|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000020
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
THER/PROPH/DIAG IV INF INIT
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
26000020
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$125.18
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Kentucky WC Medicaid |
$126.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$837.23 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.28
|
| Rate for Payer: Anthem Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$90.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.38
|
| Rate for Payer: Molina Healthcare Passport |
$90.57
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$96.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.48
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
76102628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
THER SPI PNXR CSF FLUOR/CT
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 62329
|
| Hospital Charge Code |
761P2628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.28
|
| Rate for Payer: Anthem Medicaid |
$90.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$90.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.38
|
| Rate for Payer: Molina Healthcare Passport |
$90.57
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$96.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.48
|
|
|
TH FAMILY THERAPY
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90000028
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$161.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.71
|
| Rate for Payer: Anthem Medicaid |
$78.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.00
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$142.98
|
| Rate for Payer: Healthspan PPO |
$130.54
|
| Rate for Payer: Humana Medicaid |
$78.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.74
|
| Rate for Payer: Molina Healthcare Passport |
$78.18
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.10
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.96
|
|
|
THIAMINE 100 MG/1 ML 100MG/1ML
|
Facility
|
IP
|
$116.95
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
25002424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.25
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
THIAMINE 100 MG/1 ML 100MG/1ML
|
Facility
|
OP
|
$116.95
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
25002424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$112.27 |
| Rate for Payer: Aetna Commercial |
$90.05
|
| Rate for Payer: Anthem Medicaid |
$40.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.22
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cigna Commercial |
$97.07
|
| Rate for Payer: First Health Commercial |
$111.10
|
| Rate for Payer: Humana Commercial |
$99.41
|
| Rate for Payer: Humana KY Medicaid |
$40.22
|
| Rate for Payer: Kentucky WC Medicaid |
$40.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.92
|
| Rate for Payer: Ohio Health Group HMO |
$87.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.25
|
| Rate for Payer: PHCS Commercial |
$112.27
|
| Rate for Payer: United Healthcare All Payer |
$102.92
|
|
|
THIAMINE 100 MG TAB 100MG/1TAB
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 904719106
|
| Hospital Charge Code |
25001526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
THIAMINE 100 MG TAB 100MG/1TAB
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 904719106
|
| Hospital Charge Code |
25001526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
THIGH LIFT
|
Professional
|
Both
|
$1,505.00
|
|
| Hospital Charge Code |
22200058
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$1,505.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,505.00
|
| Rate for Payer: Cash Price |
$752.50
|
| Rate for Payer: Multiplan PHCS |
$903.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,053.50
|
| Rate for Payer: UHCCP Medicaid |
$526.75
|
|
|
THIGH LIFT -80
|
Professional
|
Both
|
$752.50
|
|
| Hospital Charge Code |
22200381
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$263.38 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$752.50
|
| Rate for Payer: Cash Price |
$376.25
|
| Rate for Payer: Multiplan PHCS |
$451.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$526.75
|
| Rate for Payer: UHCCP Medicaid |
$263.38
|
|
|
TH INIT PM E/M NEW PAT INFANT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$60.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$60.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.64
|
| Rate for Payer: Molina Healthcare Passport |
$60.43
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.03
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.05
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$24.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$23.48
|
| Rate for Payer: Healthspan PPO |
$38.00
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
|
|
THIN PREP PAP SMEAR - SCREEN
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
30001425
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$87.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.61
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Humana KY Medicaid |
$87.69
|
| Rate for Payer: Humana Medicare Advantage |
$26.61
|
| Rate for Payer: Kentucky WC Medicaid |
$88.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.05
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
THIN PREP PAP SMEAR-SCRN G0123
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
30001870
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
THIN PREP PAP SMEAR-SCRN G0123
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
30001870
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$20.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.26
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$20.26
|
| Rate for Payer: Humana Medicare Advantage |
$20.26
|
| Rate for Payer: Kentucky WC Medicaid |
$20.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
THIN/REG MODERATE WRINKLE
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200669
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
THIN/REG THICK MOD/SEV WRINKLE
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200670
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
THIOPURINE METABOLITES
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
THIOPURINE METABOLITES
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Healthspan PPO |
$11.09
|
| Rate for Payer: Multiplan PHCS |
$112.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.90
|
| Rate for Payer: UHCCP Medicaid |
$65.45
|
|
|
THIOPURINE METABOLITES
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
30001810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$64.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$64.31
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$64.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.97
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
TH NURSING FAC CARE SUBSEQ
|
Professional
|
Both
|
$202.63
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.63
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$121.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.84
|
| Rate for Payer: UHCCP Medicaid |
$70.92
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
|
