|
MICRODOSIMETRY
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Aetna Commercial |
$287.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$291.72
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$310.42
|
| Rate for Payer: First Health Commercial |
$355.30
|
| Rate for Payer: Humana Commercial |
$317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$306.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$329.12
|
| Rate for Payer: Ohio Health Group HMO |
$280.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.06
|
| Rate for Payer: PHCS Commercial |
$359.04
|
| Rate for Payer: United Healthcare All Payer |
$329.12
|
|
|
MICRODOSIMETRY
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Aetna Commercial |
$287.98
|
| Rate for Payer: Anthem Medicaid |
$128.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$291.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$310.42
|
| Rate for Payer: First Health Commercial |
$355.30
|
| Rate for Payer: Humana Commercial |
$317.90
|
| Rate for Payer: Humana KY Medicaid |
$128.62
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$129.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$306.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$329.12
|
| Rate for Payer: Ohio Health Group HMO |
$280.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.06
|
| Rate for Payer: PHCS Commercial |
$359.04
|
| Rate for Payer: United Healthcare All Payer |
$329.12
|
|
|
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 |
$97.31 |
| Rate for Payer: Aetna Commercial |
$97.31
|
| Rate for Payer: Ambetter Exchange |
$60.75
|
| Rate for Payer: Anthem Medicaid |
$51.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$60.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.75
|
| 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 |
$78.97
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.75
|
|
|
MICRODOSIMETRY(T
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
333T0013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$215.04 |
| Rate for Payer: Aetna Commercial |
$172.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.72
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$185.92
|
| Rate for Payer: First Health Commercial |
$212.80
|
| Rate for Payer: Humana Commercial |
$190.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$183.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.12
|
| Rate for Payer: Ohio Health Group HMO |
$168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.56
|
| Rate for Payer: PHCS Commercial |
$215.04
|
| Rate for Payer: United Healthcare All Payer |
$197.12
|
|
|
MICRODOSIMETRY(T
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
333T0013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$215.04 |
| Rate for Payer: Aetna Commercial |
$172.48
|
| Rate for Payer: Anthem Medicaid |
$77.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$185.92
|
| Rate for Payer: First Health Commercial |
$212.80
|
| Rate for Payer: Humana Commercial |
$190.40
|
| Rate for Payer: Humana KY Medicaid |
$77.03
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$77.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$183.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.12
|
| Rate for Payer: Ohio Health Group HMO |
$168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.56
|
| Rate for Payer: PHCS Commercial |
$215.04
|
| Rate for Payer: United Healthcare All Payer |
$197.12
|
|
|
MICRO MATRIX 500ML
|
Facility
|
IP
|
$8,383.75
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,515.12 |
| Max. Negotiated Rate |
$8,048.40 |
| Rate for Payer: Aetna Commercial |
$6,455.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.32
|
| Rate for Payer: Cash Price |
$4,191.88
|
| Rate for Payer: Cigna Commercial |
$6,958.51
|
| Rate for Payer: First Health Commercial |
$7,964.56
|
| Rate for Payer: Humana Commercial |
$7,126.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,874.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,377.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,287.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,707.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,293.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,784.79
|
| Rate for Payer: PHCS Commercial |
$8,048.40
|
| Rate for Payer: United Healthcare All Payer |
$7,377.70
|
|
|
MICRO MATRIX 500ML
|
Facility
|
OP
|
$8,383.75
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,515.12 |
| Max. Negotiated Rate |
$8,048.40 |
| Rate for Payer: Aetna Commercial |
$6,455.49
|
| Rate for Payer: Anthem Medicaid |
$2,883.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.32
|
| Rate for Payer: Cash Price |
$4,191.88
|
| Rate for Payer: Cigna Commercial |
$6,958.51
|
| Rate for Payer: First Health Commercial |
$7,964.56
|
| Rate for Payer: Humana Commercial |
$7,126.19
|
| Rate for Payer: Humana KY Medicaid |
$2,883.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,874.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,377.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,287.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,707.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,293.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,784.79
|
| Rate for Payer: PHCS Commercial |
$8,048.40
|
| Rate for Payer: United Healthcare All Payer |
$7,377.70
|
|
|
MICROPOLYSPORA FAENI IGG
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| 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 |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
MICROPOLYSPORA FAENI IGG
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
MICROPUNCTURE SETS
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$770.88 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: Anthem Medicaid |
$276.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$626.34
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cigna Commercial |
$666.49
|
| Rate for Payer: First Health Commercial |
$762.85
|
| Rate for Payer: Humana Commercial |
$682.55
|
| Rate for Payer: Humana KY Medicaid |
$276.15
|
| Rate for Payer: Kentucky WC Medicaid |
$278.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.64
|
| Rate for Payer: Ohio Health Group HMO |
$602.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.07
|
| Rate for Payer: PHCS Commercial |
$770.88
|
| Rate for Payer: United Healthcare All Payer |
$706.64
|
|
|
MICROPUNCTURE SETS
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.90 |
| Max. Negotiated Rate |
$770.88 |
| Rate for Payer: Aetna Commercial |
$618.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$626.34
|
| Rate for Payer: Cash Price |
$401.50
|
| Rate for Payer: Cigna Commercial |
$666.49
|
| Rate for Payer: First Health Commercial |
$762.85
|
| Rate for Payer: Humana Commercial |
$682.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.64
|
| Rate for Payer: Ohio Health Group HMO |
$602.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.07
|
| Rate for Payer: PHCS Commercial |
$770.88
|
| Rate for Payer: United Healthcare All Payer |
$706.64
|
|
|
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 |
$9.60 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Ambetter Exchange |
$3.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.66
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$3.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.05
|
| Rate for Payer: Multiplan PHCS |
$9.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.96
|
| Rate for Payer: UHCCP Medicaid |
$5.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.05
|
|
|
MICROSCOPIC EXAM OF URINE
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
30001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.80 |
| 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 |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.04
|
| Rate for Payer: PHCS Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Payer |
$14.08
|
|
|
MICROSCOPIC EXAM OF URINE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
30001570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.05 |
| 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 |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.04
|
| Rate for Payer: PHCS Commercial |
$15.36
|
| Rate for Payer: United Healthcare All Payer |
$14.08
|
|
|
MICROSLIDE CONSULTATION
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$124.43
|
| Rate for Payer: Ambetter Exchange |
$77.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.59
|
| 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: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.16
|
| Rate for Payer: Multiplan PHCS |
$178.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.31
|
| Rate for Payer: UHCCP Medicaid |
$103.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.16
|
|
|
MICROSLIDE CONSULTATION
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.10 |
| 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 |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.93
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
MICROSLIDE CONSULTATION
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 88321
|
| Hospital Charge Code |
30001516
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$228.69
|
| Rate for Payer: Anthem Medicaid |
$36.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.27
|
| 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 |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.27
|
| Rate for Payer: Kentucky WC Medicaid |
$36.63
|
| 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 |
$43.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.00
|
| 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 |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.93
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
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 |
$1,801.07 |
| 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 |
$1,801.07
|
| 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 |
$4,802.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,223.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.45
|
| 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 |
$390.00 |
| Rate for Payer: Aetna Commercial |
$341.21
|
| Rate for Payer: Ambetter Exchange |
$208.46
|
| Rate for Payer: Anthem Medicaid |
$162.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$208.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.46
|
| 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 |
$271.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.46
|
|
|
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 |
$1,801.07 |
| 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 |
$1,801.07
|
| 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 |
$4,802.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,223.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,142.45
|
| 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 |
$1,606.07 |
| 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 |
$1,606.07
|
| 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 |
$4,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,657.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.95
|
| Rate for Payer: PHCS Commercial |
$5,139.41
|
| Rate for Payer: United Healthcare All Payer |
$4,711.12
|
|
|
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 |
$3,602.13 |
| Rate for Payer: Aetna Commercial |
$341.21
|
| Rate for Payer: Ambetter Exchange |
$208.46
|
| Rate for Payer: Anthem Medicaid |
$162.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$208.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.46
|
| 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 |
$271.00
|
| Rate for Payer: UHCCP Medicaid |
$2,101.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.46
|
|
|
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 |
$1,606.07 |
| 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 |
$1,606.07
|
| 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 |
$4,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,657.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.95
|
| Rate for Payer: PHCS Commercial |
$5,139.41
|
| Rate for Payer: United Healthcare All Payer |
$4,711.12
|
|
|
MIDLINE CATHETER INSRT ED
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
45000235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
MIDLINE CATHETER INSRT ED
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
45000235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem Medicaid |
$105.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Humana KY Medicaid |
$105.23
|
| Rate for Payer: Kentucky WC Medicaid |
$106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
