WC Medicaid |
$163.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.70
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
ED MED LEVEL III
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$246.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$345.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$333.09
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Humana Medicare Advantage |
$246.73
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
ED MED LEVEL III
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
ED ULTRASOUND EYE
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
45000310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
ED ULTRASOUND EYE
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
45000310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem Medicaid |
$125.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Humana KY Medicaid |
$125.52
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$126.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
EEG AMBULATORY
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
HCPCS 95708
|
| Hospital Charge Code |
74000012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna Commercial |
$1,409.10
|
| Rate for Payer: Anthem Medicaid |
$629.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,518.90
|
| Rate for Payer: First Health Commercial |
$1,738.50
|
| Rate for Payer: Humana Commercial |
$1,555.50
|
| Rate for Payer: Humana KY Medicaid |
$629.34
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$635.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.30
|
| Rate for Payer: PHCS Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare All Payer |
$1,610.40
|
|
|
EEG AMBULATORY
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
HCPCS 95708
|
| Hospital Charge Code |
74000012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.80 |
| Rate for Payer: Aetna Commercial |
$1,409.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.40
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,518.90
|
| Rate for Payer: First Health Commercial |
$1,738.50
|
| Rate for Payer: Humana Commercial |
$1,555.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.30
|
| Rate for Payer: PHCS Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare All Payer |
$1,610.40
|
|
|
EEG - AWAKE AND ASLEEP
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem Medicaid |
$287.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Humana KY Medicaid |
$287.16
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$290.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.85
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
EEG - AWAKE AND ASLEEP
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: Aetna Commercial |
$350.98
|
| Rate for Payer: Anthem Medicaid |
$189.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$835.00
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$280.82
|
| Rate for Payer: Healthspan PPO |
$309.14
|
| Rate for Payer: Humana Medicaid |
$189.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.37
|
| Rate for Payer: Molina Healthcare Passport |
$189.58
|
| Rate for Payer: Multiplan PHCS |
$501.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$584.50
|
| Rate for Payer: UHCCP Medicaid |
$292.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.48
|
|
|
EEG - AWAKE AND ASLEEP
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.85
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
