|
FERROUS SULFATE 300 300MG/5ML
|
Facility
|
OP
|
$11.39
|
|
|
Service Code
|
NDC 121053005
|
| Hospital Charge Code |
25000675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.88
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$9.45
|
| Rate for Payer: First Health Commercial |
$10.82
|
| Rate for Payer: Humana Commercial |
$9.68
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.02
|
| Rate for Payer: Ohio Health Group HMO |
$8.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.86
|
| Rate for Payer: PHCS Commercial |
$10.93
|
| Rate for Payer: United Healthcare All Payer |
$10.02
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Ambetter Exchange |
$108.12
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$108.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.74
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$176.49
|
| Rate for Payer: Healthspan PPO |
$174.12
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$108.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.56
|
| Rate for Payer: UHCCP Medicaid |
$241.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.12
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
FETAL BIOPHYS PROFILE W/NST
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
40200041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
FETAL BIOPHYS PROFILE W/NST(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
402P0041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.87 |
| Max. Negotiated Rate |
$185.82 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Ambetter Exchange |
$108.12
|
| Rate for Payer: Anthem Medicaid |
$76.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$108.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.74
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$176.49
|
| Rate for Payer: Healthspan PPO |
$174.12
|
| Rate for Payer: Humana Medicaid |
$76.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$108.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.47
|
| Rate for Payer: Molina Healthcare Passport |
$76.93
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.56
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.12
|
|
|
FETAL BIOPHYS PROFILE W/NST(T
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
402T0041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
FETAL BIOPHYS PROFILE W/NST(T
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
402T0041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem Medicaid |
$168.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Humana KY Medicaid |
$168.51
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$170.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
FETAL BIOPHYS PROFIL W/O NS(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
402P0042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$147.92 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Ambetter Exchange |
$78.11
|
| Rate for Payer: Anthem Medicaid |
$68.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.73
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$147.92
|
| Rate for Payer: Healthspan PPO |
$135.07
|
| Rate for Payer: Humana Medicaid |
$68.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.75
|
| Rate for Payer: Molina Healthcare Passport |
$68.38
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.54
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.11
|
|
|
FETAL BIOPHYS PROFIL W/O NS(T
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
402T0042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem Medicaid |
$168.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Humana KY Medicaid |
$168.51
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$170.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
FETAL BIOPHYS PROFIL W/O NS(T
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
402T0042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.10
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
40200042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
40200042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Ambetter Exchange |
$78.11
|
| Rate for Payer: Anthem Medicaid |
$68.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.73
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$147.92
|
| Rate for Payer: Healthspan PPO |
$135.07
|
| Rate for Payer: Humana Medicaid |
$68.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.75
|
| Rate for Payer: Molina Healthcare Passport |
$68.38
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.54
|
| Rate for Payer: UHCCP Medicaid |
$206.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.11
|
|
|
FETAL BIOPHYS PROFIL W/O NST
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
40200042
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
FETAL FIBRONECTIN
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
30000320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem Medicaid |
$64.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$64.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$90.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.41
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Humana KY Medicaid |
$64.41
|
| Rate for Payer: Humana Medicare Advantage |
$64.41
|
| Rate for Payer: Kentucky WC Medicaid |
$65.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.98
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
FETAL FIBRONECTIN
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
30000320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.23
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.98
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
FETAL HBG DETCT FMH KLEIHA-BET
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
30000608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
FETAL HBG DETCT FMH KLEIHA-BET
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
30000608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$7.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.73
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$7.73
|
| Rate for Payer: Humana Medicare Advantage |
$7.73
|
| Rate for Payer: Kentucky WC Medicaid |
$7.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
FETAL HGB DETECT FMH ROSETTE
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 85461
|
| Hospital Charge Code |
30000609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.36
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$9.36
|
| Rate for Payer: Humana Medicare Advantage |
$9.36
|
| Rate for Payer: Kentucky WC Medicaid |
$9.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
FETAL HGB DETECT FMH ROSETTE
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 85461
|
| Hospital Charge Code |
30000609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
FETAL NON-STRESS TEST
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$75.93
|
| Rate for Payer: Ambetter Exchange |
$45.69
|
| Rate for Payer: Anthem Medicaid |
$34.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.83
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$65.52
|
| Rate for Payer: Healthspan PPO |
$55.11
|
| Rate for Payer: Humana Medicaid |
$34.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.53
|
| Rate for Payer: Molina Healthcare Passport |
$34.83
|
| Rate for Payer: Multiplan PHCS |
$381.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.40
|
| Rate for Payer: UHCCP Medicaid |
$222.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.69
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$508.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.84
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$218.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$218.72
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$220.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$508.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.84
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
FETAL NON-STRESS TEST(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920P0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$75.93 |
| Rate for Payer: Aetna Commercial |
$75.93
|
| Rate for Payer: Ambetter Exchange |
$45.69
|
| Rate for Payer: Anthem Medicaid |
$34.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.83
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$65.52
|
| Rate for Payer: Healthspan PPO |
$55.11
|
| Rate for Payer: Humana Medicaid |
$34.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.53
|
| Rate for Payer: Molina Healthcare Passport |
$34.83
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.40
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.69
|
|
|
FETAL NON-STRESS TEST(T
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920T0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem Medicaid |
$175.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Humana KY Medicaid |
$175.73
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
FETAL NON-STRESS TEST(T
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920T0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
