|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
41000076
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
AIRWAY INHALATION TREAT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Ambetter Exchange |
$7.11
|
| Rate for Payer: Anthem Medicaid |
$11.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$19.72
|
| Rate for Payer: Healthspan PPO |
$15.61
|
| Rate for Payer: Humana Medicaid |
$11.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.41
|
| Rate for Payer: Molina Healthcare Passport |
$11.19
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.24
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.11
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$105.23 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem Medicaid |
$105.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Humana KY Medicaid |
$105.23
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$306.54
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$294.28 |
| Rate for Payer: Aetna Commercial |
$236.04
|
| Rate for Payer: Anthem Medicaid |
$105.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$153.27
|
| Rate for Payer: Cash Price |
$153.27
|
| Rate for Payer: Cigna Commercial |
$254.43
|
| Rate for Payer: First Health Commercial |
$291.21
|
| Rate for Payer: Humana Commercial |
$260.56
|
| Rate for Payer: Humana KY Medicaid |
$105.42
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$106.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.76
|
| Rate for Payer: Ohio Health Group HMO |
$229.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.51
|
| Rate for Payer: PHCS Commercial |
$294.28
|
| Rate for Payer: United Healthcare All Payer |
$269.76
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$306.54
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$294.28 |
| Rate for Payer: Aetna Commercial |
$236.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$239.10
|
| Rate for Payer: Cash Price |
$153.27
|
| Rate for Payer: Cigna Commercial |
$254.43
|
| Rate for Payer: First Health Commercial |
$291.21
|
| Rate for Payer: Humana Commercial |
$260.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.76
|
| Rate for Payer: Ohio Health Group HMO |
$229.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.51
|
| Rate for Payer: PHCS Commercial |
$294.28
|
| Rate for Payer: United Healthcare All Payer |
$269.76
|
|
|
AIRWAY INHALATION TREAT(T
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
761T2495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
AIRWAY INHALATION TREAT(T
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
761T2495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
A-KIT 6F 10CM
|
Facility
|
OP
|
$3,757.81
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.34 |
| Max. Negotiated Rate |
$3,607.50 |
| Rate for Payer: Aetna Commercial |
$2,893.51
|
| Rate for Payer: Anthem Medicaid |
$1,292.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.09
|
| Rate for Payer: Cash Price |
$1,878.91
|
| Rate for Payer: Cigna Commercial |
$3,118.98
|
| Rate for Payer: First Health Commercial |
$3,569.92
|
| Rate for Payer: Humana Commercial |
$3,194.14
|
| Rate for Payer: Humana KY Medicaid |
$1,292.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,305.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,318.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,006.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,269.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,592.89
|
| Rate for Payer: PHCS Commercial |
$3,607.50
|
| Rate for Payer: United Healthcare All Payer |
$3,306.87
|
|
|
A-KIT 6F 10CM
|
Facility
|
IP
|
$3,757.81
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.34 |
| Max. Negotiated Rate |
$3,607.50 |
| Rate for Payer: Aetna Commercial |
$2,893.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,931.09
|
| Rate for Payer: Cash Price |
$1,878.91
|
| Rate for Payer: Cigna Commercial |
$3,118.98
|
| Rate for Payer: First Health Commercial |
$3,569.92
|
| Rate for Payer: Humana Commercial |
$3,194.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,081.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,773.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,127.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,306.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,818.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,006.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,269.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,592.89
|
| Rate for Payer: PHCS Commercial |
$3,607.50
|
| Rate for Payer: United Healthcare All Payer |
$3,306.87
|
|
|
AL-1 CATH 5F
|
Facility
|
OP
|
$440.26
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem Medicaid |
$151.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Humana KY Medicaid |
$151.41
|
| Rate for Payer: Kentucky WC Medicaid |
$152.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
AL-1 CATH 5F
|
Facility
|
IP
|
$440.26
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
AL-2 CATH 5F
|
Facility
|
IP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
AL-2 CATH 5F
|
Facility
|
OP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem Medicaid |
$57.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Humana KY Medicaid |
$57.80
|
| Rate for Payer: Kentucky WC Medicaid |
$58.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
AL-3 CATH 5F
|
Facility
|
OP
|
$440.10
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem Medicaid |
$151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Humana KY Medicaid |
$151.35
|
| Rate for Payer: Kentucky WC Medicaid |
$152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
AL-3 CATH 5F
|
Facility
|
IP
|
$440.10
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
AL .75 GUIDE 6F
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
AL .75 GUIDE 6F
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
AL .75 SH 6F 100CM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
AL .75 SH 6F 100CM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ALAIR BRONCH THERMO CATH
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
ALAIR BRONCH THERMO CATH
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
ALBUMIN 25% (25GM/100ML)
|
Facility
|
OP
|
$542.80
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25002699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$521.09 |
| Rate for Payer: Aetna Commercial |
$417.96
|
| Rate for Payer: Anthem Medicaid |
$186.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.38
|
| Rate for Payer: Cash Price |
$271.40
|
| Rate for Payer: Cigna Commercial |
$450.52
|
| Rate for Payer: First Health Commercial |
$515.66
|
| Rate for Payer: Humana Commercial |
$461.38
|
| Rate for Payer: Humana KY Medicaid |
$186.67
|
| Rate for Payer: Kentucky WC Medicaid |
$188.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.66
|
| Rate for Payer: Ohio Health Group HMO |
$407.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.53
|
| Rate for Payer: PHCS Commercial |
$521.09
|
| Rate for Payer: United Healthcare All Payer |
$477.66
|
|
|
ALBUMIN 25% (25GM/100ML)
|
Facility
|
IP
|
$542.80
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25002699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$162.84 |
| Max. Negotiated Rate |
$521.09 |
| Rate for Payer: Aetna Commercial |
$417.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.38
|
| Rate for Payer: Cash Price |
$271.40
|
| Rate for Payer: Cigna Commercial |
$450.52
|
| Rate for Payer: First Health Commercial |
$515.66
|
| Rate for Payer: Humana Commercial |
$461.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.66
|
| Rate for Payer: Ohio Health Group HMO |
$407.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.53
|
| Rate for Payer: PHCS Commercial |
$521.09
|
| Rate for Payer: United Healthcare All Payer |
$477.66
|
|
