|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
45000080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
76100245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: Aetna Commercial |
$595.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$603.72
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$642.42
|
| Rate for Payer: First Health Commercial |
$735.30
|
| Rate for Payer: Humana Commercial |
$657.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$634.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$681.12
|
| Rate for Payer: Ohio Health Group HMO |
$580.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.06
|
| Rate for Payer: PHCS Commercial |
$743.04
|
| Rate for Payer: United Healthcare All Payer |
$681.12
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761T0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.01 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem Medicaid |
$163.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Humana KY Medicaid |
$163.01
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$164.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
DRSNGDEBRDPRTLTHKBRNLG>1EXT10%
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761T0245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.06
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: Ambetter Exchange |
$104.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$67.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.50
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$203.63
|
| Rate for Payer: Healthspan PPO |
$165.96
|
| Rate for Payer: Humana Medicaid |
$67.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.92
|
| Rate for Payer: Molina Healthcare Passport |
$67.57
|
| Rate for Payer: Multiplan PHCS |
$283.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.95
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.58
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$453.12 |
| Rate for Payer: Aetna Commercial |
$363.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$391.76
|
| Rate for Payer: First Health Commercial |
$448.40
|
| Rate for Payer: Humana Commercial |
$401.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$348.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$415.36
|
| Rate for Payer: Ohio Health Group HMO |
$354.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.68
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
45000079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$104.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$104.89
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$105.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761T0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
76100244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.32 |
| Max. Negotiated Rate |
$453.12 |
| Rate for Payer: Aetna Commercial |
$363.44
|
| Rate for Payer: Anthem Medicaid |
$162.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cigna Commercial |
$391.76
|
| Rate for Payer: First Health Commercial |
$448.40
|
| Rate for Payer: Humana Commercial |
$401.20
|
| Rate for Payer: Humana KY Medicaid |
$162.32
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$163.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$348.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$415.36
|
| Rate for Payer: Ohio Health Group HMO |
$354.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.68
|
| Rate for Payer: PHCS Commercial |
$453.12
|
| Rate for Payer: United Healthcare All Payer |
$415.36
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
45000079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761P0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$203.63 |
| Rate for Payer: Aetna Commercial |
$169.03
|
| Rate for Payer: Ambetter Exchange |
$104.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$67.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$203.63
|
| Rate for Payer: Healthspan PPO |
$165.96
|
| Rate for Payer: Humana Medicaid |
$67.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.92
|
| Rate for Payer: Molina Healthcare Passport |
$67.57
|
| Rate for Payer: Multiplan PHCS |
$100.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.95
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.58
|
|
|
DRSNGDEBRIDPRTLTHKBURN MED5>10
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
761T0244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$104.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$104.89
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$105.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
DRUG ASSAY POSACONAZOLE
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 80187
|
| Hospital Charge Code |
30001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem Medicaid |
$27.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.11
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Humana KY Medicaid |
$27.11
|
| Rate for Payer: Humana Medicare Advantage |
$27.11
|
| Rate for Payer: Kentucky WC Medicaid |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
DRUG ASSAY POSACONAZOLE
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 80187
|
| Hospital Charge Code |
30001990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.71
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| 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 |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DRUG ASSAY SALICYLATE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
30001889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.33
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DRUG SCREEN SERUM
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| 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 |
$252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.04
|
| 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 |
$94.80 |
| 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 |
$252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.04
|
| 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
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
43000034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN OT
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
43000034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
DRY NEEDLE 1-2 MUS EA 15MIN PT
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 20560
|
| Hospital Charge Code |
42000061
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.96
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
DRY NEEDLE 3+ MUS EA 15MIN OT
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 20561
|
| Hospital Charge Code |
43000035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
