|
ASPIRIN EC 325 MG T 325MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 57896092110
|
| Hospital Charge Code |
25000268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN EC TABLET 81 MG
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 46122061587
|
| Hospital Charge Code |
25000269
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN EC TABLET 81 MG
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 46122061587
|
| Hospital Charge Code |
25000269
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem Medicaid |
$168.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Humana KY Medicaid |
$168.85
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$170.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.21
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
ASPIR OR INJ GANGLION
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna Commercial |
$65.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.48
|
| Rate for Payer: Anthem Medicaid |
$28.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.00
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$92.71
|
| Rate for Payer: Healthspan PPO |
$76.98
|
| Rate for Payer: Humana Medicaid |
$28.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.48
|
| Rate for Payer: Molina Healthcare Passport |
$28.90
|
| Rate for Payer: Multiplan PHCS |
$294.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$343.70
|
| Rate for Payer: UHCCP Medicaid |
$33.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.19
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.21
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ASPIR OR INJ GANGLION(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761P0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$65.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.48
|
| Rate for Payer: Anthem Medicaid |
$28.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$92.71
|
| Rate for Payer: Healthspan PPO |
$76.98
|
| Rate for Payer: Humana Medicaid |
$28.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.48
|
| Rate for Payer: Molina Healthcare Passport |
$28.90
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$33.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.19
|
|
|
ASPIR OR INJ GANGLION(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761T0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ASPIR OR INJ GANGLION(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761T0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ASSAY OF GGT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$7.20
|
| Rate for Payer: Humana Medicare Advantage |
$7.20
|
| Rate for Payer: Kentucky WC Medicaid |
$7.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
ASSAY OF GGT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
ASSAY OF GLUCOSIDASE
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 82963
|
| Hospital Charge Code |
30001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$597.12 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem Medicaid |
$21.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.48
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Humana KY Medicaid |
$21.48
|
| Rate for Payer: Humana Medicare Advantage |
$21.48
|
| Rate for Payer: Kentucky WC Medicaid |
$21.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.82
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
ASSAY OF GLUCOSIDASE
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 82963
|
| Hospital Charge Code |
30001982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$597.12 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.47
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.82
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
ASSAY OF PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
30001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$7.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.31
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$7.31
|
| Rate for Payer: Humana Medicare Advantage |
$7.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
ASSAY OF PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
30001984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.80
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
ASSAY THYROID STIM HORMONE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$16.80
|
| Rate for Payer: Humana Medicare Advantage |
$16.80
|
| Rate for Payer: Kentucky WC Medicaid |
$16.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
ASSAY THYROID STIM HORMONE
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Aetna Commercial |
$36.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$14.86
|
| Rate for Payer: Healthspan PPO |
$17.60
|
| Rate for Payer: Multiplan PHCS |
$82.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.90
|
| Rate for Payer: UHCCP Medicaid |
$47.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.08
|
|
|
ASSAY THYROID STIM HORMONE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
ASSESSMENT OF APHASIA PER HOUR
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
44000016
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
ASSESSMENT OF APHASIA PER HOUR
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
44000016
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
ASTELIN NASAL SPRAY 137MCG
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 60505083305
|
| Hospital Charge Code |
25000270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.40
|
| Rate for Payer: First Health Commercial |
$0.46
|
| Rate for Payer: Humana Commercial |
$0.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.42
|
| Rate for Payer: Ohio Health Group HMO |
$0.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.15
|
| Rate for Payer: PHCS Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Payer |
$0.42
|
|
