|
SPECIAL PHYSICS
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$521.40 |
| Rate for Payer: Aetna Commercial |
$178.19
|
| Rate for Payer: Ambetter Exchange |
$133.24
|
| Rate for Payer: Anthem Medicaid |
$94.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.89
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$196.59
|
| Rate for Payer: Healthspan PPO |
$150.27
|
| Rate for Payer: Humana Medicaid |
$94.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Molina Healthcare Passport |
$94.42
|
| Rate for Payer: Multiplan PHCS |
$521.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.21
|
| Rate for Payer: UHCCP Medicaid |
$304.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.24
|
|
|
SPECIAL PHYSICS
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.70 |
| Max. Negotiated Rate |
$834.24 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$677.82
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
|
SPECIAL PHYSICS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333P0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$196.59 |
| Rate for Payer: Aetna Commercial |
$178.19
|
| Rate for Payer: Ambetter Exchange |
$133.24
|
| Rate for Payer: Anthem Medicaid |
$94.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.89
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$196.59
|
| Rate for Payer: Healthspan PPO |
$150.27
|
| Rate for Payer: Humana Medicaid |
$94.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Molina Healthcare Passport |
$94.42
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.21
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.24
|
|
|
SPECIAL PHYSICS(T
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333T0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$170.70 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.61
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
SPECIAL PHYSICS(T
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333T0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem Medicaid |
$195.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Humana KY Medicaid |
$195.68
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$197.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.61
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
SPECIAL PROCEDURE 3D
|
Professional
|
Both
|
$2,717.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$1,630.20 |
| Rate for Payer: Aetna Commercial |
$406.50
|
| Rate for Payer: Ambetter Exchange |
$135.90
|
| Rate for Payer: Anthem Medicaid |
$390.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.08
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cigna Commercial |
$666.26
|
| Rate for Payer: Healthspan PPO |
$342.81
|
| Rate for Payer: Humana Medicaid |
$390.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.37
|
| Rate for Payer: Molina Healthcare Passport |
$390.56
|
| Rate for Payer: Multiplan PHCS |
$1,630.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.67
|
| Rate for Payer: UHCCP Medicaid |
$950.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.90
|
|
|
SPECIAL PROCEDURE 3D
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$2,608.32 |
| Rate for Payer: Aetna Commercial |
$2,092.09
|
| Rate for Payer: Anthem Medicaid |
$934.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,119.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cigna Commercial |
$2,255.11
|
| Rate for Payer: First Health Commercial |
$2,581.15
|
| Rate for Payer: Humana Commercial |
$2,309.45
|
| Rate for Payer: Humana KY Medicaid |
$934.38
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$943.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,227.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,005.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$953.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,037.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,874.73
|
| Rate for Payer: PHCS Commercial |
$2,608.32
|
| Rate for Payer: United Healthcare All Payer |
$2,390.96
|
|
|
SPECIAL PROCEDURE 3D
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$815.10 |
| Max. Negotiated Rate |
$2,608.32 |
| Rate for Payer: Aetna Commercial |
$2,092.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,119.26
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cigna Commercial |
$2,255.11
|
| Rate for Payer: First Health Commercial |
$2,581.15
|
| Rate for Payer: Humana Commercial |
$2,309.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,227.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,005.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$815.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,390.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,037.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,874.73
|
| Rate for Payer: PHCS Commercial |
$2,608.32
|
| Rate for Payer: United Healthcare All Payer |
$2,390.96
|
|
|
SPECIAL PROCEDURE 3D(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333P0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$666.26 |
| Rate for Payer: Aetna Commercial |
$406.50
|
| Rate for Payer: Ambetter Exchange |
$135.90
|
| Rate for Payer: Anthem Medicaid |
$390.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.08
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$666.26
|
| Rate for Payer: Healthspan PPO |
$342.81
|
| Rate for Payer: Humana Medicaid |
$390.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.37
|
| Rate for Payer: Molina Healthcare Passport |
$390.56
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.67
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.90
|
|
|
SPECIAL PROCEDURE 3D(T
|
Facility
|
IP
|
$1,967.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333T0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$590.10 |
| Max. Negotiated Rate |
$1,888.32 |
| Rate for Payer: Aetna Commercial |
$1,514.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.26
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,632.61
|
| Rate for Payer: First Health Commercial |
$1,868.65
|
| Rate for Payer: Humana Commercial |
$1,671.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,711.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.23
|
| Rate for Payer: PHCS Commercial |
$1,888.32
|
| Rate for Payer: United Healthcare All Payer |
$1,730.96
|
|
|
SPECIAL PROCEDURE 3D(T
|
Facility
|
OP
|
$1,967.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333T0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$534.49 |
| Max. Negotiated Rate |
$1,888.32 |
| Rate for Payer: Aetna Commercial |
$1,514.59
|
| Rate for Payer: Anthem Medicaid |
$676.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$534.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$748.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$721.56
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cash Price |
$983.50
|
| Rate for Payer: Cigna Commercial |
$1,632.61
|
| Rate for Payer: First Health Commercial |
$1,868.65
|
| Rate for Payer: Humana Commercial |
$1,671.95
|
| Rate for Payer: Humana KY Medicaid |
$676.45
|
| Rate for Payer: Humana Medicare Advantage |
$534.49
|
| Rate for Payer: Kentucky WC Medicaid |
$683.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,711.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.23
|
| Rate for Payer: PHCS Commercial |
$1,888.32
|
| Rate for Payer: United Healthcare All Payer |
$1,730.96
|
|
|
SPECIAL STAINS GROUP 2
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$161.40 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Ambetter Exchange |
$73.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.91
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.26
|
| Rate for Payer: Multiplan PHCS |
$161.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.24
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.26
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.01
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
SPECIAL STAINS GROUP 2
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Ambetter Exchange |
$73.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.91
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.26
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.24
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.26
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SPECIAL STAINS GROUP 2 (P
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300P2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Ambetter Exchange |
$73.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.91
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.26
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.24
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.26
|
|
|
SPECIAL STAINS GROUP 2 (T
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300T2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.90
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.46
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
SPECIAL STAINS GROUP 2 (T
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300T2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Humana KY Medicaid |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.46
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
SPECI GRAVITY SEROUS/BAL FLUID
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
30000518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.28
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Humana KY Medicaid |
$3.28
|
| Rate for Payer: Humana Medicare Advantage |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.08
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
SPECI GRAVITY SEROUS/BAL FLUID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
30000518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.08
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
SPECIMEN COLLECT COVID-19
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
30001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
SPECIMEN COLLECT COVID-19
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
30001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
SPECIMEN COLLECTION
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$6.87
|
| Rate for Payer: Healthspan PPO |
$7.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Multiplan PHCS |
$28.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
|
