|
HIZENTRA 2GM/10ML VIAL
|
Facility
|
IP
|
$2,626.90
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$788.07 |
| Max. Negotiated Rate |
$2,521.82 |
| Rate for Payer: Aetna Commercial |
$2,022.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,048.98
|
| Rate for Payer: Cash Price |
$1,313.45
|
| Rate for Payer: Cigna Commercial |
$2,180.33
|
| Rate for Payer: First Health Commercial |
$2,495.55
|
| Rate for Payer: Humana Commercial |
$2,232.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,154.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,938.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$788.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,311.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,970.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,101.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,285.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,812.56
|
| Rate for Payer: PHCS Commercial |
$2,521.82
|
| Rate for Payer: United Healthcare All Payer |
$2,311.67
|
|
|
HIZENTRA 2GM/10ML VIAL
|
Facility
|
OP
|
$2,626.90
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$2,521.82 |
| Rate for Payer: Aetna Commercial |
$2,022.71
|
| Rate for Payer: Anthem Medicaid |
$903.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,048.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.06
|
| Rate for Payer: Cash Price |
$1,313.45
|
| Rate for Payer: Cash Price |
$1,313.45
|
| Rate for Payer: Cigna Commercial |
$2,180.33
|
| Rate for Payer: First Health Commercial |
$2,495.55
|
| Rate for Payer: Humana Commercial |
$2,232.86
|
| Rate for Payer: Humana KY Medicaid |
$903.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$912.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,154.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,938.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$921.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,311.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,970.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,101.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,285.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,812.56
|
| Rate for Payer: PHCS Commercial |
$2,521.82
|
| Rate for Payer: United Healthcare All Payer |
$2,311.67
|
|
|
HIZENTRA 4GM/20ML VIAL
|
Facility
|
IP
|
$5,253.80
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,576.14 |
| Max. Negotiated Rate |
$5,043.65 |
| Rate for Payer: Aetna Commercial |
$4,045.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,097.96
|
| Rate for Payer: Cash Price |
$2,626.90
|
| Rate for Payer: Cigna Commercial |
$4,360.65
|
| Rate for Payer: First Health Commercial |
$4,991.11
|
| Rate for Payer: Humana Commercial |
$4,465.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,308.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,877.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,623.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,940.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,203.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,570.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.12
|
| Rate for Payer: PHCS Commercial |
$5,043.65
|
| Rate for Payer: United Healthcare All Payer |
$4,623.34
|
|
|
HIZENTRA 4GM/20ML VIAL
|
Facility
|
OP
|
$5,253.80
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$5,043.65 |
| Rate for Payer: Aetna Commercial |
$4,045.43
|
| Rate for Payer: Anthem Medicaid |
$1,806.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,097.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.06
|
| Rate for Payer: Cash Price |
$2,626.90
|
| Rate for Payer: Cash Price |
$2,626.90
|
| Rate for Payer: Cigna Commercial |
$4,360.65
|
| Rate for Payer: First Health Commercial |
$4,991.11
|
| Rate for Payer: Humana Commercial |
$4,465.73
|
| Rate for Payer: Humana KY Medicaid |
$1,806.78
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,308.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,877.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,623.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,940.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,203.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,570.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.12
|
| Rate for Payer: PHCS Commercial |
$5,043.65
|
| Rate for Payer: United Healthcare All Payer |
$4,623.34
|
|
|
HLA A&B TYPING
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
30001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$58.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$58.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$81.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$58.00
|
| Rate for Payer: Humana Medicare Advantage |
$58.00
|
| Rate for Payer: Kentucky WC Medicaid |
$58.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
HLA A&B TYPING
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 86813
|
| Hospital Charge Code |
30001225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.20
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
HLA CLASS I HIGH DEFIN QUAL
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
30001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$322.92 |
| Max. Negotiated Rate |
$453.25 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$323.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$323.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$453.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$323.75
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$323.75
|
| Rate for Payer: Humana Medicare Advantage |
$323.75
|
| Rate for Payer: Kentucky WC Medicaid |
$326.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
HLA CLASS I HIGH DEFIN QUAL
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
30001978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.80
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
HLA CYTOTOXIC ANTIBODY SCREEN
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86808
|
| Hospital Charge Code |
30001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$29.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$29.68
|
| Rate for Payer: Humana Medicare Advantage |
$29.68
|
| Rate for Payer: Kentucky WC Medicaid |
$29.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
HLA CYTOTOXIC ANTIBODY SCREEN
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86808
|
| Hospital Charge Code |
30001223
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.47
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
HLA LEUKOCYTE ANTIBODY
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
30000970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.10 |
| Max. Negotiated Rate |
$294.72 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.83
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
HLA LEUKOCYTE ANTIBODY
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
30000970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$294.72 |
| Rate for Payer: Aetna Commercial |
$236.39
|
| Rate for Payer: Anthem Medicaid |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cash Price |
$153.50
|
| Rate for Payer: Cigna Commercial |
$254.81
|
| Rate for Payer: First Health Commercial |
$291.65
|
| Rate for Payer: Humana Commercial |
$260.95
|
| Rate for Payer: Humana KY Medicaid |
$15.05
|
| Rate for Payer: Humana Medicare Advantage |
$15.05
|
| Rate for Payer: Kentucky WC Medicaid |
$15.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$226.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$270.16
|
| Rate for Payer: Ohio Health Group HMO |
$230.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.83
|
| Rate for Payer: PHCS Commercial |
$294.72
|
| Rate for Payer: United Healthcare All Payer |
$270.16
|
|
|
HLA TYPING INTERPRETATION
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
30001226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$142.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$142.37
|
| Rate for Payer: Kentucky WC Medicaid |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
HLA TYPING INTERPRETATION
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 86849
|
| Hospital Charge Code |
30001226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
HOCKEY STICK 110CM
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
HOCKEY STICK 110CM
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
HOFFMANN3 CONNECTNG ROD 11*150
|
Facility
|
OP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem Medicaid |
$699.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Humana KY Medicaid |
$699.29
|
| Rate for Payer: Kentucky WC Medicaid |
$706.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
HOFFMANN3 CONNECTNG ROD 11*150
|
Facility
|
IP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
HOLE ELIMINATOR APEX
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
HOLE ELIMINATOR APEX
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
HOLTER MONITOR HOOKUP EDUC REC
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
73000005
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$63.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$63.97
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$64.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
HOLTER MONITOR HOOKUP EDUC REC
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
73000005
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.08
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS G0181
|
| Hospital Charge Code |
51000153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$63.81
|
| Rate for Payer: Ambetter Exchange |
$98.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.33
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.61
|
| Rate for Payer: Multiplan PHCS |
$88.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.19
|
| Rate for Payer: UHCCP Medicaid |
$51.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.61
|
|
|
HOME HEALTH CARE SUPERVISION
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS G0181
|
| Hospital Charge Code |
51000153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$50.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.66
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$50.55
|
| Rate for Payer: Kentucky WC Medicaid |
$51.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
HOME HEALTH CARE SUPERVISION
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS G0181
|
| Hospital Charge Code |
51000153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.66
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
