|
BABYGRAM(P
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
320P0182
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$42.59 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Ambetter Exchange |
$26.53
|
| Rate for Payer: Anthem Medicaid |
$21.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.84
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$42.59
|
| Rate for Payer: Healthspan PPO |
$39.83
|
| Rate for Payer: Humana Medicaid |
$21.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.25
|
| Rate for Payer: Molina Healthcare Passport |
$21.81
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.49
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.53
|
|
|
BABYGRAM(T
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
320T0182
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem Medicaid |
$119.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Humana KY Medicaid |
$119.33
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$120.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
BABYGRAM(T
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
320T0182
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
BACITRACIN EYE OINT (3.5GM)
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 574402235
|
| Hospital Charge Code |
25000304
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$16.84 |
| Rate for Payer: Aetna Commercial |
$13.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.68
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna Commercial |
$14.56
|
| Rate for Payer: First Health Commercial |
$16.66
|
| Rate for Payer: Humana Commercial |
$14.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.44
|
| Rate for Payer: Ohio Health Group HMO |
$13.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.10
|
| Rate for Payer: PHCS Commercial |
$16.84
|
| Rate for Payer: United Healthcare All Payer |
$15.44
|
|
|
BACITRACIN EYE OINT (3.5GM)
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 574402235
|
| Hospital Charge Code |
25000304
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$16.84 |
| Rate for Payer: Aetna Commercial |
$13.51
|
| Rate for Payer: Anthem Medicaid |
$6.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.68
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna Commercial |
$14.56
|
| Rate for Payer: First Health Commercial |
$16.66
|
| Rate for Payer: Humana Commercial |
$14.91
|
| Rate for Payer: Humana KY Medicaid |
$6.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.44
|
| Rate for Payer: Ohio Health Group HMO |
$13.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.10
|
| Rate for Payer: PHCS Commercial |
$16.84
|
| Rate for Payer: United Healthcare All Payer |
$15.44
|
|
|
BACITRACIN OINTMENT 1OZ
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 68001047747
|
| Hospital Charge Code |
25000305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
BACITRACIN OINTMENT 1OZ
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 68001047747
|
| Hospital Charge Code |
25000305
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
BACITRACIN OINTMENT PKT. .9GM
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 69968006009
|
| Hospital Charge Code |
25002870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
BACITRACIN OINTMENT PKT. .9GM
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 69968006009
|
| Hospital Charge Code |
25002870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
Back Full Laser Hair Removal
|
Professional
|
Both
|
$475.00
|
|
| Hospital Charge Code |
22200183
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
|
|
Back Full Lsr HairRem-PP#1 50%
|
Professional
|
Both
|
$607.00
|
|
| Hospital Charge Code |
22200347
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$212.45 |
| Max. Negotiated Rate |
$424.90 |
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Multiplan PHCS |
$364.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.90
|
| Rate for Payer: UHCCP Medicaid |
$212.45
|
|
|
Back FulLsr HairRem-PP#2/3 25%
|
Professional
|
Both
|
$302.00
|
|
| Hospital Charge Code |
22200463
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Multiplan PHCS |
$181.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$211.40
|
| Rate for Payer: UHCCP Medicaid |
$105.70
|
|
|
Back Laser Hair Removal
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200212
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Back Lsr Hair Rem-PP #1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200213
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
Back Lsr Hair Rem-PP #2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200472
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
Back partial Laser Hair Remova
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
22200182
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
Back partial Laser Hair Remova
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
22200182
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
Back partial Laser Hair Remova
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200182
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Back partl LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200346
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
Back prtlLsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200462
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
30001261
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
BACTERIAL IDENTIFICATION
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
30001261
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$8.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$8.08
|
| Rate for Payer: Humana Medicare Advantage |
$8.08
|
| Rate for Payer: Kentucky WC Medicaid |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
BACTERIAL IDENTIFICATION
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
30001261
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Ambetter Exchange |
$8.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.70
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$7.19
|
| Rate for Payer: Healthspan PPO |
$8.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.08
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.08
|
|
|
BACTERIAL VAGINOSIS
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 81513
|
| Hospital Charge Code |
30002088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
BACTERIAL VAGINOSIS
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 81513
|
| Hospital Charge Code |
30002088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$142.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$142.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$199.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.63
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$142.63
|
| Rate for Payer: Humana Medicare Advantage |
$142.63
|
| Rate for Payer: Kentucky WC Medicaid |
$144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
