|
BLOOD GASES
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
30000334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.39
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
BLOOD PATCH
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.67 |
| Max. Negotiated Rate |
$1,400.64 |
| Rate for Payer: Aetna Commercial |
$1,123.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.02
|
| Rate for Payer: Cash Price |
$729.50
|
| Rate for Payer: Cigna Commercial |
$1,210.97
|
| Rate for Payer: First Health Commercial |
$1,386.05
|
| Rate for Payer: Humana Commercial |
$1,240.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,196.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,076.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$437.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,283.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,094.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.29
|
| Rate for Payer: PHCS Commercial |
$1,400.64
|
| Rate for Payer: United Healthcare All Payer |
$1,283.92
|
|
|
BLOOD PATCH
|
Professional
|
Both
|
$1,459.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$1,459.00 |
| Rate for Payer: Aetna Commercial |
$180.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.28
|
| Rate for Payer: Anthem Medicaid |
$99.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,459.00
|
| Rate for Payer: Cash Price |
$729.50
|
| Rate for Payer: Cash Price |
$729.50
|
| Rate for Payer: Cigna Commercial |
$165.72
|
| Rate for Payer: Healthspan PPO |
$200.95
|
| Rate for Payer: Humana Medicaid |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.44
|
| Rate for Payer: Molina Healthcare Passport |
$99.45
|
| Rate for Payer: Multiplan PHCS |
$875.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,021.30
|
| Rate for Payer: UHCCP Medicaid |
$60.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.44
|
|
|
BLOOD PATCH
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.67 |
| Max. Negotiated Rate |
$1,400.64 |
| Rate for Payer: Aetna Commercial |
$1,123.43
|
| Rate for Payer: Anthem Medicaid |
$501.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$729.50
|
| Rate for Payer: Cash Price |
$729.50
|
| Rate for Payer: Cigna Commercial |
$1,210.97
|
| Rate for Payer: First Health Commercial |
$1,386.05
|
| Rate for Payer: Humana Commercial |
$1,240.15
|
| Rate for Payer: Humana KY Medicaid |
$501.75
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$506.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,196.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,076.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$511.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,283.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,094.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$291.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.29
|
| Rate for Payer: PHCS Commercial |
$1,400.64
|
| Rate for Payer: United Healthcare All Payer |
$1,283.92
|
|
|
BLOOD PATCH
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
45000294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Humana KY Medicaid |
$312.61
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$315.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
BLOOD PATCH
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
45000294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
BLOOD PATCH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761P2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$180.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.28
|
| Rate for Payer: Anthem Medicaid |
$99.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$165.72
|
| Rate for Payer: Healthspan PPO |
$200.95
|
| Rate for Payer: Humana Medicaid |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.44
|
| Rate for Payer: Molina Healthcare Passport |
$99.45
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$60.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.44
|
|
|
BLOOD PATCH(T
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761T2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Humana KY Medicaid |
$312.61
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$315.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
BLOOD PATCH(T
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761T2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
BLOOD SMEAR INTERPRETATION
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$18.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$18.61
|
| Rate for Payer: Kentucky WC Medicaid |
$18.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
BLOOD SMEAR INTERPRETATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$35.43
|
| Rate for Payer: Anthem Medicaid |
$18.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Healthspan PPO |
$31.53
|
| Rate for Payer: Humana Medicaid |
$18.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.98
|
| Rate for Payer: Molina Healthcare Passport |
$18.61
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.17
|
|
|
BLOOD SMEAR INTERPRETATION
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
BLOOD TYPING ABO
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
30001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$2.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.99
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$2.99
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
BLOOD TYPING ABO
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
30001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
BLOOD TYPING RBC ANTIGENS
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
30001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
BLOOD TYPING RBC ANTIGENS
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
30001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$435.16 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$3.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$3.83
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
BLOOD TYPING RH (D)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
30001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$2.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.99
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$2.99
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
BLOOD TYPING RH (D)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
30001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
BML 4 Q COIL SHEATH
|
Facility
|
IP
|
$3,257.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.41 |
| Max. Negotiated Rate |
$3,126.72 |
| Rate for Payer: Aetna Commercial |
$2,507.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,540.46
|
| Rate for Payer: Cash Price |
$1,628.50
|
| Rate for Payer: Cigna Commercial |
$2,703.31
|
| Rate for Payer: First Health Commercial |
$3,094.15
|
| Rate for Payer: Humana Commercial |
$2,768.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,670.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,403.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$977.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,866.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,442.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$651.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,009.67
|
| Rate for Payer: PHCS Commercial |
$3,126.72
|
| Rate for Payer: United Healthcare All Payer |
$2,866.16
|
|
|
BML 4 Q COIL SHEATH
|
Facility
|
OP
|
$3,257.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.41 |
| Max. Negotiated Rate |
$3,126.72 |
| Rate for Payer: Aetna Commercial |
$2,507.89
|
| Rate for Payer: Anthem Medicaid |
$1,120.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,540.46
|
| Rate for Payer: Cash Price |
$1,628.50
|
| Rate for Payer: Cigna Commercial |
$2,703.31
|
| Rate for Payer: First Health Commercial |
$3,094.15
|
| Rate for Payer: Humana Commercial |
$2,768.45
|
| Rate for Payer: Humana KY Medicaid |
$1,120.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,131.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,670.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,403.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$977.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,142.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,866.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,442.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$651.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,009.67
|
| Rate for Payer: PHCS Commercial |
$3,126.72
|
| Rate for Payer: United Healthcare All Payer |
$2,866.16
|
|
|
BML 4 Q TEFLON SHEATH
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
BML 4 Q TEFLON SHEATH
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
BMW2 190CM STRAIGHT
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
BMW2 190CM STRAIGHT
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
BODY COMPOSITION SCAN
|
Professional
|
Both
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$103.00
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Multiplan PHCS |
$61.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$36.05
|
|
