|
ED ARTERIAL BLOOD GAS STICK
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.59 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
EDECRIN 25MG TAB
|
Facility
|
IP
|
$41.44
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
25000594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.43 |
| 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 |
$33.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.59
|
| Rate for Payer: PHCS Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Payer |
$36.47
|
|
|
EDECRIN 25MG TAB
|
Facility
|
OP
|
$41.44
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
25000594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.43 |
| 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 |
$33.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.59
|
| 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 |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| 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
|
| 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 |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
EDECRIN (ETHACRYNATE 50MG/50ML
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
NDC 67457029750
|
| Hospital Charge Code |
25003818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.23
|
| 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 |
$1,255.23
|
| 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 |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| 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
|
$1,737.84
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$521.35 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,338.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,355.52
|
| Rate for Payer: Cash Price |
$868.92
|
| Rate for Payer: Cigna Commercial |
$1,442.41
|
| Rate for Payer: First Health Commercial |
$1,650.95
|
| Rate for Payer: Humana Commercial |
$1,477.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,282.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,390.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.11
|
| Rate for Payer: PHCS Commercial |
$1,668.33
|
| Rate for Payer: United Healthcare All Payer |
$1,529.30
|
|
|
EDEX 1.25mcg (40MCG SDV)
|
Facility
|
OP
|
$1,737.84
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$521.35 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,338.14
|
| Rate for Payer: Anthem Medicaid |
$597.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,355.52
|
| Rate for Payer: Cash Price |
$868.92
|
| Rate for Payer: Cigna Commercial |
$1,442.41
|
| Rate for Payer: First Health Commercial |
$1,650.95
|
| Rate for Payer: Humana Commercial |
$1,477.16
|
| Rate for Payer: Humana KY Medicaid |
$597.64
|
| Rate for Payer: Kentucky WC Medicaid |
$603.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,425.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,282.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,529.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,303.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,390.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.11
|
| Rate for Payer: PHCS Commercial |
$1,668.33
|
| Rate for Payer: United Healthcare All Payer |
$1,529.30
|
|
|
ED HIGH LEVEL IV
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.60 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
ED HIGH LEVEL IV
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.71 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem Medicaid |
$337.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$393.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$550.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$531.16
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Humana KY Medicaid |
$337.71
|
| Rate for Payer: Humana Medicare Advantage |
$393.45
|
| Rate for Payer: Kentucky WC Medicaid |
$341.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.58
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
ED HIGH LEVEL V
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.61 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem Medicaid |
$399.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$566.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$793.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.76
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Humana KY Medicaid |
$399.61
|
| Rate for Payer: Humana Medicare Advantage |
$566.49
|
| Rate for Payer: Kentucky WC Medicaid |
$403.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
ED HIGH LEVEL V
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
ED LOW LEVEL I
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
45000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem Medicaid |
$120.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Humana KY Medicaid |
$120.71
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
ED LOW LEVEL I
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
45000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
ED LOW LEVEL II
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
ED LOW LEVEL II
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.32 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$146.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.53
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$146.32
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
ED MED LEVEL III
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$639.36 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$519.48
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
ED MED LEVEL III
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
45000003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.04 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem Medicaid |
$229.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$255.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$519.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.38
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Humana KY Medicaid |
$229.04
|
| Rate for Payer: Humana Medicare Advantage |
$255.84
|
| Rate for Payer: Kentucky WC Medicaid |
$231.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
ED ULTRASOUND EYE
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
45000310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.50 |
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| 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 |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
EEG AMBULATORY
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
HCPCS 95708
|
| Hospital Charge Code |
74000012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$549.00 |
| 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 |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.70
|
| Rate for Payer: PHCS Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare All Payer |
$1,610.40
|
|
|
EEG AMBULATORY
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
HCPCS 95708
|
| Hospital Charge Code |
74000012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$490.26 |
| 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 |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| 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 |
$490.26
|
| 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 |
$588.31
|
| 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 |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.70
|
| Rate for Payer: PHCS Commercial |
$1,756.80
|
| Rate for Payer: United Healthcare All Payer |
$1,610.40
|
|
|
EEG - AWAKE AND ASLEEP
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$264.90 |
| Max. Negotiated Rate |
$847.68 |
| Rate for Payer: Aetna Commercial |
$679.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$688.74
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cigna Commercial |
$732.89
|
| Rate for Payer: First Health Commercial |
$838.85
|
| Rate for Payer: Humana Commercial |
$750.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$651.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.04
|
| Rate for Payer: Ohio Health Group HMO |
$662.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.27
|
| Rate for Payer: PHCS Commercial |
$847.68
|
| Rate for Payer: United Healthcare All Payer |
$777.04
|
|
|
EEG - AWAKE AND ASLEEP
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$529.80 |
| Rate for Payer: Aetna Commercial |
$350.98
|
| Rate for Payer: Ambetter Exchange |
$402.16
|
| Rate for Payer: Anthem Medicaid |
$189.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.59
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cash Price |
$441.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$402.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.37
|
| Rate for Payer: Molina Healthcare Passport |
$189.58
|
| Rate for Payer: Multiplan PHCS |
$529.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.81
|
| Rate for Payer: UHCCP Medicaid |
$309.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.16
|
|
|
EEG - AWAKE AND ASLEEP
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
74000008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$847.68 |
| Rate for Payer: Aetna Commercial |
$679.91
|
| Rate for Payer: Anthem Medicaid |
$303.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$688.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cash Price |
$441.50
|
| Rate for Payer: Cigna Commercial |
$732.89
|
| Rate for Payer: First Health Commercial |
$838.85
|
| Rate for Payer: Humana Commercial |
$750.55
|
| Rate for Payer: Humana KY Medicaid |
$303.66
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$306.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$651.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$309.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.04
|
| Rate for Payer: Ohio Health Group HMO |
$662.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$768.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.27
|
| Rate for Payer: PHCS Commercial |
$847.68
|
| Rate for Payer: United Healthcare All Payer |
$777.04
|
|
|
EEG - AWAKE AND ASLEEP(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740P0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$522.81 |
| Rate for Payer: Aetna Commercial |
$350.98
|
| Rate for Payer: Ambetter Exchange |
$402.16
|
| Rate for Payer: Anthem Medicaid |
$189.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.59
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$402.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.37
|
| Rate for Payer: Molina Healthcare Passport |
$189.58
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.81
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.16
|
|
