|
BLOOD ADMINISTRATION(T
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
380T0001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$358.69 |
| Max. Negotiated Rate |
$1,001.28 |
| Rate for Payer: Aetna Commercial |
$803.11
|
| Rate for Payer: Anthem Medicaid |
$358.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$813.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cash Price |
$521.50
|
| Rate for Payer: Cigna Commercial |
$865.69
|
| Rate for Payer: First Health Commercial |
$990.85
|
| Rate for Payer: Humana Commercial |
$886.55
|
| Rate for Payer: Humana KY Medicaid |
$358.69
|
| Rate for Payer: Humana Medicare Advantage |
$403.95
|
| Rate for Payer: Kentucky WC Medicaid |
$362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$855.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$917.84
|
| Rate for Payer: Ohio Health Group HMO |
$782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$719.67
|
| Rate for Payer: PHCS Commercial |
$1,001.28
|
| Rate for Payer: United Healthcare All Payer |
$917.84
|
|
|
BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT
|
Facility
|
OP
|
$10.88
|
|
|
Service Code
|
CPT 85025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.49
|
| Rate for Payer: Humana Medicare Advantage |
$7.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.32
|
|
|
BLOOD GASES
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
30000334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$26.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$26.07
|
| Rate for Payer: Humana Medicare Advantage |
$26.07
|
| Rate for Payer: Kentucky WC Medicaid |
$26.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
BLOOD GASES
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
30000334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
BLOOD PATCH
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
45000294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.30 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.29
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
BLOOD PATCH
|
Facility
|
IP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$1,431.36 |
| Rate for Payer: Aetna Commercial |
$1,148.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.98
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,237.53
|
| Rate for Payer: First Health Commercial |
$1,416.45
|
| Rate for Payer: Humana Commercial |
$1,267.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,312.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.79
|
| Rate for Payer: PHCS Commercial |
$1,431.36
|
| Rate for Payer: United Healthcare All Payer |
$1,312.08
|
|
|
BLOOD PATCH
|
Professional
|
Both
|
$1,491.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$894.60 |
| Rate for Payer: Aetna Commercial |
$180.48
|
| Rate for Payer: Ambetter Exchange |
$106.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.28
|
| Rate for Payer: Anthem Medicaid |
$99.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.29
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$165.72
|
| Rate for Payer: Healthspan PPO |
$200.95
|
| Rate for Payer: Humana Medicaid |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.44
|
| Rate for Payer: Molina Healthcare Passport |
$99.45
|
| Rate for Payer: Multiplan PHCS |
$894.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.98
|
| Rate for Payer: UHCCP Medicaid |
$60.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.91
|
|
|
BLOOD PATCH
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
45000294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.61 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem Medicaid |
$323.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Humana KY Medicaid |
$323.61
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$326.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.29
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
BLOOD PATCH
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
76102292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.75 |
| Max. Negotiated Rate |
$1,431.36 |
| Rate for Payer: Aetna Commercial |
$1,148.07
|
| Rate for Payer: Anthem Medicaid |
$512.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$1,237.53
|
| Rate for Payer: First Health Commercial |
$1,416.45
|
| Rate for Payer: Humana Commercial |
$1,267.35
|
| Rate for Payer: Humana KY Medicaid |
$512.75
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$517.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,222.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$523.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,312.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,118.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.79
|
| Rate for Payer: PHCS Commercial |
$1,431.36
|
| Rate for Payer: United Healthcare All Payer |
$1,312.08
|
|
|
BLOOD PATCH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761P2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$180.48
|
| Rate for Payer: Ambetter Exchange |
$106.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.28
|
| Rate for Payer: Anthem Medicaid |
$99.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.29
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$165.72
|
| Rate for Payer: Healthspan PPO |
$200.95
|
| Rate for Payer: Humana Medicaid |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$142.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.44
|
| Rate for Payer: Molina Healthcare Passport |
$99.45
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.98
|
| Rate for Payer: UHCCP Medicaid |
$60.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.91
|
|
|
BLOOD PATCH(T
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761T2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.30 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.29
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
BLOOD PATCH(T
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
761T2292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.61 |
| Max. Negotiated Rate |
$903.36 |
| Rate for Payer: Aetna Commercial |
$724.57
|
| Rate for Payer: Anthem Medicaid |
$323.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cigna Commercial |
$781.03
|
| Rate for Payer: First Health Commercial |
$893.95
|
| Rate for Payer: Humana Commercial |
$799.85
|
| Rate for Payer: Humana KY Medicaid |
$323.61
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$326.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$771.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$694.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.08
|
| Rate for Payer: Ohio Health Group HMO |
$705.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.29
|
| Rate for Payer: PHCS Commercial |
$903.36
|
| Rate for Payer: United Healthcare All Payer |
$828.08
|
|
|
BLOOD SMEAR INTERPRETATION
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
BLOOD SMEAR INTERPRETATION
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$83.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$83.22
|
| Rate for Payer: Kentucky WC Medicaid |
$84.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
BLOOD SMEAR INTERPRETATION
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 85060
|
| Hospital Charge Code |
30001572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Aetna Commercial |
$35.43
|
| Rate for Payer: Ambetter Exchange |
$22.04
|
| Rate for Payer: Anthem Medicaid |
$18.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.45
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Healthspan PPO |
$31.53
|
| Rate for Payer: Humana Medicaid |
$18.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.98
|
| Rate for Payer: Molina Healthcare Passport |
$18.61
|
| Rate for Payer: Multiplan PHCS |
$145.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.65
|
| Rate for Payer: UHCCP Medicaid |
$84.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.04
|
|
|
BLOOD TYPING ABO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
30001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$119.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Humana KY Medicaid |
$119.10
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$120.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
BLOOD TYPING ABO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
30001232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
BLOOD TYPING RBC ANTIGENS
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
30001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$3.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$3.83
|
| Rate for Payer: Humana Medicare Advantage |
$3.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
BLOOD TYPING RBC ANTIGENS
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
30001235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.33
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
BLOOD TYPING RH (D)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
30001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$36.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.27
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$36.27
|
| Rate for Payer: Humana Medicare Advantage |
$36.27
|
| Rate for Payer: Kentucky WC Medicaid |
$36.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
BLOOD TYPING RH (D)
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
30001233
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
BML 4 Q COIL SHEATH
|
Facility
|
IP
|
$3,132.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.75 |
| Max. Negotiated Rate |
$3,007.20 |
| Rate for Payer: Aetna Commercial |
$2,412.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.35
|
| Rate for Payer: Cash Price |
$1,566.25
|
| Rate for Payer: Cigna Commercial |
$2,599.97
|
| Rate for Payer: First Health Commercial |
$2,975.88
|
| Rate for Payer: Humana Commercial |
$2,662.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,568.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,756.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.43
|
| Rate for Payer: PHCS Commercial |
$3,007.20
|
| Rate for Payer: United Healthcare All Payer |
$2,756.60
|
|
|
BML 4 Q COIL SHEATH
|
Facility
|
OP
|
$3,132.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.75 |
| Max. Negotiated Rate |
$3,007.20 |
| Rate for Payer: Aetna Commercial |
$2,412.03
|
| Rate for Payer: Anthem Medicaid |
$1,077.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.35
|
| Rate for Payer: Cash Price |
$1,566.25
|
| Rate for Payer: Cigna Commercial |
$2,599.97
|
| Rate for Payer: First Health Commercial |
$2,975.88
|
| Rate for Payer: Humana Commercial |
$2,662.62
|
| Rate for Payer: Humana KY Medicaid |
$1,077.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,088.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,568.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,311.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,756.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.43
|
| Rate for Payer: PHCS Commercial |
$3,007.20
|
| Rate for Payer: United Healthcare All Payer |
$2,756.60
|
|
|
BML 4 Q TEFLON SHEATH
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
BML 4 Q TEFLON SHEATH
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
