|
STREP PYOGENES HSP60 GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREPTOCOCCUS GRP A
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
30001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
STREPTOCOCCUS GRP A
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
30001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$16.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$16.53
|
| Rate for Payer: Humana Medicare Advantage |
$16.53
|
| Rate for Payer: Kentucky WC Medicaid |
$16.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
STREPTOCOCCUS GRP A
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
30001577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Ambetter Exchange |
$16.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.84
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.53
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.49
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.53
|
|
|
STREPTOCOCCUS TUF GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREPTOCOCCUS TUF GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREPTOCO PNEUMO URINE ANTIGEN
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001361
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem Medicaid |
$16.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Humana KY Medicaid |
$16.07
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Kentucky WC Medicaid |
$16.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.77
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
STREPTOCO PNEUMO URINE ANTIGEN
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
30001361
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$127.68 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.80
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cigna Commercial |
$110.39
|
| Rate for Payer: First Health Commercial |
$126.35
|
| Rate for Payer: Humana Commercial |
$113.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.04
|
| Rate for Payer: Ohio Health Group HMO |
$99.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.77
|
| Rate for Payer: PHCS Commercial |
$127.68
|
| Rate for Payer: United Healthcare All Payer |
$117.04
|
|
|
STREPTOMYCIN SULFATE 1GM/2.5ML
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
25002373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$264.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.32
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$285.52
|
| Rate for Payer: First Health Commercial |
$326.80
|
| Rate for Payer: Humana Commercial |
$292.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$302.72
|
| Rate for Payer: Ohio Health Group HMO |
$258.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$275.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.36
|
| Rate for Payer: PHCS Commercial |
$330.24
|
| Rate for Payer: United Healthcare All Payer |
$302.72
|
|
|
STREPTOMYCIN SULFATE 1GM/2.5ML
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
25002373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$330.24 |
| Rate for Payer: Aetna Commercial |
$264.88
|
| Rate for Payer: Anthem Medicaid |
$118.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$268.32
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cigna Commercial |
$285.52
|
| Rate for Payer: First Health Commercial |
$326.80
|
| Rate for Payer: Humana Commercial |
$292.40
|
| Rate for Payer: Humana KY Medicaid |
$118.30
|
| Rate for Payer: Kentucky WC Medicaid |
$119.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$302.72
|
| Rate for Payer: Ohio Health Group HMO |
$258.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$275.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.36
|
| Rate for Payer: PHCS Commercial |
$330.24
|
| Rate for Payer: United Healthcare All Payer |
$302.72
|
|
|
STRESS TEST
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$379.80 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem Medicaid |
$435.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Humana KY Medicaid |
$435.38
|
| Rate for Payer: Kentucky WC Medicaid |
$439.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$444.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.54
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
STRESS TEST
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$379.80 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,101.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.54
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
STRESS TEST
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Aetna Commercial |
$26.80
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$19.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$24.12
|
| Rate for Payer: Healthspan PPO |
$25.20
|
| Rate for Payer: Humana Medicaid |
$19.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.11
|
| Rate for Payer: Molina Healthcare Passport |
$19.72
|
| Rate for Payer: Multiplan PHCS |
$759.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$443.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
|
STRESS TEST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
482P0002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$26.80
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$19.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$24.12
|
| Rate for Payer: Healthspan PPO |
$25.20
|
| Rate for Payer: Humana Medicaid |
$19.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.11
|
| Rate for Payer: Molina Healthcare Passport |
$19.72
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
|
STRESS TEST(T
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
482T0002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STRESS TEST(T
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
482T0002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STRESS TEST W/O INT/REPORT
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,263.36 |
| Rate for Payer: Aetna Commercial |
$1,013.32
|
| Rate for Payer: Anthem Medicaid |
$452.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$1,092.28
|
| Rate for Payer: First Health Commercial |
$1,250.20
|
| Rate for Payer: Humana Commercial |
$1,118.60
|
| Rate for Payer: Humana KY Medicaid |
$452.57
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$457.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,079.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$971.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$461.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,158.08
|
| Rate for Payer: Ohio Health Group HMO |
$987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,052.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$908.04
|
| Rate for Payer: PHCS Commercial |
$1,263.36
|
| Rate for Payer: United Healthcare All Payer |
$1,158.08
|
|
|
STRESS TEST W/O INT/REPORT
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$789.60 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Ambetter Exchange |
$33.97
|
| Rate for Payer: Anthem Medicaid |
$45.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.76
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$100.88
|
| Rate for Payer: Healthspan PPO |
$89.08
|
| Rate for Payer: Humana Medicaid |
$45.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.75
|
| Rate for Payer: Molina Healthcare Passport |
$45.83
|
| Rate for Payer: Multiplan PHCS |
$789.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.16
|
| Rate for Payer: UHCCP Medicaid |
$460.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.97
|
|
|
STRESS TEST W/O INT/REPORT
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$1,263.36 |
| Rate for Payer: Aetna Commercial |
$1,013.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,026.48
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cigna Commercial |
$1,092.28
|
| Rate for Payer: First Health Commercial |
$1,250.20
|
| Rate for Payer: Humana Commercial |
$1,118.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,079.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$971.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,158.08
|
| Rate for Payer: Ohio Health Group HMO |
$987.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,052.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$908.04
|
| Rate for Payer: PHCS Commercial |
$1,263.36
|
| Rate for Payer: United Healthcare All Payer |
$1,158.08
|
|
|
STRESS TEST W/O INT/REPORT(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482P0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Ambetter Exchange |
$33.97
|
| Rate for Payer: Anthem Medicaid |
$45.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.76
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$100.88
|
| Rate for Payer: Healthspan PPO |
$89.08
|
| Rate for Payer: Humana Medicaid |
$45.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.75
|
| Rate for Payer: Molina Healthcare Passport |
$45.83
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.16
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.97
|
|
|
STRESS TEST W/O INT/REPORT(T
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482T0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STRESS TEST W/O INT/REPORT(T
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
482T0003
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
STROMECTOL(IVERMECTIN) 3MG TAB
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
25001440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Anthem Medicaid |
$4.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.47
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.53
|
| Rate for Payer: Humana Commercial |
$10.32
|
| Rate for Payer: Humana KY Medicaid |
$4.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.68
|
| Rate for Payer: Ohio Health Group HMO |
$9.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.38
|
| Rate for Payer: PHCS Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Payer |
$10.68
|
|
|
STROMECTOL(IVERMECTIN) 3MG TAB
|
Facility
|
IP
|
$12.14
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
25001440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.47
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cigna Commercial |
$10.08
|
| Rate for Payer: First Health Commercial |
$11.53
|
| Rate for Payer: Humana Commercial |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.68
|
| Rate for Payer: Ohio Health Group HMO |
$9.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.38
|
| Rate for Payer: PHCS Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Payer |
$10.68
|
|
|
STRONG IODINE SOLUTION (LUGOL)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 38779059805
|
| Hospital Charge Code |
25001442
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
