|
ASPIR OR INJ GANGLION
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ASPIR OR INJ GANGLION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$310.20 |
| Rate for Payer: Aetna Commercial |
$65.73
|
| Rate for Payer: Ambetter Exchange |
$38.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.48
|
| Rate for Payer: Anthem Medicaid |
$41.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.74
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$92.71
|
| Rate for Payer: Healthspan PPO |
$76.98
|
| Rate for Payer: Humana Medicaid |
$41.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.32
|
| Rate for Payer: Molina Healthcare Passport |
$41.49
|
| Rate for Payer: Multiplan PHCS |
$310.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.63
|
| Rate for Payer: UHCCP Medicaid |
$33.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.95
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$496.32 |
| Rate for Payer: Aetna Commercial |
$398.09
|
| Rate for Payer: Anthem Medicaid |
$177.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$429.11
|
| Rate for Payer: First Health Commercial |
$491.15
|
| Rate for Payer: Humana Commercial |
$439.45
|
| Rate for Payer: Humana KY Medicaid |
$177.80
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$179.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
| Rate for Payer: Ohio Health Group HMO |
$387.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.73
|
| Rate for Payer: PHCS Commercial |
$496.32
|
| Rate for Payer: United Healthcare All Payer |
$454.96
|
|
|
ASPIR OR INJ GANGLION(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761P0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$92.71 |
| Rate for Payer: Aetna Commercial |
$65.73
|
| Rate for Payer: Ambetter Exchange |
$38.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.48
|
| Rate for Payer: Anthem Medicaid |
$41.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.74
|
| 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 |
$41.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.32
|
| Rate for Payer: Molina Healthcare Passport |
$41.49
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.63
|
| Rate for Payer: UHCCP Medicaid |
$33.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.95
|
|
|
ASPIR OR INJ GANGLION(T
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761T0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ASPIR OR INJ GANGLION(T
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
761T0347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ASSAY OF GGT
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.20
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| 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 |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ASSAY OF GGT
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
30000351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
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 |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| 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 |
$186.60 |
| 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 |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| 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 |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| 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 |
$20.10 |
| 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 |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
ASSAY OF PYRUVATE
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
30002075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
ASSAY OF PYRUVATE
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 84210
|
| Hospital Charge Code |
30002075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$14.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.48
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$14.48
|
| Rate for Payer: Humana Medicare Advantage |
$14.48
|
| Rate for Payer: Kentucky WC Medicaid |
$14.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30001888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| 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 |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ASSAY THYROID STIM HORMONE
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$36.77
|
| Rate for Payer: Ambetter Exchange |
$16.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.16
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$14.86
|
| Rate for Payer: Healthspan PPO |
$17.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.84
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.80
|
|
|
ASSAY THYROID STIM HORMONE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
ASSAY THYROID STIM HORMONE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
30000530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| 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 |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
ASSESSMENT OF APHASIA PER HOUR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
44000016
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
ASSESSMENT OF APHASIA PER HOUR
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
44000016
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$43.33
|
| Rate for Payer: Kentucky WC Medicaid |
$43.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
ASSMT & CARE PLN PT COG IMP
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
51000373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
ASSMT & CARE PLN PT COG IMP
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
51000373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
ASSMT & CARE PLN PT COG IMP
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
51000373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Ambetter Exchange |
$181.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.33
|
| Rate for Payer: Anthem Medicaid |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.87
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$383.23
|
| Rate for Payer: Humana Medicaid |
$184.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$188.38
|
| Rate for Payer: Molina Healthcare Passport |
$184.69
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.03
|
| Rate for Payer: UHCCP Medicaid |
$154.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.56
|
|
|
ASSMT & CARE PLN PT COG IMP (P
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
510P0373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Ambetter Exchange |
$181.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.33
|
| Rate for Payer: Anthem Medicaid |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.87
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$383.23
|
| Rate for Payer: Humana Medicaid |
$184.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$188.38
|
| Rate for Payer: Molina Healthcare Passport |
$184.69
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.03
|
| Rate for Payer: UHCCP Medicaid |
$154.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$186.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.56
|
|
