|
BLA IMP BLD POS QL PRB MAG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001287
|
|
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
|
|
|
BLA IMP BLD POS QL PRB MAG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001287
|
|
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
|
|
|
BLAKEMORE TUBE INSERTION
|
Facility
|
OP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
45000339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem Medicaid |
$1,465.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Humana KY Medicaid |
$1,465.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.40
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
BLAKEMORE TUBE INSERTION
|
Facility
|
IP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
45000339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,278.00 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.40
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
BLA KPC GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001289
|
|
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
|
|
|
BLA KPC GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001289
|
|
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
|
|
|
BLA NDM ISLT QL PCR
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001290
|
|
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
|
|
|
BLA NDM ISLT QL PCR
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001290
|
|
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
|
|
|
BLA OXA BLD POS QL PRB MAG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001295
|
|
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
|
|
|
BLA OXA BLD POS QL PRB MAG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001295
|
|
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
|
|
|
BLA VIM BLD POS QL PRB MAG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001308
|
|
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
|
|
|
BLA VIM BLD POS QL PRB MAG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001308
|
|
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
|
|
|
BLD SMEAR WO DIFF WBC COUNT
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 85008
|
| Hospital Charge Code |
30001811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Ambetter Exchange |
$3.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.12
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$4.98
|
| Rate for Payer: Healthspan PPO |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.43
|
| Rate for Payer: Multiplan PHCS |
$22.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.46
|
| Rate for Payer: UHCCP Medicaid |
$12.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.43
|
|
|
BLD SMEAR WO DIFF WBC COUNT
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 85008
|
| Hospital Charge Code |
30001811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$3.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$3.43
|
| Rate for Payer: Humana Medicare Advantage |
$3.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
BLD SMEAR WO DIFF WBC COUNT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 85008
|
| Hospital Charge Code |
30001811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
BLEOMYCIN 30 UNIT VIAL
|
Facility
|
IP
|
$363.46
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
25002569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$348.92 |
| Rate for Payer: Aetna Commercial |
$279.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.50
|
| Rate for Payer: Cash Price |
$181.73
|
| Rate for Payer: Cigna Commercial |
$301.67
|
| Rate for Payer: First Health Commercial |
$345.29
|
| Rate for Payer: Humana Commercial |
$308.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$319.84
|
| Rate for Payer: Ohio Health Group HMO |
$272.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.79
|
| Rate for Payer: PHCS Commercial |
$348.92
|
| Rate for Payer: United Healthcare All Payer |
$319.84
|
|
|
BLEOMYCIN 30 UNIT VIAL
|
Facility
|
OP
|
$363.46
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
25002569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.04 |
| Max. Negotiated Rate |
$348.92 |
| Rate for Payer: Aetna Commercial |
$279.86
|
| Rate for Payer: Anthem Medicaid |
$124.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.50
|
| Rate for Payer: Cash Price |
$181.73
|
| Rate for Payer: Cigna Commercial |
$301.67
|
| Rate for Payer: First Health Commercial |
$345.29
|
| Rate for Payer: Humana Commercial |
$308.94
|
| Rate for Payer: Humana KY Medicaid |
$124.99
|
| Rate for Payer: Kentucky WC Medicaid |
$126.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$319.84
|
| Rate for Payer: Ohio Health Group HMO |
$272.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.79
|
| Rate for Payer: PHCS Commercial |
$348.92
|
| Rate for Payer: United Healthcare All Payer |
$319.84
|
|
|
BLEOMYCIN SULFATE15 UNIT VIAL
|
Facility
|
IP
|
$180.50
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
25002570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$138.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.79
|
| Rate for Payer: Cash Price |
$90.25
|
| Rate for Payer: Cigna Commercial |
$149.81
|
| Rate for Payer: First Health Commercial |
$171.47
|
| Rate for Payer: Humana Commercial |
$153.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.84
|
| Rate for Payer: Ohio Health Group HMO |
$135.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.55
|
| Rate for Payer: PHCS Commercial |
$173.28
|
| Rate for Payer: United Healthcare All Payer |
$158.84
|
|
|
BLEOMYCIN SULFATE15 UNIT VIAL
|
Facility
|
OP
|
$180.50
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
25002570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$173.28 |
| Rate for Payer: Aetna Commercial |
$138.99
|
| Rate for Payer: Anthem Medicaid |
$62.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.79
|
| Rate for Payer: Cash Price |
$90.25
|
| Rate for Payer: Cigna Commercial |
$149.81
|
| Rate for Payer: First Health Commercial |
$171.47
|
| Rate for Payer: Humana Commercial |
$153.43
|
| Rate for Payer: Humana KY Medicaid |
$62.07
|
| Rate for Payer: Kentucky WC Medicaid |
$62.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.84
|
| Rate for Payer: Ohio Health Group HMO |
$135.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.55
|
| Rate for Payer: PHCS Commercial |
$173.28
|
| Rate for Payer: United Healthcare All Payer |
$158.84
|
|
|
BLEPH-10(SULFACETAMIDE) 1 15ML
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 24208067004
|
| Hospital Charge Code |
25000340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: Anthem Medicaid |
$0.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.52
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna Commercial |
$0.56
|
| Rate for Payer: First Health Commercial |
$0.64
|
| Rate for Payer: Humana Commercial |
$0.57
|
| Rate for Payer: Humana KY Medicaid |
$0.23
|
| Rate for Payer: Kentucky WC Medicaid |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.59
|
| Rate for Payer: Ohio Health Group HMO |
$0.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.46
|
| Rate for Payer: PHCS Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Payer |
$0.59
|
|
|
BLEPH-10(SULFACETAMIDE) 1 15ML
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 24208067004
|
| Hospital Charge Code |
25000340
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.52
|
| Rate for Payer: Cash Price |
$0.34
|
| Rate for Payer: Cigna Commercial |
$0.56
|
| Rate for Payer: First Health Commercial |
$0.64
|
| Rate for Payer: Humana Commercial |
$0.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.59
|
| Rate for Payer: Ohio Health Group HMO |
$0.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.46
|
| Rate for Payer: PHCS Commercial |
$0.64
|
| Rate for Payer: United Healthcare All Payer |
$0.59
|
|
|
BLEPHAROPLASTY, LOWER EYELID
|
Facility
|
OP
|
$4,665.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
76100214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,604.29 |
| Max. Negotiated Rate |
$4,478.40 |
| Rate for Payer: Aetna Commercial |
$3,592.05
|
| Rate for Payer: Anthem Medicaid |
$1,604.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,638.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,332.50
|
| Rate for Payer: Cash Price |
$2,332.50
|
| Rate for Payer: Cigna Commercial |
$3,871.95
|
| Rate for Payer: First Health Commercial |
$4,431.75
|
| Rate for Payer: Humana Commercial |
$3,965.25
|
| Rate for Payer: Humana KY Medicaid |
$1,604.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,620.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,825.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,442.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,498.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,058.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,218.85
|
| Rate for Payer: PHCS Commercial |
$4,478.40
|
| Rate for Payer: United Healthcare All Payer |
$4,105.20
|
|
|
BLEPHAROPLASTY, LOWER EYELID
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
76100214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.09 |
| Max. Negotiated Rate |
$2,799.00 |
| Rate for Payer: Aetna Commercial |
$670.68
|
| Rate for Payer: Ambetter Exchange |
$475.00
|
| Rate for Payer: Anthem Medicaid |
$321.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$475.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$570.00
|
| Rate for Payer: Cash Price |
$2,332.50
|
| Rate for Payer: Cash Price |
$2,332.50
|
| Rate for Payer: Cigna Commercial |
$649.50
|
| Rate for Payer: Healthspan PPO |
$589.34
|
| Rate for Payer: Humana Medicaid |
$321.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$629.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$475.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$327.51
|
| Rate for Payer: Molina Healthcare Passport |
$321.09
|
| Rate for Payer: Multiplan PHCS |
$2,799.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$617.50
|
| Rate for Payer: UHCCP Medicaid |
$1,632.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$475.00
|
|
|
BLEPHAROPLASTY, LOWER EYELID
|
Facility
|
IP
|
$4,665.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
76100214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,399.50 |
| Max. Negotiated Rate |
$4,478.40 |
| Rate for Payer: Aetna Commercial |
$3,592.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,638.70
|
| Rate for Payer: Cash Price |
$2,332.50
|
| Rate for Payer: Cigna Commercial |
$3,871.95
|
| Rate for Payer: First Health Commercial |
$4,431.75
|
| Rate for Payer: Humana Commercial |
$3,965.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,825.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,442.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,498.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,058.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,218.85
|
| Rate for Payer: PHCS Commercial |
$4,478.40
|
| Rate for Payer: United Healthcare All Payer |
$4,105.20
|
|
|
BLEPHAROPLASTY, LOWER EYELID(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
761P0214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$670.68
|
| Rate for Payer: Ambetter Exchange |
$475.00
|
| Rate for Payer: Anthem Medicaid |
$321.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$475.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$570.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$649.50
|
| Rate for Payer: Healthspan PPO |
$589.34
|
| Rate for Payer: Humana Medicaid |
$321.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$629.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$475.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$475.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$327.51
|
| Rate for Payer: Molina Healthcare Passport |
$321.09
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$617.50
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$475.00
|
|
