|
MICROSCOPIC EXAM OF URINE
|
Facility
|
OP
|
$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 Medicaid |
$3.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.05
|
| Rate for Payer: Cash Price |
$8.00
|
| 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: Humana KY Medicaid |
$3.05
|
| Rate for Payer: Humana Medicare Advantage |
$3.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3.08
|
| 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 |
$3.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.11
|
| 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
|
|
|
MICROSCOPIC EXAM OF URINE
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
30001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cigna Commercial |
$2.63
|
| Rate for Payer: Healthspan PPO |
$3.18
|
| Rate for Payer: Multiplan PHCS |
$9.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$5.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.83
|
|
|
MICROSLIDE CONSULTATION
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$228.69
|
| Rate for Payer: Anthem Medicaid |
$102.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$246.51
|
| Rate for Payer: First Health Commercial |
$282.15
|
| Rate for Payer: Humana Commercial |
$252.45
|
| Rate for Payer: Humana KY Medicaid |
$102.14
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$103.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$243.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$261.36
|
| Rate for Payer: Ohio Health Group HMO |
$222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.07
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
MICROSLIDE CONSULTATION
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$228.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.49
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$246.51
|
| Rate for Payer: First Health Commercial |
$282.15
|
| Rate for Payer: Humana Commercial |
$252.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$243.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$261.36
|
| Rate for Payer: Ohio Health Group HMO |
$222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.07
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
MICROSLIDE CONSULTATION
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna Commercial |
$124.43
|
| Rate for Payer: Anthem Medicaid |
$52.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$57.67
|
| Rate for Payer: Healthspan PPO |
$130.34
|
| Rate for Payer: Humana Medicaid |
$52.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.13
|
| Rate for Payer: Molina Healthcare Passport |
$52.09
|
| Rate for Payer: Multiplan PHCS |
$178.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.90
|
| Rate for Payer: UHCCP Medicaid |
$103.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.61
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Professional
|
Both
|
$6,003.55
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
76102438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$6,003.55 |
| Rate for Payer: Aetna Commercial |
$341.21
|
| Rate for Payer: Anthem Medicaid |
$162.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,003.55
|
| Rate for Payer: Cash Price |
$3,001.78
|
| Rate for Payer: Cash Price |
$3,001.78
|
| Rate for Payer: Cigna Commercial |
$334.65
|
| Rate for Payer: Healthspan PPO |
$302.67
|
| Rate for Payer: Humana Medicaid |
$162.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.16
|
| Rate for Payer: Molina Healthcare Passport |
$162.90
|
| Rate for Payer: Multiplan PHCS |
$3,602.13
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,202.48
|
| Rate for Payer: UHCCP Medicaid |
$2,101.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.53
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Facility
|
OP
|
$6,003.55
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
76102438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.46 |
| Max. Negotiated Rate |
$5,763.41 |
| Rate for Payer: Aetna Commercial |
$4,622.73
|
| Rate for Payer: Anthem Medicaid |
$2,064.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,682.77
|
| Rate for Payer: Cash Price |
$3,001.78
|
| Rate for Payer: Cigna Commercial |
$4,982.95
|
| Rate for Payer: First Health Commercial |
$5,703.37
|
| Rate for Payer: Humana Commercial |
$5,103.02
|
| Rate for Payer: Humana KY Medicaid |
$2,064.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,085.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,922.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,430.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,801.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,106.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,283.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,861.10
|
| Rate for Payer: PHCS Commercial |
$5,763.41
|
| Rate for Payer: United Healthcare All Payer |
$5,283.12
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Facility
|
OP
|
$5,353.55
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
761T2438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.96 |
| Max. Negotiated Rate |
$5,139.41 |
| Rate for Payer: Aetna Commercial |
$4,122.23
|
| Rate for Payer: Anthem Medicaid |
$1,841.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,175.77
|
| Rate for Payer: Cash Price |
$2,676.78
|
| Rate for Payer: Cigna Commercial |
$4,443.45
|
| Rate for Payer: First Health Commercial |
$5,085.87
|
| Rate for Payer: Humana Commercial |
$4,550.52
|
| Rate for Payer: Humana KY Medicaid |
$1,841.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,389.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,950.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,711.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,015.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.60
|
| Rate for Payer: PHCS Commercial |
$5,139.41
|
| Rate for Payer: United Healthcare All Payer |
$4,711.12
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Facility
|
IP
|
$6,003.55
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
76102438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.46 |
| Max. Negotiated Rate |
$5,763.41 |
| Rate for Payer: Aetna Commercial |
$4,622.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,682.77
|
| Rate for Payer: Cash Price |
$3,001.78
|
| Rate for Payer: Cigna Commercial |
$4,982.95
|
| Rate for Payer: First Health Commercial |
$5,703.37
|
| Rate for Payer: Humana Commercial |
$5,103.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,922.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,430.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,801.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,283.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,861.10
|
| Rate for Payer: PHCS Commercial |
$5,763.41
|
| Rate for Payer: United Healthcare All Payer |
$5,283.12
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
761P2438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$341.21
|
| Rate for Payer: Anthem Medicaid |
$162.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$334.65
|
| Rate for Payer: Healthspan PPO |
$302.67
|
| Rate for Payer: Humana Medicaid |
$162.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.16
|
| Rate for Payer: Molina Healthcare Passport |
$162.90
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.53
|
|
|
MICROSURG TECH W/OR MICROSCOPE
|
Facility
|
IP
|
$5,353.55
|
|
|
Service Code
|
HCPCS 69990
|
| Hospital Charge Code |
761T2438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.96 |
| Max. Negotiated Rate |
$5,139.41 |
| Rate for Payer: Aetna Commercial |
$4,122.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,175.77
|
| Rate for Payer: Cash Price |
$2,676.78
|
| Rate for Payer: Cigna Commercial |
$4,443.45
|
| Rate for Payer: First Health Commercial |
$5,085.87
|
| Rate for Payer: Humana Commercial |
$4,550.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,389.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,950.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,711.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,015.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.60
|
| Rate for Payer: PHCS Commercial |
$5,139.41
|
| Rate for Payer: United Healthcare All Payer |
$4,711.12
|
|
|
MIDLINE CATHETER INSRT ED
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
45000235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
MIDLINE CATHETER INSRT ED
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
45000235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.49
|
| Rate for Payer: Anthem Medicaid |
$7.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$508.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: Healthspan PPO |
$22.14
|
| Rate for Payer: Humana Medicaid |
$7.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.81
|
| Rate for Payer: Molina Healthcare Passport |
$7.66
|
| Rate for Payer: Multiplan PHCS |
$304.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$355.60
|
| Rate for Payer: UHCCP Medicaid |
$7.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.74
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761P2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.49
|
| Rate for Payer: Anthem Medicaid |
$7.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: Healthspan PPO |
$22.14
|
| Rate for Payer: Humana Medicaid |
$7.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.81
|
| Rate for Payer: Molina Healthcare Passport |
$7.66
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$7.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.74
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761T2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Humana KY Medicaid |
$174.70
|
| Rate for Payer: Kentucky WC Medicaid |
$176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.48
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761T2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
MIKAELSSON CATH
|
Facility
|
OP
|
$436.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Humana KY Medicaid |
$150.11
|
| Rate for Payer: Kentucky WC Medicaid |
$151.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
MIKAELSSON CATH
|
Facility
|
IP
|
$436.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$419.04 |
| Rate for Payer: Aetna Commercial |
$336.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$340.47
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cigna Commercial |
$362.30
|
| Rate for Payer: First Health Commercial |
$414.68
|
| Rate for Payer: Humana Commercial |
$371.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$357.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.12
|
| Rate for Payer: Ohio Health Group HMO |
$327.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.32
|
| Rate for Payer: PHCS Commercial |
$419.04
|
| Rate for Payer: United Healthcare All Payer |
$384.12
|
|
|
MILK OF MAGNESIA SUSP(MG 30ML
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 57896064916
|
| Hospital Charge Code |
25000985
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
MILK OF MAGNESIA SUSP(MG 30ML
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 57896064916
|
| Hospital Charge Code |
25000985
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
MINERAL OIL 2 ML VIAL
|
Facility
|
IP
|
$34.29
|
|
|
Service Code
|
NDC 63323025402
|
| Hospital Charge Code |
25004119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.75
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna Commercial |
$28.46
|
| Rate for Payer: First Health Commercial |
$32.58
|
| Rate for Payer: Humana Commercial |
$29.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.18
|
| Rate for Payer: Ohio Health Group HMO |
$25.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.63
|
| Rate for Payer: PHCS Commercial |
$32.92
|
| Rate for Payer: United Healthcare All Payer |
$30.18
|
|
|
MINERAL OIL 2 ML VIAL
|
Facility
|
OP
|
$34.29
|
|
|
Service Code
|
NDC 63323025402
|
| Hospital Charge Code |
25004119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$32.92 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Anthem Medicaid |
$11.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.75
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna Commercial |
$28.46
|
| Rate for Payer: First Health Commercial |
$32.58
|
| Rate for Payer: Humana Commercial |
$29.15
|
| Rate for Payer: Humana KY Medicaid |
$11.79
|
| Rate for Payer: Kentucky WC Medicaid |
$11.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.18
|
| Rate for Payer: Ohio Health Group HMO |
$25.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.63
|
| Rate for Payer: PHCS Commercial |
$32.92
|
| Rate for Payer: United Healthcare All Payer |
$30.18
|
|
