|
IMME. INSERT OF BREAST PROSTHE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
IMME. INSERT OF BREAST PROSTHE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
76100311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
IMMUN ADM NASAL/ORAL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
77000003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.22
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.19
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
IMMUN ADM NASAL/ORAL
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
77000003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.00
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$28.79
|
| Rate for Payer: Healthspan PPO |
$15.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.58
|
| Rate for Payer: Multiplan PHCS |
$29.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.30
|
| Rate for Payer: UHCCP Medicaid |
$17.15
|
|
|
IMMUN ADM NASAL/ORAL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
77000003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Humana KY Medicaid |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$60.92
|
| Rate for Payer: Kentucky WC Medicaid |
$17.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.19
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
IMMUN ADM NASAL/ORAL(T
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
770T0003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.22
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.19
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
IMMUN ADM NASAL/ORAL(T
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 90473
|
| Hospital Charge Code |
770T0003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Humana KY Medicaid |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$60.92
|
| Rate for Payer: Kentucky WC Medicaid |
$17.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.19
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
HCPCS 90474
|
| Hospital Charge Code |
77000008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
IMMUNE ADMIN ORAL/NASAL ADDL
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
HCPCS 90474
|
| Hospital Charge Code |
77000008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.06
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
IMMUNE ADMIN ORAL/NASAL ADDL
|
Professional
|
Both
|
$29.23
|
|
|
Service Code
|
HCPCS 90474
|
| Hospital Charge Code |
77000008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.23
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$14.56
|
| Rate for Payer: Healthspan PPO |
$10.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.43
|
| Rate for Payer: Multiplan PHCS |
$17.54
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.46
|
| Rate for Payer: UHCCP Medicaid |
$10.23
|
|
|
IMMUNOASSAY FOR ANALYTE
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$152.64 |
| Rate for Payer: Aetna Commercial |
$122.43
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$131.97
|
| Rate for Payer: First Health Commercial |
$151.05
|
| Rate for Payer: Humana Commercial |
$135.15
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$130.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$117.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.92
|
| Rate for Payer: Ohio Health Group HMO |
$119.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.29
|
| Rate for Payer: PHCS Commercial |
$152.64
|
| Rate for Payer: United Healthcare All Payer |
$139.92
|
|
|
IMMUNOASSAY FOR ANALYTE
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$152.64 |
| Rate for Payer: Aetna Commercial |
$122.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$131.97
|
| Rate for Payer: First Health Commercial |
$151.05
|
| Rate for Payer: Humana Commercial |
$135.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$130.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$117.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.92
|
| Rate for Payer: Ohio Health Group HMO |
$119.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.29
|
| Rate for Payer: PHCS Commercial |
$152.64
|
| Rate for Payer: United Healthcare All Payer |
$139.92
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001524
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.29
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001524
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.29
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
IMMUNOHISTO ANTB ADDL SLIDE
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001524
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Anthem Medicaid |
$50.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$45.99
|
| Rate for Payer: Humana Medicaid |
$50.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.46
|
| Rate for Payer: Molina Healthcare Passport |
$50.45
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.95
|
|
|
IMMUNOLOGICAL ID AND TYPING
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
30001285
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
IMMUNOLOGICAL ID AND TYPING
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
30001285
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
IMMUNOTHERAPY 2 OR MORE INJEC
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 95125
|
| Hospital Charge Code |
94000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
IMMUNOTHERAPY 2 OR MORE INJEC
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 95125
|
| Hospital Charge Code |
94000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
IMMUNOTHERAPY 2 OR MORE INJEC
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 95125
|
| Hospital Charge Code |
94000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$30.52
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
|
|
IMMUNOTHERAPY 2 OR MORE INJE(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 95125
|
| Hospital Charge Code |
940P0010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$30.52
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.78
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
|
|
IMMUNOTHERAPY SINGLE INJECTION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
94000009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IMMUNOTHERAPY SINGLE INJECTION
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
940T0009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
IMMUNOTHERAPY SINGLE INJECTION
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
94000009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$25.43
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.75
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
|
|
IMMUNOTHERAPY SINGLE INJECTION
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 95120
|
| Hospital Charge Code |
940T0009
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
