|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$70.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$70.20
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$70.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001267
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001267
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.07
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$241.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$241.00
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$144.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.70
|
| Rate for Payer: UHCCP Medicaid |
$84.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$193.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.71
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$193.52
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.71
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
GROUP EA 30 MIN.
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
51000053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$8.61
|
| Rate for Payer: Anthem Medicaid |
$4.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$18.99
|
| Rate for Payer: Humana Medicaid |
$4.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.73
|
| Rate for Payer: Molina Healthcare Passport |
$4.64
|
| Rate for Payer: Multiplan PHCS |
$45.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.20
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.69
|
|
|
GROUP EA 30 MIN.
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
51000053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
GROUP EA 30 MIN.
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
51000053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Anthem Medicaid |
$26.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.28
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna Commercial |
$63.08
|
| Rate for Payer: First Health Commercial |
$72.20
|
| Rate for Payer: Humana Commercial |
$64.60
|
| Rate for Payer: Humana KY Medicaid |
$26.14
|
| Rate for Payer: Kentucky WC Medicaid |
$26.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.88
|
| Rate for Payer: Ohio Health Group HMO |
$57.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.56
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
GROUP EA 30 MIN.(P
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
510P0053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$8.61
|
| Rate for Payer: Anthem Medicaid |
$4.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$18.99
|
| Rate for Payer: Humana Medicaid |
$4.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.73
|
| Rate for Payer: Molina Healthcare Passport |
$4.64
|
| Rate for Payer: Multiplan PHCS |
$12.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.70
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.69
|
|
|
GROUP EA 30 MIN.(T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
510T0053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
GROUP EA 30 MIN.(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
510T0053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
GROUP EXERCISE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000099
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP EXERCISE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
46000024
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP EXERCISE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
41000099
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP EXERCISE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
46000024
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP THERAPY
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
43000018
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP THERAPY
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
43000018
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP THERAPY
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROUP THERAPY
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
GROWTH FACTOR SERUM 30 ML GBL
|
Professional
|
Both
|
$148.00
|
|
| Hospital Charge Code |
22200146
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$148.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Multiplan PHCS |
$88.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.60
|
| Rate for Payer: UHCCP Medicaid |
$51.80
|
|
|
GSTRRRHPHY SUT DUOD/GASTRC ULC
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
76101798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.26 |
| Max. Negotiated Rate |
$1,890.12 |
| Rate for Payer: Aetna Commercial |
$1,890.12
|
| Rate for Payer: Anthem Medicaid |
$557.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,715.52
|
| Rate for Payer: Healthspan PPO |
$1,593.97
|
| Rate for Payer: Humana Medicaid |
$557.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,722.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.41
|
| Rate for Payer: Molina Healthcare Passport |
$557.26
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.83
|
|
|
GSTRRRHPHY SUT DUOD/GASTRC ULC
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
761P1798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.26 |
| Max. Negotiated Rate |
$1,890.12 |
| Rate for Payer: Aetna Commercial |
$1,890.12
|
| Rate for Payer: Anthem Medicaid |
$557.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,715.52
|
| Rate for Payer: Healthspan PPO |
$1,593.97
|
| Rate for Payer: Humana Medicaid |
$557.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,722.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.41
|
| Rate for Payer: Molina Healthcare Passport |
$557.26
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.83
|
|
|
GSTRRRHPHY SUT DUOD/GASTRC ULC
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
76101798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
