|
DRUG ASSAY POSACONAZOLE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 80187
|
| Hospital Charge Code |
30001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
DRUG SCREEN SERUM
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$303.36 |
| Rate for Payer: Aetna Commercial |
$243.32
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$262.28
|
| Rate for Payer: First Health Commercial |
$300.20
|
| Rate for Payer: Humana Commercial |
$268.60
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.08
|
| Rate for Payer: Ohio Health Group HMO |
$237.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.96
|
| Rate for Payer: PHCS Commercial |
$303.36
|
| Rate for Payer: United Healthcare All Payer |
$278.08
|
|
|
DRUG SCREEN SERUM
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$303.36 |
| Rate for Payer: Aetna Commercial |
$243.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.75
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$262.28
|
| Rate for Payer: First Health Commercial |
$300.20
|
| Rate for Payer: Humana Commercial |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.08
|
| Rate for Payer: Ohio Health Group HMO |
$237.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.96
|
| Rate for Payer: PHCS Commercial |
$303.36
|
| Rate for Payer: United Healthcare All Payer |
$278.08
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN OT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
43000034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN OT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
43000034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 3+ MUS EA 15MIN OT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
43000035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 3+ MUS EA 15MIN OT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
43000035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 3+ MUS EA 15MIN PT
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY NEEDLE 3+ MUS EA 15MIN PT
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
DRY SEAL SHEATH 26F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DRY SEAL SHEATH 26F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DSTRJ NULYT AGT GNCLR NRV
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
76102922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.21
|
| Rate for Payer: Anthem Medicaid |
$117.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Humana Medicaid |
$117.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$189.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.92
|
| Rate for Payer: Molina Healthcare Passport |
$117.57
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$124.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.75
|
|
|
DSTRJ NULYT AGT GNCLR NRV
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
76102922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DSTRJ NULYT AGT GNCLR NRV
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 64624
|
| Hospital Charge Code |
76102922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Facility
|
IP
|
$2,805.93
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
76102358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.77 |
| Max. Negotiated Rate |
$2,693.69 |
| Rate for Payer: Aetna Commercial |
$2,160.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,188.63
|
| Rate for Payer: Cash Price |
$1,402.96
|
| Rate for Payer: Cigna Commercial |
$2,328.92
|
| Rate for Payer: First Health Commercial |
$2,665.63
|
| Rate for Payer: Humana Commercial |
$2,385.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,469.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,104.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$561.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.84
|
| Rate for Payer: PHCS Commercial |
$2,693.69
|
| Rate for Payer: United Healthcare All Payer |
$2,469.22
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
761P2358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.67 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna Commercial |
$255.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.67
|
| Rate for Payer: Anthem Medicaid |
$126.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$233.76
|
| Rate for Payer: Healthspan PPO |
$363.22
|
| Rate for Payer: Humana Medicaid |
$126.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.49
|
| Rate for Payer: Molina Healthcare Passport |
$126.95
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.22
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Facility
|
OP
|
$2,805.93
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
76102358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.77 |
| Max. Negotiated Rate |
$2,693.69 |
| Rate for Payer: Aetna Commercial |
$2,160.57
|
| Rate for Payer: Anthem Medicaid |
$964.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,188.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,402.96
|
| Rate for Payer: Cash Price |
$1,402.96
|
| Rate for Payer: Cigna Commercial |
$2,328.92
|
| Rate for Payer: First Health Commercial |
$2,665.63
|
| Rate for Payer: Humana Commercial |
$2,385.04
|
| Rate for Payer: Humana KY Medicaid |
$964.96
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$974.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$984.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,469.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,104.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$561.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.84
|
| Rate for Payer: PHCS Commercial |
$2,693.69
|
| Rate for Payer: United Healthcare All Payer |
$2,469.22
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Professional
|
Both
|
$2,805.93
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
76102358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.67 |
| Max. Negotiated Rate |
$2,805.93 |
| Rate for Payer: Aetna Commercial |
$255.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.67
|
| Rate for Payer: Anthem Medicaid |
$126.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,805.93
|
| Rate for Payer: Cash Price |
$1,402.96
|
| Rate for Payer: Cash Price |
$1,402.96
|
| Rate for Payer: Cigna Commercial |
$233.76
|
| Rate for Payer: Healthspan PPO |
$363.22
|
| Rate for Payer: Humana Medicaid |
$126.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.49
|
| Rate for Payer: Molina Healthcare Passport |
$126.95
|
| Rate for Payer: Multiplan PHCS |
$1,683.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,964.15
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.22
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Facility
|
OP
|
$2,440.93
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
761T2358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.32 |
| Max. Negotiated Rate |
$2,343.29 |
| Rate for Payer: Aetna Commercial |
$1,879.52
|
| Rate for Payer: Anthem Medicaid |
$839.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,903.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,220.46
|
| Rate for Payer: Cash Price |
$1,220.46
|
| Rate for Payer: Cigna Commercial |
$2,025.97
|
| Rate for Payer: First Health Commercial |
$2,318.88
|
| Rate for Payer: Humana Commercial |
$2,074.79
|
| Rate for Payer: Humana KY Medicaid |
$839.44
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$847.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,001.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,801.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$856.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,830.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.69
|
| Rate for Payer: PHCS Commercial |
$2,343.29
|
| Rate for Payer: United Healthcare All Payer |
$2,148.02
|
|
|
DSTR NEURO WWORAD MONTCELCPLEX
|
Facility
|
IP
|
$2,440.93
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
761T2358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.32 |
| Max. Negotiated Rate |
$2,343.29 |
| Rate for Payer: Aetna Commercial |
$1,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,903.93
|
| Rate for Payer: Cash Price |
$1,220.46
|
| Rate for Payer: Cigna Commercial |
$2,025.97
|
| Rate for Payer: First Health Commercial |
$2,318.88
|
| Rate for Payer: Humana Commercial |
$2,074.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,001.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,801.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,830.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.69
|
| Rate for Payer: PHCS Commercial |
$2,343.29
|
| Rate for Payer: United Healthcare All Payer |
$2,148.02
|
|
|
DTAP .5ML
|
Professional
|
Both
|
$234.50
|
|
|
Service Code
|
HCPCS 90749
|
| Hospital Charge Code |
77000054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$234.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$234.50
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Cash Price |
$117.25
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$140.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.15
|
| Rate for Payer: UHCCP Medicaid |
$82.08
|
|
