|
FLOW RESERVE MEASURE - INITI(T
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
761T2492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna Commercial |
$198.84
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$931.00
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$193.50
|
| Rate for Payer: Healthspan PPO |
$152.12
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$558.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$651.70
|
| Rate for Payer: UHCCP Medicaid |
$325.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem Medicaid |
$320.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Humana KY Medicaid |
$320.17
|
| Rate for Payer: Kentucky WC Medicaid |
$323.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.61
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
FL SMALL BOWEL ENTEROCLYSIS
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
32000994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.61
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320P0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$198.84
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$193.50
|
| Rate for Payer: Healthspan PPO |
$152.12
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (T
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320T0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.13 |
| Max. Negotiated Rate |
$672.96 |
| Rate for Payer: Aetna Commercial |
$539.77
|
| Rate for Payer: Anthem Medicaid |
$241.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.78
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$581.83
|
| Rate for Payer: First Health Commercial |
$665.95
|
| Rate for Payer: Humana Commercial |
$595.85
|
| Rate for Payer: Humana KY Medicaid |
$241.07
|
| Rate for Payer: Kentucky WC Medicaid |
$243.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$517.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.88
|
| Rate for Payer: Ohio Health Group HMO |
$525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.31
|
| Rate for Payer: PHCS Commercial |
$672.96
|
| Rate for Payer: United Healthcare All Payer |
$616.88
|
|
|
FL SMALL BOWEL ENTEROCLYSIS (T
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
HCPCS 74340
|
| Hospital Charge Code |
320T0994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.13 |
| Max. Negotiated Rate |
$672.96 |
| Rate for Payer: Aetna Commercial |
$539.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.78
|
| Rate for Payer: Cash Price |
$350.50
|
| Rate for Payer: Cigna Commercial |
$581.83
|
| Rate for Payer: First Health Commercial |
$665.95
|
| Rate for Payer: Humana Commercial |
$595.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$517.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.88
|
| Rate for Payer: Ohio Health Group HMO |
$525.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.31
|
| Rate for Payer: PHCS Commercial |
$672.96
|
| Rate for Payer: United Healthcare All Payer |
$616.88
|
|
|
FLUAD PFS 24-25
|
Facility
|
IP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
25004494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.04
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUAD PFS 24-25
|
Facility
|
OP
|
$319.49
|
|
|
Service Code
|
HCPCS 90653
|
| Hospital Charge Code |
25004494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$306.71 |
| Rate for Payer: Aetna Commercial |
$246.01
|
| Rate for Payer: Anthem Medicaid |
$109.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.20
|
| Rate for Payer: Cash Price |
$159.74
|
| Rate for Payer: Cigna Commercial |
$265.18
|
| Rate for Payer: First Health Commercial |
$303.52
|
| Rate for Payer: Humana Commercial |
$271.57
|
| Rate for Payer: Humana KY Medicaid |
$109.87
|
| Rate for Payer: Kentucky WC Medicaid |
$110.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$235.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.15
|
| Rate for Payer: Ohio Health Group HMO |
$239.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.04
|
| Rate for Payer: PHCS Commercial |
$306.71
|
| Rate for Payer: United Healthcare All Payer |
$281.15
|
|
|
FLUBLOK QUAD SYRINGE
|
Professional
|
Both
|
$323.73
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.03 |
| Max. Negotiated Rate |
$323.73 |
| Rate for Payer: Buckeye Medicare Advantage |
$323.73
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| Rate for Payer: Multiplan PHCS |
$194.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.61
|
| Rate for Payer: UHCCP Medicaid |
$113.31
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
IP
|
$323.73
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna Commercial |
$249.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.51
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cigna Commercial |
$268.70
|
| Rate for Payer: First Health Commercial |
$307.54
|
| Rate for Payer: Humana Commercial |
$275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.88
|
| Rate for Payer: Ohio Health Group HMO |
$242.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.36
|
| Rate for Payer: PHCS Commercial |
$310.78
|
| Rate for Payer: United Healthcare All Payer |
$284.88
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
OP
|
$323.73
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
636T0004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna Commercial |
$249.27
|
| Rate for Payer: Anthem Medicaid |
$111.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.51
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cigna Commercial |
$268.70
|
| Rate for Payer: First Health Commercial |
$307.54
|
| Rate for Payer: Humana Commercial |
$275.17
|
| Rate for Payer: Humana KY Medicaid |
$111.33
|
| Rate for Payer: Kentucky WC Medicaid |
$112.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.88
|
| Rate for Payer: Ohio Health Group HMO |
$242.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.36
|
| Rate for Payer: PHCS Commercial |
$310.78
|
| Rate for Payer: United Healthcare All Payer |
$284.88
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
IP
|
$323.73
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
636T0004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna Commercial |
$249.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.51
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cigna Commercial |
$268.70
|
| Rate for Payer: First Health Commercial |
$307.54
|
| Rate for Payer: Humana Commercial |
$275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.88
|
| Rate for Payer: Ohio Health Group HMO |
$242.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.36
|
| Rate for Payer: PHCS Commercial |
$310.78
|
| Rate for Payer: United Healthcare All Payer |
$284.88
|
|
|
FLUBLOK QUAD SYRINGE
|
Facility
|
OP
|
$323.73
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna Commercial |
$249.27
|
| Rate for Payer: Anthem Medicaid |
$111.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.51
|
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Cigna Commercial |
$268.70
|
| Rate for Payer: First Health Commercial |
$307.54
|
| Rate for Payer: Humana Commercial |
$275.17
|
| Rate for Payer: Humana KY Medicaid |
$111.33
|
| Rate for Payer: Kentucky WC Medicaid |
$112.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.88
|
| Rate for Payer: Ohio Health Group HMO |
$242.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.36
|
| Rate for Payer: PHCS Commercial |
$310.78
|
| Rate for Payer: United Healthcare All Payer |
$284.88
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
OP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
25004493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem Medicaid |
$44.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Humana KY Medicaid |
$44.05
|
| Rate for Payer: Kentucky WC Medicaid |
$44.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.71
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCELVAX PFS 24-25
|
Facility
|
IP
|
$128.09
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
25004493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Commercial |
$98.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.91
|
| Rate for Payer: Cash Price |
$64.04
|
| Rate for Payer: Cigna Commercial |
$106.31
|
| Rate for Payer: First Health Commercial |
$121.69
|
| Rate for Payer: Humana Commercial |
$108.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.72
|
| Rate for Payer: Ohio Health Group HMO |
$96.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.71
|
| Rate for Payer: PHCS Commercial |
$122.97
|
| Rate for Payer: United Healthcare All Payer |
$112.72
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Professional
|
Both
|
$183.97
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.63 |
| Max. Negotiated Rate |
$183.97 |
| Rate for Payer: Buckeye Medicare Advantage |
$183.97
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.63
|
| Rate for Payer: Multiplan PHCS |
$110.38
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.78
|
| Rate for Payer: UHCCP Medicaid |
$64.39
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Facility
|
IP
|
$183.97
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.61 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.50
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cigna Commercial |
$152.70
|
| Rate for Payer: First Health Commercial |
$174.77
|
| Rate for Payer: Humana Commercial |
$156.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.89
|
| Rate for Payer: Ohio Health Group HMO |
$137.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.03
|
| Rate for Payer: PHCS Commercial |
$176.61
|
| Rate for Payer: United Healthcare All Payer |
$161.89
|
|
|
FLUCEL VAX QUAD 0.5ML PFS
|
Facility
|
OP
|
$183.97
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.61 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Anthem Medicaid |
$63.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.50
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cigna Commercial |
$152.70
|
| Rate for Payer: First Health Commercial |
$174.77
|
| Rate for Payer: Humana Commercial |
$156.37
|
| Rate for Payer: Humana KY Medicaid |
$63.27
|
| Rate for Payer: Kentucky WC Medicaid |
$63.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.89
|
| Rate for Payer: Ohio Health Group HMO |
$137.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.03
|
| Rate for Payer: PHCS Commercial |
$176.61
|
| Rate for Payer: United Healthcare All Payer |
$161.89
|
|
|
FLUCEL VAX QUAD 0.5ML PFS (T
|
Facility
|
IP
|
$183.97
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
636T0193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.61 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.50
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cigna Commercial |
$152.70
|
| Rate for Payer: First Health Commercial |
$174.77
|
| Rate for Payer: Humana Commercial |
$156.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.89
|
| Rate for Payer: Ohio Health Group HMO |
$137.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.03
|
| Rate for Payer: PHCS Commercial |
$176.61
|
| Rate for Payer: United Healthcare All Payer |
$161.89
|
|
|
FLUCEL VAX QUAD 0.5ML PFS (T
|
Facility
|
OP
|
$183.97
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
636T0193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.61 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Anthem Medicaid |
$63.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.50
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cigna Commercial |
$152.70
|
| Rate for Payer: First Health Commercial |
$174.77
|
| Rate for Payer: Humana Commercial |
$156.37
|
| Rate for Payer: Humana KY Medicaid |
$63.27
|
| Rate for Payer: Kentucky WC Medicaid |
$63.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.89
|
| Rate for Payer: Ohio Health Group HMO |
$137.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.03
|
| Rate for Payer: PHCS Commercial |
$176.61
|
| Rate for Payer: United Healthcare All Payer |
$161.89
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Facility
|
OP
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Facility
|
IP
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
FLU CLINIC STAFF AND SUPPLY
|
Professional
|
Both
|
$3,500.00
|
|
| Hospital Charge Code |
51000353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
|
|
FLUCONAZOLE 400MG/200ML IVPB
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
25002064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.51
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
