|
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
|
|
|
FLU VACCINE 3 YRS +
|
Facility
|
OP
|
$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 Medicaid |
$22.93
|
| 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: Humana KY Medicaid |
$22.93
|
| Rate for Payer: Kentucky WC Medicaid |
$23.16
|
| 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: Molina Healthcare Medicaid |
$23.39
|
| 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
|
|
|
FLU VACCINE 3 YRS +(T
|
Facility
|
OP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
770T0022
|
|
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 Medicaid |
$22.93
|
| 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: Humana KY Medicaid |
$22.93
|
| Rate for Payer: Kentucky WC Medicaid |
$23.16
|
| 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: Molina Healthcare Medicaid |
$23.39
|
| 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
|
|
|
FLU VACCINE 3 YRS +(T
|
Facility
|
IP
|
$66.67
|
|
|
Service Code
|
HCPCS 90658
|
| Hospital Charge Code |
770T0022
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
OP
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
636T0003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
IP
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
636T0003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Professional
|
Both
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| 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: Healthspan PPO |
$0.60
|
| 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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
IP
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
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
|
|
|
FLUZONE HIGH DOSE VACCINE SYR
|
Facility
|
OP
|
$323.73
|
|
|
Service Code
|
HCPCS 90662
|
| Hospital Charge Code |
63600003
|
|
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
|
|
|
FLUZONE VACC, 3 YRS & >, IM
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Hospital Charge Code |
77000060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
FLUZONE VACC, 3 YRS & >, IM
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Hospital Charge Code |
77000060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.92
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
FLXOR BALKIN SHEATH 8.0 WO WIR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FLXOR BALKIN SHEATH 8.0 WO WIR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FNA BX W/CT GDN EA ADDL
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.11
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
FNA BX W/CT GDN EA ADDL
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$781.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$67.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$781.00
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$445.49
|
| Rate for Payer: Humana Medicaid |
$67.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.35
|
| Rate for Payer: Molina Healthcare Passport |
$67.99
|
| Rate for Payer: Multiplan PHCS |
$468.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.70
|
| Rate for Payer: UHCCP Medicaid |
$42.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.67
|
|
|
FNA BX W/CT GDN EA ADDL
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
76100004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem Medicaid |
$268.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Humana KY Medicaid |
$268.59
|
| Rate for Payer: Kentucky WC Medicaid |
$271.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.11
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
FNA BX W/CT GDN EA ADDL(P
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761P0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$445.49 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$67.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$445.49
|
| Rate for Payer: Humana Medicaid |
$67.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.35
|
| Rate for Payer: Molina Healthcare Passport |
$67.99
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$42.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.67
|
|
|
FNA BX W/CT GDN EA ADDL(T
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761T0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
FNA BX W/CT GDN EA ADDL(T
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761T0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
FNA BX W/US GDN EA ADDL
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$698.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$40.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$698.00
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$40.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.53
|
| Rate for Payer: Molina Healthcare Passport |
$40.72
|
| Rate for Payer: Multiplan PHCS |
$418.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.60
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.13
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.38
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem Medicaid |
$240.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Humana KY Medicaid |
$240.04
|
| Rate for Payer: Kentucky WC Medicaid |
$242.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$244.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.38
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
FNA BX W/US GDN EA ADDL(P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761P0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$40.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$40.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.53
|
| Rate for Payer: Molina Healthcare Passport |
$40.72
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.13
|
|
|
FNA BX W/US GDN EA ADDL(T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
FNA BX W/US GDN EA ADDL(T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
