|
GRFT ENDURNT BIFUR 3 PIECE BUN
|
Facility
|
OP
|
$90,300.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,090.00 |
| Max. Negotiated Rate |
$86,688.00 |
| Rate for Payer: Aetna Commercial |
$69,531.00
|
| Rate for Payer: Anthem Medicaid |
$31,054.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,434.00
|
| Rate for Payer: Cash Price |
$45,150.00
|
| Rate for Payer: Cigna Commercial |
$74,949.00
|
| Rate for Payer: First Health Commercial |
$85,785.00
|
| Rate for Payer: Humana Commercial |
$76,755.00
|
| Rate for Payer: Humana KY Medicaid |
$31,054.17
|
| Rate for Payer: Kentucky WC Medicaid |
$31,370.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,046.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,641.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,090.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,677.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$67,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,561.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,307.00
|
| Rate for Payer: PHCS Commercial |
$86,688.00
|
| Rate for Payer: United Healthcare All Payer |
$79,464.00
|
|
|
GRIS-PEG 250MG TABLET
|
Facility
|
IP
|
$22.10
|
|
|
Service Code
|
NDC 115172501
|
| Hospital Charge Code |
25000740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$17.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.24
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cigna Commercial |
$18.34
|
| Rate for Payer: First Health Commercial |
$21.00
|
| Rate for Payer: Humana Commercial |
$18.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.45
|
| Rate for Payer: Ohio Health Group HMO |
$16.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.25
|
| Rate for Payer: PHCS Commercial |
$21.22
|
| Rate for Payer: United Healthcare All Payer |
$19.45
|
|
|
GRIS-PEG 250MG TABLET
|
Facility
|
OP
|
$22.10
|
|
|
Service Code
|
NDC 115172501
|
| Hospital Charge Code |
25000740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna Commercial |
$17.02
|
| Rate for Payer: Anthem Medicaid |
$7.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.24
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cigna Commercial |
$18.34
|
| Rate for Payer: First Health Commercial |
$21.00
|
| Rate for Payer: Humana Commercial |
$18.79
|
| Rate for Payer: Humana KY Medicaid |
$7.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.45
|
| Rate for Payer: Ohio Health Group HMO |
$16.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.25
|
| Rate for Payer: PHCS Commercial |
$21.22
|
| Rate for Payer: United Healthcare All Payer |
$19.45
|
|
|
GROIN SOFT TISSUE US LTD
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
GROIN SOFT TISSUE US LTD
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
GROIN SOFT TISSUE US LTD
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
GROIN SOFT TISSUE US LTD(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
GROIN SOFT TISSUE US LTD(T
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
GROIN SOFT TISSUE US LTD(T
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0057
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
GROLLMAN PIGTAIL 7F
|
Facility
|
OP
|
$513.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$492.96 |
| Rate for Payer: Aetna Commercial |
$395.39
|
| Rate for Payer: Anthem Medicaid |
$176.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.53
|
| Rate for Payer: Cash Price |
$256.75
|
| Rate for Payer: Cigna Commercial |
$426.20
|
| Rate for Payer: First Health Commercial |
$487.82
|
| Rate for Payer: Humana Commercial |
$436.48
|
| Rate for Payer: Humana KY Medicaid |
$176.59
|
| Rate for Payer: Kentucky WC Medicaid |
$178.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.88
|
| Rate for Payer: Ohio Health Group HMO |
$385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.31
|
| Rate for Payer: PHCS Commercial |
$492.96
|
| Rate for Payer: United Healthcare All Payer |
$451.88
|
|
|
GROLLMAN PIGTAIL 7F
|
Facility
|
IP
|
$513.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$492.96 |
| Rate for Payer: Aetna Commercial |
$395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.53
|
| Rate for Payer: Cash Price |
$256.75
|
| Rate for Payer: Cigna Commercial |
$426.20
|
| Rate for Payer: First Health Commercial |
$487.82
|
| Rate for Payer: Humana Commercial |
$436.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.88
|
| Rate for Payer: Ohio Health Group HMO |
$385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.31
|
| Rate for Payer: PHCS Commercial |
$492.96
|
| Rate for Payer: United Healthcare All Payer |
$451.88
|
|
|
GROUP A STREPTOCOCCUS CULTURE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
GROUP A STREPTOCOCCUS CULTURE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| 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 |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
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 |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| 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 |
$29.10 |
| 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 |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.23
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
GROUP B STREPTOCOCCUS CULTURE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30001408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$70.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| 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 |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| 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 |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$153.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$89.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
GROUP B STREPTOCOCCUS SCN MOL
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
30001391
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.57
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
GROUP EA 30 MIN.
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
51000053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| 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 |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| Rate for Payer: PHCS Commercial |
$72.96
|
| Rate for Payer: United Healthcare All Payer |
$66.88
|
|
|
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 |
$45.60 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Ambetter Exchange |
$14.31
|
| 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 Individual/Medicaid |
$14.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$14.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.31
|
| 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 |
$18.60
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.31
|
|
|
GROUP EA 30 MIN.
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
51000053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| 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 |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.44
|
| 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 |
$20.49 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Ambetter Exchange |
$14.31
|
| 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 Individual/Medicaid |
$14.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$14.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.31
|
| 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 |
$18.60
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.31
|
|
|
GROUP EA 30 MIN.(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
510T0053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.50 |
| 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 |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
