|
HSV 1 & 2 PCR EACH
|
Facility
|
OP
|
$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 Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$129.50
|
| 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: 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 |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| 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
|
|
|
HSV 1 & 2 PCR EACH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$259.00
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$155.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.30
|
| Rate for Payer: UHCCP Medicaid |
$90.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
HSV II AB IGM S
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
30001170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HSV II AB IGM S
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
30001170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HTLV I AB S
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
30001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HTLV I AB S
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
30001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$9.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$9.09
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$9.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.12
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$658.58 |
| Max. Negotiated Rate |
$4,863.36 |
| Rate for Payer: Aetna Commercial |
$3,900.82
|
| Rate for Payer: Anthem Medicaid |
$1,742.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,951.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$2,533.00
|
| Rate for Payer: Cash Price |
$2,533.00
|
| Rate for Payer: Cigna Commercial |
$4,204.78
|
| Rate for Payer: First Health Commercial |
$4,812.70
|
| Rate for Payer: Humana Commercial |
$4,306.10
|
| Rate for Payer: Humana KY Medicaid |
$1,742.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,759.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,154.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,738.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,777.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,458.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,799.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.46
|
| Rate for Payer: PHCS Commercial |
$4,863.36
|
| Rate for Payer: United Healthcare All Payer |
$4,458.08
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$658.58 |
| Max. Negotiated Rate |
$4,863.36 |
| Rate for Payer: Aetna Commercial |
$3,900.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,951.48
|
| Rate for Payer: Cash Price |
$2,533.00
|
| Rate for Payer: Cigna Commercial |
$4,204.78
|
| Rate for Payer: First Health Commercial |
$4,812.70
|
| Rate for Payer: Humana Commercial |
$4,306.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,154.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,738.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,458.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,799.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.46
|
| Rate for Payer: PHCS Commercial |
$4,863.36
|
| Rate for Payer: United Healthcare All Payer |
$4,458.08
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$5,066.00 |
| Rate for Payer: Aetna Commercial |
$701.44
|
| Rate for Payer: Anthem Medicaid |
$273.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,066.00
|
| Rate for Payer: Cash Price |
$2,533.00
|
| Rate for Payer: Cash Price |
$2,533.00
|
| Rate for Payer: Cigna Commercial |
$590.49
|
| Rate for Payer: Healthspan PPO |
$448.66
|
| Rate for Payer: Humana Medicaid |
$273.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Molina Healthcare Passport |
$273.49
|
| Rate for Payer: Multiplan PHCS |
$3,039.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,546.20
|
| Rate for Payer: UHCCP Medicaid |
$1,773.10
|
| Rate for Payer: United Healthcare Non-Options |
$459.23
|
| Rate for Payer: United Healthcare Options |
$459.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.22
|
|
|
HT MUSCLE IMAGE SPECT MULT(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340P0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$701.44 |
| Rate for Payer: Aetna Commercial |
$701.44
|
| Rate for Payer: Anthem Medicaid |
$273.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$590.49
|
| Rate for Payer: Healthspan PPO |
$448.66
|
| Rate for Payer: Humana Medicaid |
$273.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Molina Healthcare Passport |
$273.49
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: United Healthcare Non-Options |
$459.23
|
| Rate for Payer: United Healthcare Options |
$459.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.22
|
|
|
HT MUSCLE IMAGE SPECT MULT(T
|
Facility
|
OP
|
$4,891.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340T0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$635.83 |
| Max. Negotiated Rate |
$4,695.36 |
| Rate for Payer: Aetna Commercial |
$3,766.07
|
| Rate for Payer: Anthem Medicaid |
$1,682.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$2,445.50
|
| Rate for Payer: Cash Price |
$2,445.50
|
| Rate for Payer: Cigna Commercial |
$4,059.53
|
| Rate for Payer: First Health Commercial |
$4,646.45
|
| Rate for Payer: Humana Commercial |
$4,157.35
|
| Rate for Payer: Humana KY Medicaid |
$1,682.01
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,699.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,010.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,609.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,715.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,304.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.21
|
| Rate for Payer: PHCS Commercial |
$4,695.36
|
| Rate for Payer: United Healthcare All Payer |
$4,304.08
|
|
|
HT MUSCLE IMAGE SPECT MULT(T
|
Facility
|
IP
|
$4,891.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340T0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$635.83 |
| Max. Negotiated Rate |
$4,695.36 |
| Rate for Payer: Aetna Commercial |
$3,766.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.98
|
| Rate for Payer: Cash Price |
$2,445.50
|
| Rate for Payer: Cigna Commercial |
$4,059.53
|
| Rate for Payer: First Health Commercial |
$4,646.45
|
| Rate for Payer: Humana Commercial |
$4,157.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,010.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,609.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,304.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.21
|
| Rate for Payer: PHCS Commercial |
$4,695.36
|
| Rate for Payer: United Healthcare All Payer |
$4,304.08
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Facility
|
IP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$425.88 |
| Max. Negotiated Rate |
$3,144.96 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.56
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Facility
|
OP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$425.88 |
| Max. Negotiated Rate |
$3,144.96 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem Medicaid |
$1,126.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Humana KY Medicaid |
$1,126.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,138.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,149.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.56
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$74.45 |
| Max. Negotiated Rate |
$3,276.00 |
| Rate for Payer: Aetna Commercial |
$336.72
|
| Rate for Payer: Anthem Medicaid |
$161.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,276.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$484.11
|
| Rate for Payer: Healthspan PPO |
$264.21
|
| Rate for Payer: Humana Medicaid |
$161.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.76
|
| Rate for Payer: Molina Healthcare Passport |
$161.53
|
| Rate for Payer: Multiplan PHCS |
$1,965.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,293.20
|
| Rate for Payer: UHCCP Medicaid |
$1,146.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.15
|
|
|
HT MUSCLE IMAGE SPECT SING(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340P0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$484.11 |
| Rate for Payer: Aetna Commercial |
$336.72
|
| Rate for Payer: Anthem Medicaid |
$161.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$484.11
|
| Rate for Payer: Healthspan PPO |
$264.21
|
| Rate for Payer: Humana Medicaid |
$161.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.76
|
| Rate for Payer: Molina Healthcare Passport |
$161.53
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.15
|
|
|
HT MUSCLE IMAGE SPECT SING(T
|
Facility
|
OP
|
$3,101.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340T0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$403.13 |
| Max. Negotiated Rate |
$2,976.96 |
| Rate for Payer: Aetna Commercial |
$2,387.77
|
| Rate for Payer: Anthem Medicaid |
$1,066.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$1,550.50
|
| Rate for Payer: Cash Price |
$1,550.50
|
| Rate for Payer: Cigna Commercial |
$2,573.83
|
| Rate for Payer: First Health Commercial |
$2,945.95
|
| Rate for Payer: Humana Commercial |
$2,635.85
|
| Rate for Payer: Humana KY Medicaid |
$1,066.43
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,077.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,288.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.31
|
| Rate for Payer: PHCS Commercial |
$2,976.96
|
| Rate for Payer: United Healthcare All Payer |
$2,728.88
|
|
|
HT MUSCLE IMAGE SPECT SING(T
|
Facility
|
IP
|
$3,101.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340T0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$403.13 |
| Max. Negotiated Rate |
$2,976.96 |
| Rate for Payer: Aetna Commercial |
$2,387.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.78
|
| Rate for Payer: Cash Price |
$1,550.50
|
| Rate for Payer: Cigna Commercial |
$2,573.83
|
| Rate for Payer: First Health Commercial |
$2,945.95
|
| Rate for Payer: Humana Commercial |
$2,635.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,288.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.31
|
| Rate for Payer: PHCS Commercial |
$2,976.96
|
| Rate for Payer: United Healthcare All Payer |
$2,728.88
|
|
|
HT WHISPER MS 190CM
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HT WHISPER MS 190CM
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HUM 150MM STD
|
Facility
|
OP
|
$27,831.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,618.10 |
| Max. Negotiated Rate |
$26,718.24 |
| Rate for Payer: Aetna Commercial |
$21,430.26
|
| Rate for Payer: Anthem Medicaid |
$9,571.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,708.57
|
| Rate for Payer: Cash Price |
$13,915.75
|
| Rate for Payer: Cigna Commercial |
$23,100.14
|
| Rate for Payer: First Health Commercial |
$26,439.92
|
| Rate for Payer: Humana Commercial |
$23,656.78
|
| Rate for Payer: Humana KY Medicaid |
$9,571.25
|
| Rate for Payer: Kentucky WC Medicaid |
$9,668.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,821.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,539.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,349.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,763.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,491.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,873.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,566.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,618.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,627.76
|
| Rate for Payer: PHCS Commercial |
$26,718.24
|
| Rate for Payer: United Healthcare All Payer |
$24,491.72
|
|
|
HUM 150MM STD
|
Facility
|
IP
|
$27,831.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,618.10 |
| Max. Negotiated Rate |
$26,718.24 |
| Rate for Payer: Aetna Commercial |
$21,430.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,708.57
|
| Rate for Payer: Cash Price |
$13,915.75
|
| Rate for Payer: Cigna Commercial |
$23,100.14
|
| Rate for Payer: First Health Commercial |
$26,439.92
|
| Rate for Payer: Humana Commercial |
$23,656.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,821.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,539.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,349.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,491.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,873.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,566.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,618.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,627.76
|
| Rate for Payer: PHCS Commercial |
$26,718.24
|
| Rate for Payer: United Healthcare All Payer |
$24,491.72
|
|
|
HUM 200MM STD
|
Facility
|
OP
|
$29,693.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.09 |
| Max. Negotiated Rate |
$28,505.28 |
| Rate for Payer: Aetna Commercial |
$22,863.61
|
| Rate for Payer: Anthem Medicaid |
$10,211.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,160.54
|
| Rate for Payer: Cash Price |
$14,846.50
|
| Rate for Payer: Cigna Commercial |
$24,645.19
|
| Rate for Payer: First Health Commercial |
$28,208.35
|
| Rate for Payer: Humana Commercial |
$25,239.05
|
| Rate for Payer: Humana KY Medicaid |
$10,211.42
|
| Rate for Payer: Kentucky WC Medicaid |
$10,315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,907.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,416.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,129.84
|
| Rate for Payer: Ohio Health Group HMO |
$22,269.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,204.83
|
| Rate for Payer: PHCS Commercial |
$28,505.28
|
| Rate for Payer: United Healthcare All Payer |
$26,129.84
|
|
|
HUM 200MM STD
|
Facility
|
IP
|
$29,693.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.09 |
| Max. Negotiated Rate |
$28,505.28 |
| Rate for Payer: Aetna Commercial |
$22,863.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,160.54
|
| Rate for Payer: Cash Price |
$14,846.50
|
| Rate for Payer: Cigna Commercial |
$24,645.19
|
| Rate for Payer: First Health Commercial |
$28,208.35
|
| Rate for Payer: Humana Commercial |
$25,239.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,348.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,913.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,907.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,129.84
|
| Rate for Payer: Ohio Health Group HMO |
$22,269.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,204.83
|
| Rate for Payer: PHCS Commercial |
$28,505.28
|
| Rate for Payer: United Healthcare All Payer |
$26,129.84
|
|
|
HUMALOG 5 U (100 U/ML)
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
