|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$16,565.82
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$11,241.09 |
| Max. Negotiated Rate |
$16,565.82 |
| Rate for Payer: Anthem Medicaid |
$11,241.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,832.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,565.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,974.19
|
| Rate for Payer: Humana KY Medicaid |
$11,241.09
|
| Rate for Payer: Humana Medicare Advantage |
$11,832.73
|
| Rate for Payer: Kentucky WC Medicaid |
$11,353.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,199.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,465.92
|
|
|
HIZENTRA 100mg (10gm Vial)
|
Facility
|
OP
|
$12,392.76
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$11,897.05 |
| Rate for Payer: Aetna Commercial |
$9,542.43
|
| Rate for Payer: Anthem Medicaid |
$4,261.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,666.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.48
|
| Rate for Payer: Cash Price |
$6,196.38
|
| Rate for Payer: Cash Price |
$6,196.38
|
| Rate for Payer: Cigna Commercial |
$10,285.99
|
| Rate for Payer: First Health Commercial |
$11,773.12
|
| Rate for Payer: Humana Commercial |
$10,533.85
|
| Rate for Payer: Humana KY Medicaid |
$4,261.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,305.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,162.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,145.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,347.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,905.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,294.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,611.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.76
|
| Rate for Payer: PHCS Commercial |
$11,897.05
|
| Rate for Payer: United Healthcare All Payer |
$10,905.63
|
|
|
HIZENTRA 100mg (10gm Vial)
|
Facility
|
IP
|
$12,392.76
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,611.06 |
| Max. Negotiated Rate |
$11,897.05 |
| Rate for Payer: Aetna Commercial |
$9,542.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,666.35
|
| Rate for Payer: Cash Price |
$6,196.38
|
| Rate for Payer: Cigna Commercial |
$10,285.99
|
| Rate for Payer: First Health Commercial |
$11,773.12
|
| Rate for Payer: Humana Commercial |
$10,533.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,162.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,145.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,717.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,905.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,294.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,611.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.76
|
| Rate for Payer: PHCS Commercial |
$11,897.05
|
| Rate for Payer: United Healthcare All Payer |
$10,905.63
|
|
|
HIZENTRA 1GM/5ML VIAL
|
Facility
|
OP
|
$1,239.28
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$1,189.71 |
| Rate for Payer: Aetna Commercial |
$954.25
|
| Rate for Payer: Anthem Medicaid |
$426.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$966.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.48
|
| Rate for Payer: Cash Price |
$619.64
|
| Rate for Payer: Cash Price |
$619.64
|
| Rate for Payer: Cigna Commercial |
$1,028.60
|
| Rate for Payer: First Health Commercial |
$1,177.32
|
| Rate for Payer: Humana Commercial |
$1,053.39
|
| Rate for Payer: Humana KY Medicaid |
$426.19
|
| Rate for Payer: Humana Medicare Advantage |
$12.94
|
| Rate for Payer: Kentucky WC Medicaid |
$430.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,090.57
|
| Rate for Payer: Ohio Health Group HMO |
$929.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.18
|
| Rate for Payer: PHCS Commercial |
$1,189.71
|
| Rate for Payer: United Healthcare All Payer |
$1,090.57
|
|
|
HIZENTRA 1GM/5ML VIAL
|
Facility
|
IP
|
$1,239.28
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.11 |
| Max. Negotiated Rate |
$1,189.71 |
| Rate for Payer: Aetna Commercial |
$954.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$966.64
|
| Rate for Payer: Cash Price |
$619.64
|
| Rate for Payer: Cigna Commercial |
$1,028.60
|
| Rate for Payer: First Health Commercial |
$1,177.32
|
| Rate for Payer: Humana Commercial |
$1,053.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,090.57
|
| Rate for Payer: Ohio Health Group HMO |
$929.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.18
|
| Rate for Payer: PHCS Commercial |
$1,189.71
|
| Rate for Payer: United Healthcare All Payer |
$1,090.57
|
|
|
HIZENTRA 2GM/10ML VIAL
|
Facility
|
IP
|
$2,478.55
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.21 |
| Max. Negotiated Rate |
$2,379.41 |
| Rate for Payer: Aetna Commercial |
$1,908.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.27
|
| Rate for Payer: Cash Price |
$1,239.28
|
| Rate for Payer: Cigna Commercial |
$2,057.20
|
| Rate for Payer: First Health Commercial |
$2,354.62
|
| Rate for Payer: Humana Commercial |
$2,106.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,858.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.35
|
| Rate for Payer: PHCS Commercial |
$2,379.41
|
| Rate for Payer: United Healthcare All Payer |
$2,181.12
|
|
|
HIZENTRA 2GM/10ML VIAL
|
Facility
|
OP
|
$2,478.55
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$2,379.41 |
| Rate for Payer: Aetna Commercial |
$1,908.48
|
| Rate for Payer: Anthem Medicaid |
$852.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.48
|
| Rate for Payer: Cash Price |
$1,239.28
|
| Rate for Payer: Cash Price |
$1,239.28
|
| Rate for Payer: Cigna Commercial |
$2,057.20
|
| Rate for Payer: First Health Commercial |
$2,354.62
|
| Rate for Payer: Humana Commercial |
$2,106.77
|
| Rate for Payer: Humana KY Medicaid |
$852.37
|
| Rate for Payer: Humana Medicare Advantage |
$12.94
|
| Rate for Payer: Kentucky WC Medicaid |
$861.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$869.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,858.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.35
|
| Rate for Payer: PHCS Commercial |
$2,379.41
|
| Rate for Payer: United Healthcare All Payer |
$2,181.12
|
|
|
HIZENTRA 4GM/20ML VIAL
|
Facility
|
OP
|
$4,957.10
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$4,758.82 |
| Rate for Payer: Aetna Commercial |
$3,816.97
|
| Rate for Payer: Anthem Medicaid |
$1,704.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,866.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.48
|
| Rate for Payer: Cash Price |
$2,478.55
|
| Rate for Payer: Cash Price |
$2,478.55
|
| Rate for Payer: Cigna Commercial |
$4,114.39
|
| Rate for Payer: First Health Commercial |
$4,709.24
|
| Rate for Payer: Humana Commercial |
$4,213.54
|
| Rate for Payer: Humana KY Medicaid |
$1,704.75
|
| Rate for Payer: Humana Medicare Advantage |
$12.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,722.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,064.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,658.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,738.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,362.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,717.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.70
|
| Rate for Payer: PHCS Commercial |
$4,758.82
|
| Rate for Payer: United Healthcare All Payer |
$4,362.25
|
|
|
HIZENTRA 4GM/20ML VIAL
|
Facility
|
IP
|
$4,957.10
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$644.42 |
| Max. Negotiated Rate |
$4,758.82 |
| Rate for Payer: Aetna Commercial |
$3,816.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,866.54
|
| Rate for Payer: Cash Price |
$2,478.55
|
| Rate for Payer: Cigna Commercial |
$4,114.39
|
| Rate for Payer: First Health Commercial |
$4,709.24
|
| Rate for Payer: Humana Commercial |
$4,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,064.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,658.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,487.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,362.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,717.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.70
|
| Rate for Payer: PHCS Commercial |
$4,758.82
|
| Rate for Payer: United Healthcare All Payer |
$4,362.25
|
|
|
HLA A&B TYPING
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
30001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
HLA A&B TYPING
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
30001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$58.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$58.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$81.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$58.00
|
| Rate for Payer: Humana Medicare Advantage |
$58.00
|
| Rate for Payer: Kentucky WC Medicaid |
$58.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
HLA CLASS I HIGH DEFIN QUAL
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
30001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.80
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.08
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
HLA CLASS I HIGH DEFIN QUAL
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
30001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$453.25 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$323.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$323.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$453.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$323.75
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$323.75
|
| Rate for Payer: Humana Medicare Advantage |
$323.75
|
| Rate for Payer: Kentucky WC Medicaid |
$326.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.08
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
HLA CYTOTOXIC ANTIBODY SCREEN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86808
|
| Hospital Charge Code |
30001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
HLA CYTOTOXIC ANTIBODY SCREEN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86808
|
| Hospital Charge Code |
30001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$29.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$29.68
|
| Rate for Payer: Humana Medicare Advantage |
$29.68
|
| Rate for Payer: Kentucky WC Medicaid |
$29.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
HLA LEUKOCYTE ANTIBODY
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
30000970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$294.72 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.17
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
HLA LEUKOCYTE ANTIBODY
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
30000970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$294.72 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.17
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
HLA TYPING INTERPRETATION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
30001226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
HLA TYPING INTERPRETATION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
30001226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$110.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$110.00
|
| Rate for Payer: Kentucky WC Medicaid |
$111.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
HOCKEY STICK 110CM
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
HOCKEY STICK 110CM
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
HOLE ELIMINATOR APEX
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
HOLE ELIMINATOR APEX
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
HOLTER MONITOR HOOKUP EDUC REC
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
73000005
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
HOLTER MONITOR HOOKUP EDUC REC
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
73000005
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
