|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$20,095.17
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$13,636.01 |
| Max. Negotiated Rate |
$20,095.17 |
| Rate for Payer: Anthem Medicaid |
$13,636.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,353.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,095.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,377.48
|
| Rate for Payer: Humana KY Medicaid |
$13,636.01
|
| Rate for Payer: Humana Medicare Advantage |
$14,353.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,772.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,224.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,908.73
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$34,209.07
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$23,213.30 |
| Max. Negotiated Rate |
$34,209.07 |
| Rate for Payer: Anthem Medicaid |
$23,213.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,435.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,209.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$32,987.32
|
| Rate for Payer: Humana KY Medicaid |
$23,213.30
|
| Rate for Payer: Humana Medicare Advantage |
$24,435.05
|
| Rate for Payer: Kentucky WC Medicaid |
$23,445.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,322.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,677.56
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$15,939.97
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$10,816.41 |
| Max. Negotiated Rate |
$15,939.97 |
| Rate for Payer: Anthem Medicaid |
$10,816.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,385.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,939.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,370.68
|
| Rate for Payer: Humana KY Medicaid |
$10,816.41
|
| Rate for Payer: Humana Medicare Advantage |
$11,385.69
|
| Rate for Payer: Kentucky WC Medicaid |
$10,924.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,662.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,032.73
|
|
|
HERNIA REPAIR
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
HERNIA REPAIR
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.57 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$910.02
|
| Rate for Payer: Anthem Medicaid |
$378.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$847.48
|
| Rate for Payer: Healthspan PPO |
$767.43
|
| Rate for Payer: Humana Medicaid |
$378.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$386.14
|
| Rate for Payer: Molina Healthcare Passport |
$378.57
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$382.36
|
|
|
HERNIA REPAIR
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
HERNIA REPAIR(P
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
761P2013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.57 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$910.02
|
| Rate for Payer: Anthem Medicaid |
$378.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$847.48
|
| Rate for Payer: Healthspan PPO |
$767.43
|
| Rate for Payer: Humana Medicaid |
$378.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$386.14
|
| Rate for Payer: Molina Healthcare Passport |
$378.57
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$382.36
|
|
|
HERZUMA 10mg (150mg SDV)
|
Facility
|
IP
|
$7,643.63
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$993.67 |
| Max. Negotiated Rate |
$7,337.88 |
| Rate for Payer: Aetna Commercial |
$5,885.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.03
|
| Rate for Payer: Cash Price |
$3,821.82
|
| Rate for Payer: Cigna Commercial |
$6,344.21
|
| Rate for Payer: First Health Commercial |
$7,261.45
|
| Rate for Payer: Humana Commercial |
$6,497.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,267.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,726.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,732.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.53
|
| Rate for Payer: PHCS Commercial |
$7,337.88
|
| Rate for Payer: United Healthcare All Payer |
$6,726.39
|
|
|
HERZUMA 10mg (150mg SDV)
|
Facility
|
OP
|
$7,643.63
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$7,337.88 |
| Rate for Payer: Aetna Commercial |
$5,885.60
|
| Rate for Payer: Anthem Medicaid |
$2,628.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$56.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.41
|
| Rate for Payer: Cash Price |
$3,821.82
|
| Rate for Payer: Cash Price |
$3,821.82
|
| Rate for Payer: Cigna Commercial |
$6,344.21
|
| Rate for Payer: First Health Commercial |
$7,261.45
|
| Rate for Payer: Humana Commercial |
$6,497.09
|
| Rate for Payer: Humana KY Medicaid |
$2,628.64
|
| Rate for Payer: Humana Medicare Advantage |
$40.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,655.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,267.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,681.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,726.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,732.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,528.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$993.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,369.53
|
| Rate for Payer: PHCS Commercial |
$7,337.88
|
| Rate for Payer: United Healthcare All Payer |
$6,726.39
|
|
|
HERZUMA 10mg (from 420mg MDV)
|
Facility
|
OP
|
$509.58
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$489.20 |
| Rate for Payer: Aetna Commercial |
$392.38
|
| Rate for Payer: Anthem Medicaid |
$175.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$56.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.41
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cigna Commercial |
$422.95
|
| Rate for Payer: First Health Commercial |
$484.10
|
| Rate for Payer: Humana Commercial |
$433.14
|
| Rate for Payer: Humana KY Medicaid |
$175.24
|
| Rate for Payer: Humana Medicare Advantage |
$40.31
|
| Rate for Payer: Kentucky WC Medicaid |
$177.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.43
|
| Rate for Payer: Ohio Health Group HMO |
$382.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.97
|
| Rate for Payer: PHCS Commercial |
$489.20
|
| Rate for Payer: United Healthcare All Payer |
$448.43
|
|
|
HERZUMA 10mg (from 420mg MDV)
|
Facility
|
IP
|
$509.58
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$489.20 |
| Rate for Payer: Aetna Commercial |
$392.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.47
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cigna Commercial |
$422.95
|
| Rate for Payer: First Health Commercial |
$484.10
|
| Rate for Payer: Humana Commercial |
$433.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.43
|
| Rate for Payer: Ohio Health Group HMO |
$382.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.97
|
| Rate for Payer: PHCS Commercial |
$489.20
|
| Rate for Payer: United Healthcare All Payer |
$448.43
|
|
|
HESPAN (HETASTARCH 6%/0. 500ML
|
Facility
|
OP
|
$111.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$107.38 |
| Rate for Payer: Aetna Commercial |
$86.12
|
| Rate for Payer: Anthem Medicaid |
$38.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.24
|
| Rate for Payer: Cash Price |
$55.92
|
| Rate for Payer: Cigna Commercial |
$92.84
|
| Rate for Payer: First Health Commercial |
$106.26
|
| Rate for Payer: Humana Commercial |
$95.07
|
| Rate for Payer: Humana KY Medicaid |
$38.47
|
| Rate for Payer: Kentucky WC Medicaid |
$38.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.43
|
| Rate for Payer: Ohio Health Group HMO |
$83.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.67
|
| Rate for Payer: PHCS Commercial |
$107.38
|
| Rate for Payer: United Healthcare All Payer |
$98.43
|
|
|
HESPAN (HETASTARCH 6%/0. 500ML
|
Facility
|
IP
|
$111.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$107.38 |
| Rate for Payer: Aetna Commercial |
$86.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.24
|
| Rate for Payer: Cash Price |
$55.92
|
| Rate for Payer: Cigna Commercial |
$92.84
|
| Rate for Payer: First Health Commercial |
$106.26
|
| Rate for Payer: Humana Commercial |
$95.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.43
|
| Rate for Payer: Ohio Health Group HMO |
$83.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.67
|
| Rate for Payer: PHCS Commercial |
$107.38
|
| Rate for Payer: United Healthcare All Payer |
$98.43
|
|
|
HEX DOME HOLE PLUG
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
HEX DOME HOLE PLUG
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
HGB A1C - GLYCATED
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
HGB A1C - GLYCATED
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
HGB A1C - GLYCATED
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$13.80
|
| Rate for Payer: Healthspan PPO |
$10.17
|
| Rate for Payer: Multiplan PHCS |
$44.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.80
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.83
|
|
|
HGB A1C POC
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
HGB A1C POC
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
HGB A1C POC
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$13.80
|
| Rate for Payer: Healthspan PPO |
$10.17
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.83
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Healthspan PPO |
$28.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.16
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB PRP-OMP VACC 3 DOSE IM(T
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
770T0014
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
