|
HERNIA REPAIR
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,690.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
HERNIA REPAIR
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.57 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$910.02
|
| Rate for Payer: Ambetter Exchange |
$562.22
|
| Rate for Payer: Anthem Medicaid |
$378.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$562.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$562.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$674.66
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$847.48
|
| Rate for Payer: Healthspan PPO |
$767.43
|
| Rate for Payer: Humana Medicaid |
$378.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$562.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$386.14
|
| Rate for Payer: Molina Healthcare Passport |
$378.57
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$730.89
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$382.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$562.22
|
|
|
HERNIA REPAIR
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
76102013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$842.55 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,690.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
HERNIA REPAIR(P
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
761P2013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.57 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: Aetna Commercial |
$910.02
|
| Rate for Payer: Ambetter Exchange |
$562.22
|
| Rate for Payer: Anthem Medicaid |
$378.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$562.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$562.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$674.66
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$847.48
|
| Rate for Payer: Healthspan PPO |
$767.43
|
| Rate for Payer: Humana Medicaid |
$378.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$806.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$562.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$386.14
|
| Rate for Payer: Molina Healthcare Passport |
$378.57
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$730.89
|
| Rate for Payer: UHCCP Medicaid |
$857.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$382.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$562.22
|
|
|
HERZUMA 10mg (150mg SDV)
|
Facility
|
IP
|
$5,944.59
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,783.38 |
| Max. Negotiated Rate |
$5,706.81 |
| Rate for Payer: Aetna Commercial |
$4,577.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,636.78
|
| Rate for Payer: Cash Price |
$2,972.30
|
| Rate for Payer: Cigna Commercial |
$4,934.01
|
| Rate for Payer: First Health Commercial |
$5,647.36
|
| Rate for Payer: Humana Commercial |
$5,052.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,874.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,387.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,783.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,231.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,458.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,755.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,171.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,101.77
|
| Rate for Payer: PHCS Commercial |
$5,706.81
|
| Rate for Payer: United Healthcare All Payer |
$5,231.24
|
|
|
HERZUMA 10mg (150mg SDV)
|
Facility
|
OP
|
$5,944.59
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.49 |
| Max. Negotiated Rate |
$5,706.81 |
| Rate for Payer: Aetna Commercial |
$4,577.33
|
| Rate for Payer: Anthem Medicaid |
$2,044.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,636.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$108.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.61
|
| Rate for Payer: Cash Price |
$2,972.30
|
| Rate for Payer: Cash Price |
$2,972.30
|
| Rate for Payer: Cigna Commercial |
$4,934.01
|
| Rate for Payer: First Health Commercial |
$5,647.36
|
| Rate for Payer: Humana Commercial |
$5,052.90
|
| Rate for Payer: Humana KY Medicaid |
$2,044.34
|
| Rate for Payer: Humana Medicare Advantage |
$77.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,065.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,874.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,387.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,085.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,231.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,458.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,755.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,171.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,101.77
|
| Rate for Payer: PHCS Commercial |
$5,706.81
|
| Rate for Payer: United Healthcare All Payer |
$5,231.24
|
|
|
HERZUMA 10mg (from 420mg MDV)
|
Facility
|
IP
|
$509.58
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.87 |
| Max. Negotiated Rate |
$489.20 |
| Rate for Payer: Aetna Commercial |
$392.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.47
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cigna Commercial |
$422.95
|
| Rate for Payer: First Health Commercial |
$484.10
|
| Rate for Payer: Humana Commercial |
$433.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.43
|
| Rate for Payer: Ohio Health Group HMO |
$382.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.61
|
| Rate for Payer: PHCS Commercial |
$489.20
|
| Rate for Payer: United Healthcare All Payer |
$448.43
|
|
|
HERZUMA 10mg (from 420mg MDV)
|
Facility
|
OP
|
$509.58
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
25004109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.49 |
| Max. Negotiated Rate |
$489.20 |
| Rate for Payer: Aetna Commercial |
$392.38
|
| Rate for Payer: Anthem Medicaid |
$175.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$108.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.61
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cash Price |
$254.79
|
| Rate for Payer: Cigna Commercial |
$422.95
|
| Rate for Payer: First Health Commercial |
$484.10
|
| Rate for Payer: Humana Commercial |
$433.14
|
| Rate for Payer: Humana KY Medicaid |
$175.24
|
| Rate for Payer: Humana Medicare Advantage |
$77.49
|
| Rate for Payer: Kentucky WC Medicaid |
$177.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.43
|
| Rate for Payer: Ohio Health Group HMO |
$382.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.61
|
| Rate for Payer: PHCS Commercial |
$489.20
|
| Rate for Payer: United Healthcare All Payer |
$448.43
|
|
|
HESPAN (HETASTARCH 6%/0. 500ML
|
Facility
|
OP
|
$131.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003101
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$126.25 |
| Rate for Payer: Aetna Commercial |
$101.26
|
| Rate for Payer: Anthem Medicaid |
$45.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cigna Commercial |
$109.15
|
| Rate for Payer: First Health Commercial |
$124.93
|
| Rate for Payer: Humana Commercial |
$111.78
|
| Rate for Payer: Humana KY Medicaid |
$45.23
|
| Rate for Payer: Kentucky WC Medicaid |
$45.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.73
|
| Rate for Payer: Ohio Health Group HMO |
$98.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.74
|
| Rate for Payer: PHCS Commercial |
$126.25
|
| Rate for Payer: United Healthcare All Payer |
$115.73
|
|
|
HESPAN (HETASTARCH 6%/0. 500ML
|
Facility
|
IP
|
$131.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003101
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$126.25 |
| Rate for Payer: Aetna Commercial |
$101.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cigna Commercial |
$109.15
|
| Rate for Payer: First Health Commercial |
$124.93
|
| Rate for Payer: Humana Commercial |
$111.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.73
|
| Rate for Payer: Ohio Health Group HMO |
$98.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.74
|
| Rate for Payer: PHCS Commercial |
$126.25
|
| Rate for Payer: United Healthcare All Payer |
$115.73
|
|
|
HEX DOME HOLE PLUG
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
HEX DOME HOLE PLUG
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
HGB A1C - GLYCATED
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
HGB A1C - GLYCATED
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
HGB A1C - GLYCATED
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30000362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Ambetter Exchange |
$9.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.65
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$13.80
|
| Rate for Payer: Healthspan PPO |
$10.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.71
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.62
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.71
|
|
|
HGB A1C POC
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
HGB A1C POC
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
HGB A1C POC
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
30001929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Ambetter Exchange |
$9.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.65
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$13.80
|
| Rate for Payer: Healthspan PPO |
$10.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.71
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.62
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.71
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.77 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Anthem Medicaid |
$22.77
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Healthspan PPO |
$28.93
|
| Rate for Payer: Humana Medicaid |
$22.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.23
|
| Rate for Payer: Molina Healthcare Passport |
$22.77
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.00
|
|
|
HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
77000014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB PRP-OMP VACC 3 DOSE IM(T
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
770T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB PRP-OMP VACC 3 DOSE IM(T
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
770T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Anthem Medicaid |
$26.21
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Healthspan PPO |
$29.41
|
| Rate for Payer: Humana Medicaid |
$26.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.73
|
| Rate for Payer: Molina Healthcare Passport |
$26.21
|
| Rate for Payer: Multiplan PHCS |
$68.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.80
|
| Rate for Payer: UHCCP Medicaid |
$39.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.47
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| 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 |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
