|
FLUOROSCOPY
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY CHARGE
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY CHARGE
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY CHARGE
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32001012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$768.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$460.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$537.60
|
| Rate for Payer: UHCCP Medicaid |
$268.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
|
|
FLUOROSCOPY CHARGE (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320P1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
|
|
FLUOROSCOPY CHARGE (T
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.83
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROSCOPY CHARGE (T
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T1012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem Medicaid |
$238.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Humana KY Medicaid |
$238.32
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$240.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.83
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROSCOPY (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320P0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$106.04
|
| Rate for Payer: Healthspan PPO |
$129.87
|
| Rate for Payer: Humana Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.16
|
| Rate for Payer: Molina Healthcare Passport |
$42.31
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.73
|
|
|
FLUOROSCOPY (T
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.83
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROSCOPY (T
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
320T0181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$665.28 |
| Rate for Payer: Aetna Commercial |
$533.61
|
| Rate for Payer: Anthem Medicaid |
$238.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$575.19
|
| Rate for Payer: First Health Commercial |
$658.35
|
| Rate for Payer: Humana Commercial |
$589.05
|
| Rate for Payer: Humana KY Medicaid |
$238.32
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$240.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$568.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.84
|
| Rate for Payer: Ohio Health Group HMO |
$519.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.83
|
| Rate for Payer: PHCS Commercial |
$665.28
|
| Rate for Payer: United Healthcare All Payer |
$609.84
|
|
|
FLUOROURACIL 500MG
|
Facility
|
OP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
25002617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$6.41
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$6.41
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Kentucky WC Medicaid |
$6.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
|
|
FLUOROURACIL 500MG
|
Facility
|
IP
|
$18.64
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
25002617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$15.47
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: First Health Commercial |
$17.71
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana Commercial |
$15.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$13.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.78
|
| Rate for Payer: PHCS Commercial |
$17.89
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$16.40
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Professional
|
Both
|
$344.43
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.06 |
| Max. Negotiated Rate |
$344.43 |
| Rate for Payer: Buckeye Medicare Advantage |
$344.43
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.06
|
| Rate for Payer: Multiplan PHCS |
$206.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$241.10
|
| Rate for Payer: UHCCP Medicaid |
$120.55
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Facility
|
IP
|
$344.43
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.66
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cigna Commercial |
$285.88
|
| Rate for Payer: First Health Commercial |
$327.21
|
| Rate for Payer: Humana Commercial |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.10
|
| Rate for Payer: Ohio Health Group HMO |
$258.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.77
|
| Rate for Payer: PHCS Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Payer |
$303.10
|
|
|
FLU QUAD PFS 0.5ML PFS
|
Facility
|
OP
|
$344.43
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
63600192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Anthem Medicaid |
$118.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.66
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cigna Commercial |
$285.88
|
| Rate for Payer: First Health Commercial |
$327.21
|
| Rate for Payer: Humana Commercial |
$292.77
|
| Rate for Payer: Humana KY Medicaid |
$118.45
|
| Rate for Payer: Kentucky WC Medicaid |
$119.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.10
|
| Rate for Payer: Ohio Health Group HMO |
$258.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.77
|
| Rate for Payer: PHCS Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Payer |
$303.10
|
|
|
FLU QUAD PFS 0.5ML PFS (T
|
Facility
|
IP
|
$344.43
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
636T0192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.66
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cigna Commercial |
$285.88
|
| Rate for Payer: First Health Commercial |
$327.21
|
| Rate for Payer: Humana Commercial |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.10
|
| Rate for Payer: Ohio Health Group HMO |
$258.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.77
|
| Rate for Payer: PHCS Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Payer |
$303.10
|
|
|
FLU QUAD PFS 0.5ML PFS (T
|
Facility
|
OP
|
$344.43
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
636T0192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Aetna Commercial |
$265.21
|
| Rate for Payer: Anthem Medicaid |
$118.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.66
|
| Rate for Payer: Cash Price |
$172.22
|
| Rate for Payer: Cigna Commercial |
$285.88
|
| Rate for Payer: First Health Commercial |
$327.21
|
| Rate for Payer: Humana Commercial |
$292.77
|
| Rate for Payer: Humana KY Medicaid |
$118.45
|
| Rate for Payer: Kentucky WC Medicaid |
$119.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.10
|
| Rate for Payer: Ohio Health Group HMO |
$258.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.77
|
| Rate for Payer: PHCS Commercial |
$330.65
|
| Rate for Payer: United Healthcare All Payer |
$303.10
|
|
|
FLUTED STEM MOB TIB COMP SZ6
|
Facility
|
OP
|
$9,332.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.26 |
| Max. Negotiated Rate |
$8,959.46 |
| Rate for Payer: Aetna Commercial |
$7,186.23
|
| Rate for Payer: Anthem Medicaid |
$3,209.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.56
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.20
|
| Rate for Payer: First Health Commercial |
$8,866.13
|
| Rate for Payer: Humana Commercial |
$7,932.85
|
| Rate for Payer: Humana KY Medicaid |
$3,209.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,273.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.16
|
| Rate for Payer: PHCS Commercial |
$8,959.46
|
| Rate for Payer: United Healthcare All Payer |
$8,212.84
|
|
|
FLUTED STEM MOB TIB COMP SZ6
|
Facility
|
IP
|
$9,332.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.26 |
| Max. Negotiated Rate |
$8,959.46 |
| Rate for Payer: Aetna Commercial |
$7,186.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,279.56
|
| Rate for Payer: Cash Price |
$4,666.38
|
| Rate for Payer: Cigna Commercial |
$7,746.20
|
| Rate for Payer: First Health Commercial |
$8,866.13
|
| Rate for Payer: Humana Commercial |
$7,932.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,652.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,887.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,799.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,212.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,999.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,866.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.16
|
| Rate for Payer: PHCS Commercial |
$8,959.46
|
| Rate for Payer: United Healthcare All Payer |
$8,212.84
|
|
|
FLU VACC IIV3 NO PRESERV ID
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 90654
|
| Hospital Charge Code |
77000018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Healthspan PPO |
$18.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.36
|
| Rate for Payer: Multiplan PHCS |
$34.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.90
|
| Rate for Payer: UHCCP Medicaid |
$19.95
|
|
|
FLU VACC IIV3 NO PRESERV ID
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 90654
|
| Hospital Charge Code |
77000018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$19.60
|
| Rate for Payer: Kentucky WC Medicaid |
$19.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLU VACC IIV3 NO PRESERV ID
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 90654
|
| Hospital Charge Code |
77000018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLU VACC IIV3 NO PRESERV ID(T
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 90654
|
| Hospital Charge Code |
770T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$19.60
|
| Rate for Payer: Kentucky WC Medicaid |
$19.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLU VACC IIV3 NO PRESERV ID(T
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 90654
|
| Hospital Charge Code |
770T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
IP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
77000022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.00
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.34
|
| Rate for Payer: Humana Commercial |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.67
|
| Rate for Payer: Ohio Health Group HMO |
$50.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.67
|
| Rate for Payer: PHCS Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Payer |
$58.67
|
|
