|
PHOTOFIX BOVNE PERCRDM 0.8*8CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PHOXILLUM B22K4/0 SOLUTION
|
Facility
|
OP
|
$106.90
|
|
|
Service Code
|
NDC 24571011705
|
| Hospital Charge Code |
25003734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$82.31
|
| Rate for Payer: Anthem Medicaid |
$36.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.38
|
| Rate for Payer: Cash Price |
$53.45
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: First Health Commercial |
$101.56
|
| Rate for Payer: Humana Commercial |
$90.86
|
| Rate for Payer: Humana KY Medicaid |
$36.76
|
| Rate for Payer: Kentucky WC Medicaid |
$37.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.07
|
| Rate for Payer: Ohio Health Group HMO |
$80.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.76
|
| Rate for Payer: PHCS Commercial |
$102.62
|
| Rate for Payer: United Healthcare All Payer |
$94.07
|
|
|
PHOXILLUM B22K4/0 SOLUTION
|
Facility
|
IP
|
$106.90
|
|
|
Service Code
|
NDC 24571011705
|
| Hospital Charge Code |
25003734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$82.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.38
|
| Rate for Payer: Cash Price |
$53.45
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: First Health Commercial |
$101.56
|
| Rate for Payer: Humana Commercial |
$90.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.07
|
| Rate for Payer: Ohio Health Group HMO |
$80.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.76
|
| Rate for Payer: PHCS Commercial |
$102.62
|
| Rate for Payer: United Healthcare All Payer |
$94.07
|
|
|
PHOXILLUM BK 4/2.5 SOLUTION
|
Facility
|
IP
|
$106.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003355
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$82.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.38
|
| Rate for Payer: Cash Price |
$53.45
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: First Health Commercial |
$101.56
|
| Rate for Payer: Humana Commercial |
$90.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.07
|
| Rate for Payer: Ohio Health Group HMO |
$80.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.76
|
| Rate for Payer: PHCS Commercial |
$102.62
|
| Rate for Payer: United Healthcare All Payer |
$94.07
|
|
|
PHOXILLUM BK 4/2.5 SOLUTION
|
Facility
|
OP
|
$106.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003355
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$102.62 |
| Rate for Payer: Aetna Commercial |
$82.31
|
| Rate for Payer: Anthem Medicaid |
$36.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.38
|
| Rate for Payer: Cash Price |
$53.45
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: First Health Commercial |
$101.56
|
| Rate for Payer: Humana Commercial |
$90.86
|
| Rate for Payer: Humana KY Medicaid |
$36.76
|
| Rate for Payer: Kentucky WC Medicaid |
$37.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.07
|
| Rate for Payer: Ohio Health Group HMO |
$80.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.76
|
| Rate for Payer: PHCS Commercial |
$102.62
|
| Rate for Payer: United Healthcare All Payer |
$94.07
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Ambetter Exchange |
$141.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.14
|
| Rate for Payer: Anthem Medicaid |
$97.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.04
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$221.80
|
| Rate for Payer: Healthspan PPO |
$132.37
|
| Rate for Payer: Humana Medicaid |
$97.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.76
|
| Rate for Payer: Molina Healthcare Passport |
$97.80
|
| Rate for Payer: Multiplan PHCS |
$350.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.21
|
| Rate for Payer: UHCCP Medicaid |
$81.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.70
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem Medicaid |
$200.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Humana KY Medicaid |
$200.84
|
| Rate for Payer: Humana Medicare Advantage |
$148.46
|
| Rate for Payer: Kentucky WC Medicaid |
$202.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$402.96
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$402.96
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900P0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Ambetter Exchange |
$141.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.14
|
| Rate for Payer: Anthem Medicaid |
$97.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.04
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$221.80
|
| Rate for Payer: Healthspan PPO |
$132.37
|
| Rate for Payer: Humana Medicaid |
$97.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.76
|
| Rate for Payer: Molina Healthcare Passport |
$97.80
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.21
|
| Rate for Payer: UHCCP Medicaid |
$81.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.70
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(T
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900T0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$114.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$114.86
|
| Rate for Payer: Humana Medicare Advantage |
$148.46
|
| Rate for Payer: Kentucky WC Medicaid |
$116.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(T
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900T0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 94626
|
| Hospital Charge Code |
41000116
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem Medicaid |
$77.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Humana KY Medicaid |
$77.72
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$78.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 94626
|
| Hospital Charge Code |
41000116
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$73.53
|
| Rate for Payer: Ambetter Exchange |
$45.30
|
| Rate for Payer: Anthem Medicaid |
$39.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.36
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$31.67
|
| Rate for Payer: Healthspan PPO |
$37.35
|
| Rate for Payer: Humana Medicaid |
$39.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.73
|
| Rate for Payer: Molina Healthcare Passport |
$39.93
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.89
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.30
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$73.53
|
| Rate for Payer: Ambetter Exchange |
$45.00
|
| Rate for Payer: Anthem Medicaid |
$39.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$31.42
|
| Rate for Payer: Healthspan PPO |
$37.44
|
| Rate for Payer: Humana Medicaid |
$39.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.94
|
| Rate for Payer: Molina Healthcare Passport |
$39.16
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.50
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.00
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.81
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Humana KY Medicaid |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
PHYS REVIEW/INTERPRETATION
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Aetna Commercial |
$39.48
|
| Rate for Payer: Ambetter Exchange |
$22.79
|
| Rate for Payer: Anthem Medicaid |
$4.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.35
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$37.71
|
| Rate for Payer: Healthspan PPO |
$30.58
|
| Rate for Payer: Humana Medicaid |
$4.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.99
|
| Rate for Payer: Molina Healthcare Passport |
$4.89
|
| Rate for Payer: Multiplan PHCS |
$128.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.63
|
| Rate for Payer: UHCCP Medicaid |
$74.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.79
|
|
|
PHYS REVIEW/INTERPRETATION
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
PHYS REVIEW/INTERPRETATION
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$73.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$73.59
|
| Rate for Payer: Kentucky WC Medicaid |
$74.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
PHYS REVIEW/INTERPRETATION(P
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410P0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$39.48
|
| Rate for Payer: Ambetter Exchange |
$22.79
|
| Rate for Payer: Anthem Medicaid |
$4.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.35
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$37.71
|
| Rate for Payer: Healthspan PPO |
$30.58
|
| Rate for Payer: Humana Medicaid |
$4.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.99
|
| Rate for Payer: Molina Healthcare Passport |
$4.89
|
| Rate for Payer: Multiplan PHCS |
$31.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.63
|
| Rate for Payer: UHCCP Medicaid |
$18.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.79
|
|
|
PHYS REVIEW/INTERPRETATION(T
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410T0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
PHYS REVIEW/INTERPRETATION(T
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410T0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$55.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$55.37
|
| Rate for Payer: Kentucky WC Medicaid |
$55.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.09
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
