|
HOT OR COLD PACK APP
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 97010
|
| Hospital Charge Code |
42000005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.02
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
HOT OR COLD PACK APP
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 97010
|
| Hospital Charge Code |
42000005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$20.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.02
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Humana KY Medicaid |
$20.29
|
| Rate for Payer: Kentucky WC Medicaid |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
HOT OR COLD PACKS APP
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 97010
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$20.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.02
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Humana KY Medicaid |
$20.29
|
| Rate for Payer: Kentucky WC Medicaid |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
HOT OR COLD PACKS APP
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 97010
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.02
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
HPV 6, 11,16,18,31,33,45,52
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
77000017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
HPV 6, 11,16,18,31,33,45,52
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
77000017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
HPV 6, 11,16,18,31,33,45,52
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
77000017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$874.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$395.28
|
| Rate for Payer: Multiplan PHCS |
$524.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$611.80
|
| Rate for Payer: UHCCP Medicaid |
$305.90
|
|
|
HPV 6, 11,16,18,31,33,45,52(T
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
770T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
HPV 6, 11,16,18,31,33,45,52(T
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
770T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
HPV SCREEN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS G0476
|
| Hospital Charge Code |
30001786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
HPV SCREEN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS G0476
|
| Hospital Charge Code |
30001786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| 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 |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
HPV SCREEN
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS G0476
|
| Hospital Charge Code |
30001786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$86.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Multiplan PHCS |
$51.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.20
|
| Rate for Payer: UHCCP Medicaid |
$30.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
HPV TYPES 16 & 18 & 45
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
30001787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
HPV TYPES 16 & 18 & 45
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 87625
|
| Hospital Charge Code |
30001787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$40.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$56.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.55
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$40.55
|
| Rate for Payer: Humana Medicare Advantage |
$40.55
|
| Rate for Payer: Kentucky WC Medicaid |
$40.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
H PYLORI BREATH TEST
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
30001782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$94.30 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$67.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$67.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$94.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$67.36
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$67.36
|
| Rate for Payer: Humana Medicare Advantage |
$67.36
|
| Rate for Payer: Kentucky WC Medicaid |
$68.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
H PYLORI BREATH TEST
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
30001782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$95.13 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$95.13
|
| Rate for Payer: Healthspan PPO |
$70.58
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.42
|
|
|
H PYLORI BREATH TEST
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 83013
|
| Hospital Charge Code |
30001782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.24
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
H PYLORI STOOL ANTIGEN
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
30001349
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
H PYLORI STOOL ANTIGEN
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
30001349
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$12.71
|
| Rate for Payer: Healthspan PPO |
$61.00
|
| Rate for Payer: Multiplan PHCS |
$109.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.40
|
| Rate for Payer: UHCCP Medicaid |
$63.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.63
|
|
|
H PYLORI STOOL ANTIGEN
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 87338
|
| Hospital Charge Code |
30001349
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$14.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.38
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$14.38
|
| Rate for Payer: Humana Medicare Advantage |
$14.38
|
| Rate for Payer: Kentucky WC Medicaid |
$14.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
HSG CATH 7FR
|
Facility
|
IP
|
$478.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$459.60 |
| Rate for Payer: Aetna Commercial |
$368.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.42
|
| Rate for Payer: Cash Price |
$239.38
|
| Rate for Payer: Cigna Commercial |
$397.36
|
| Rate for Payer: First Health Commercial |
$454.81
|
| Rate for Payer: Humana Commercial |
$406.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.30
|
| Rate for Payer: Ohio Health Group HMO |
$359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.41
|
| Rate for Payer: PHCS Commercial |
$459.60
|
| Rate for Payer: United Healthcare All Payer |
$421.30
|
|
|
HSG CATH 7FR
|
Facility
|
OP
|
$478.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$459.60 |
| Rate for Payer: Aetna Commercial |
$368.64
|
| Rate for Payer: Anthem Medicaid |
$164.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.42
|
| Rate for Payer: Cash Price |
$239.38
|
| Rate for Payer: Cigna Commercial |
$397.36
|
| Rate for Payer: First Health Commercial |
$454.81
|
| Rate for Payer: Humana Commercial |
$406.94
|
| Rate for Payer: Humana KY Medicaid |
$164.64
|
| Rate for Payer: Kentucky WC Medicaid |
$166.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.30
|
| Rate for Payer: Ohio Health Group HMO |
$359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.41
|
| Rate for Payer: PHCS Commercial |
$459.60
|
| Rate for Payer: United Healthcare All Payer |
$421.30
|
|
|
HSG/SIS CATHETER 5F
|
Facility
|
OP
|
$478.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$459.60 |
| Rate for Payer: Aetna Commercial |
$368.64
|
| Rate for Payer: Anthem Medicaid |
$164.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.42
|
| Rate for Payer: Cash Price |
$239.38
|
| Rate for Payer: Cigna Commercial |
$397.36
|
| Rate for Payer: First Health Commercial |
$454.81
|
| Rate for Payer: Humana Commercial |
$406.94
|
| Rate for Payer: Humana KY Medicaid |
$164.64
|
| Rate for Payer: Kentucky WC Medicaid |
$166.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.30
|
| Rate for Payer: Ohio Health Group HMO |
$359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.41
|
| Rate for Payer: PHCS Commercial |
$459.60
|
| Rate for Payer: United Healthcare All Payer |
$421.30
|
|
|
HSG/SIS CATHETER 5F
|
Facility
|
IP
|
$478.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$459.60 |
| Rate for Payer: Aetna Commercial |
$368.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$373.42
|
| Rate for Payer: Cash Price |
$239.38
|
| Rate for Payer: Cigna Commercial |
$397.36
|
| Rate for Payer: First Health Commercial |
$454.81
|
| Rate for Payer: Humana Commercial |
$406.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$421.30
|
| Rate for Payer: Ohio Health Group HMO |
$359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.41
|
| Rate for Payer: PHCS Commercial |
$459.60
|
| Rate for Payer: United Healthcare All Payer |
$421.30
|
|
|
HSV 1 & 2 PCR EACH
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
