|
MIC J-TUBE 18FR 2.3*30CM KIT
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS B4088
|
| Hospital Charge Code |
27000187
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MICONAZOLE 2% OINTMENT 71gm
|
Facility
|
OP
|
$5.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Anthem Medicaid |
$1.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.24
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna Commercial |
$4.51
|
| Rate for Payer: First Health Commercial |
$5.16
|
| Rate for Payer: Humana Commercial |
$4.62
|
| Rate for Payer: Humana KY Medicaid |
$1.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.78
|
| Rate for Payer: Ohio Health Group HMO |
$4.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.68
|
| Rate for Payer: PHCS Commercial |
$5.21
|
| Rate for Payer: United Healthcare All Payer |
$4.78
|
|
|
MICONAZOLE 2% OINTMENT 71gm
|
Facility
|
IP
|
$5.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004440
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.24
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna Commercial |
$4.51
|
| Rate for Payer: First Health Commercial |
$5.16
|
| Rate for Payer: Humana Commercial |
$4.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.78
|
| Rate for Payer: Ohio Health Group HMO |
$4.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.68
|
| Rate for Payer: PHCS Commercial |
$5.21
|
| Rate for Payer: United Healthcare All Payer |
$4.78
|
|
|
MICONAZOLE 2% POWDER 85gm
|
Facility
|
IP
|
$5.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.34
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.28
|
| Rate for Payer: Humana Commercial |
$4.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.89
|
| Rate for Payer: Ohio Health Group HMO |
$4.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.34
|
| Rate for Payer: United Healthcare All Payer |
$4.89
|
|
|
MICONAZOLE 2% POWDER 85gm
|
Facility
|
OP
|
$5.56
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Anthem Medicaid |
$1.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.34
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.28
|
| Rate for Payer: Humana Commercial |
$4.73
|
| Rate for Payer: Humana KY Medicaid |
$1.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.89
|
| Rate for Payer: Ohio Health Group HMO |
$4.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.34
|
| Rate for Payer: United Healthcare All Payer |
$4.89
|
| Rate for Payer: Aetna Commercial |
$4.28
|
|
|
MICRA TRANSCATHETER PACING SYS
|
Facility
|
OP
|
$68,200.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,866.00 |
| Max. Negotiated Rate |
$65,472.00 |
| Rate for Payer: Aetna Commercial |
$52,514.00
|
| Rate for Payer: Anthem Medicaid |
$23,453.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,196.00
|
| Rate for Payer: Cash Price |
$34,100.00
|
| Rate for Payer: Cigna Commercial |
$56,606.00
|
| Rate for Payer: First Health Commercial |
$64,790.00
|
| Rate for Payer: Humana Commercial |
$57,970.00
|
| Rate for Payer: Humana KY Medicaid |
$23,453.98
|
| Rate for Payer: Kentucky WC Medicaid |
$23,692.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,924.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,331.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,460.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,924.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$51,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,866.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,142.00
|
| Rate for Payer: PHCS Commercial |
$65,472.00
|
| Rate for Payer: United Healthcare All Payer |
$60,016.00
|
|
|
MICRA TRANSCATHETER PACING SYS
|
Facility
|
IP
|
$68,200.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,866.00 |
| Max. Negotiated Rate |
$65,472.00 |
| Rate for Payer: Aetna Commercial |
$52,514.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,196.00
|
| Rate for Payer: Cash Price |
$34,100.00
|
| Rate for Payer: Cigna Commercial |
$56,606.00
|
| Rate for Payer: First Health Commercial |
$64,790.00
|
| Rate for Payer: Humana Commercial |
$57,970.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,924.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,331.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,460.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$51,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,866.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,142.00
|
| Rate for Payer: PHCS Commercial |
$65,472.00
|
| Rate for Payer: United Healthcare All Payer |
$60,016.00
|
|
|
MICROALBUMIN RANDOM QT.
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$4.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$5.04
|
| Rate for Payer: Healthspan PPO |
$6.07
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.47
|
|
|
MICROALBUMIN RANDOM QT.
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
MICROALBUMIN RANDOM QT.
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
30000227
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$5.78
|
| Rate for Payer: Humana Medicare Advantage |
$5.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
MICRO ASSMBLY LENGTHER HOFFMAN
|
Facility
|
OP
|
$18,542.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.58 |
| Max. Negotiated Rate |
$17,801.18 |
| Rate for Payer: Aetna Commercial |
$14,278.03
|
| Rate for Payer: Anthem Medicaid |
$6,376.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,463.46
|
| Rate for Payer: Cash Price |
$9,271.45
|
| Rate for Payer: Cigna Commercial |
$15,390.61
|
| Rate for Payer: First Health Commercial |
$17,615.76
|
| Rate for Payer: Humana Commercial |
$15,761.46
|
| Rate for Payer: Humana KY Medicaid |
$6,376.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,441.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,684.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,562.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,504.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,317.75
|
| Rate for Payer: Ohio Health Group HMO |
$13,907.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,708.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,410.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,748.30
|
| Rate for Payer: PHCS Commercial |
$17,801.18
|
| Rate for Payer: United Healthcare All Payer |
$16,317.75
|
|
|
MICRO ASSMBLY LENGTHER HOFFMAN
|
Facility
|
IP
|
$18,542.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.58 |
| Max. Negotiated Rate |
$17,801.18 |
| Rate for Payer: Aetna Commercial |
$14,278.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,463.46
|
| Rate for Payer: Cash Price |
$9,271.45
|
| Rate for Payer: Cigna Commercial |
$15,390.61
|
| Rate for Payer: First Health Commercial |
$17,615.76
|
| Rate for Payer: Humana Commercial |
$15,761.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,684.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,562.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,317.75
|
| Rate for Payer: Ohio Health Group HMO |
$13,907.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,708.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,410.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,748.30
|
| Rate for Payer: PHCS Commercial |
$17,801.18
|
| Rate for Payer: United Healthcare All Payer |
$16,317.75
|
|
|
MICRODOSIMETRY
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$51.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$366.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$93.02
|
| Rate for Payer: Healthspan PPO |
$82.07
|
| Rate for Payer: Humana Medicaid |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.07
|
| Rate for Payer: Molina Healthcare Passport |
$51.05
|
| Rate for Payer: Multiplan PHCS |
$219.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.20
|
| Rate for Payer: UHCCP Medicaid |
$128.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.56
|
|
|
MICRODOSIMETRY
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$351.36 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Anthem Medicaid |
$125.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$303.78
|
| Rate for Payer: First Health Commercial |
$347.70
|
| Rate for Payer: Humana Commercial |
$311.10
|
| Rate for Payer: Humana KY Medicaid |
$125.87
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$127.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.08
|
| Rate for Payer: Ohio Health Group HMO |
$274.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.46
|
| Rate for Payer: PHCS Commercial |
$351.36
|
| Rate for Payer: United Healthcare All Payer |
$322.08
|
|
|
MICRODOSIMETRY
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$351.36 |
| Rate for Payer: Aetna Commercial |
$281.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$285.48
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$303.78
|
| Rate for Payer: First Health Commercial |
$347.70
|
| Rate for Payer: Humana Commercial |
$311.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.08
|
| Rate for Payer: Ohio Health Group HMO |
$274.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.46
|
| Rate for Payer: PHCS Commercial |
$351.36
|
| Rate for Payer: United Healthcare All Payer |
$322.08
|
|
|
MICRODOSIMETRY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
333P0013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: Anthem Medicaid |
$51.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$93.02
|
| Rate for Payer: Healthspan PPO |
$82.07
|
| Rate for Payer: Humana Medicaid |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.07
|
| Rate for Payer: Molina Healthcare Passport |
$51.05
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.56
|
|
|
MICRODOSIMETRY(T
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
333T0013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.48
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
MICRODOSIMETRY(T
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
333T0013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$74.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$74.28
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$75.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
MICRO MATRIX 500ML
|
Facility
|
IP
|
$8,183.75
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,063.89 |
| Max. Negotiated Rate |
$7,856.40 |
| Rate for Payer: Aetna Commercial |
$6,301.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.32
|
| Rate for Payer: Cash Price |
$4,091.88
|
| Rate for Payer: Cigna Commercial |
$6,792.51
|
| Rate for Payer: First Health Commercial |
$7,774.56
|
| Rate for Payer: Humana Commercial |
$6,956.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,063.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.96
|
| Rate for Payer: PHCS Commercial |
$7,856.40
|
| Rate for Payer: United Healthcare All Payer |
$7,201.70
|
|
|
MICRO MATRIX 500ML
|
Facility
|
OP
|
$8,183.75
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,063.89 |
| Max. Negotiated Rate |
$7,856.40 |
| Rate for Payer: Aetna Commercial |
$6,301.49
|
| Rate for Payer: Anthem Medicaid |
$2,814.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,383.32
|
| Rate for Payer: Cash Price |
$4,091.88
|
| Rate for Payer: Cigna Commercial |
$6,792.51
|
| Rate for Payer: First Health Commercial |
$7,774.56
|
| Rate for Payer: Humana Commercial |
$6,956.19
|
| Rate for Payer: Humana KY Medicaid |
$2,814.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,710.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,039.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,870.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,201.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,137.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,063.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.96
|
| Rate for Payer: PHCS Commercial |
$7,856.40
|
| Rate for Payer: United Healthcare All Payer |
$7,201.70
|
|
|
MICROPOLYSPORA FAENI IGG
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
MICROPOLYSPORA FAENI IGG
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
MICROPUNCTURE SETS
|
Facility
|
IP
|
$782.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$751.39 |
| Rate for Payer: Aetna Commercial |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.51
|
| Rate for Payer: Cash Price |
$391.35
|
| Rate for Payer: Cigna Commercial |
$649.64
|
| Rate for Payer: First Health Commercial |
$743.56
|
| Rate for Payer: Humana Commercial |
$665.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$641.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$688.78
|
| Rate for Payer: Ohio Health Group HMO |
$587.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.64
|
| Rate for Payer: PHCS Commercial |
$751.39
|
| Rate for Payer: United Healthcare All Payer |
$688.78
|
|
|
MICROPUNCTURE SETS
|
Facility
|
OP
|
$782.70
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$751.39 |
| Rate for Payer: Aetna Commercial |
$602.68
|
| Rate for Payer: Anthem Medicaid |
$269.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.51
|
| Rate for Payer: Cash Price |
$391.35
|
| Rate for Payer: Cigna Commercial |
$649.64
|
| Rate for Payer: First Health Commercial |
$743.56
|
| Rate for Payer: Humana Commercial |
$665.30
|
| Rate for Payer: Humana KY Medicaid |
$269.17
|
| Rate for Payer: Kentucky WC Medicaid |
$271.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$641.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$688.78
|
| Rate for Payer: Ohio Health Group HMO |
$587.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.64
|
| Rate for Payer: PHCS Commercial |
$751.39
|
| Rate for Payer: United Healthcare All Payer |
$688.78
|
|
|
MICROSCOPIC EXAM OF URINE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
30001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.85
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cigna Commercial |
$13.28
|
| Rate for Payer: First Health Commercial |
$15.20
|
| Rate for Payer: Humana Commercial |
$13.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.08
|
| Rate for Payer: Ohio Health Group HMO |
$12.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.96
|
| Rate for Payer: PHCS Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Payer |
$14.08
|
|
