|
ALLERGENIC EXTRACT(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
940T0011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ALLERGENIC EXTRACT(T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
940T0011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ALLERGEN SPECIFIC IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
30001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem Medicaid |
$7.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.82
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Humana KY Medicaid |
$7.82
|
| Rate for Payer: Humana Medicare Advantage |
$7.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
ALLERGEN SPECIFIC IGG
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86001
|
| Hospital Charge Code |
30001863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.32
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
|
ALLERGY INJ MULTIPLE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Ambetter Exchange |
$10.94
|
| Rate for Payer: Anthem Medicaid |
$13.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$25.40
|
| Rate for Payer: Healthspan PPO |
$21.81
|
| Rate for Payer: Humana Medicaid |
$13.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.64
|
| Rate for Payer: Molina Healthcare Passport |
$13.37
|
| Rate for Payer: Multiplan PHCS |
$32.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.22
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.94
|
|
|
ALLERGY INJ MULTIPLE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
ALLERGY INJ MULTIPLE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 95117
|
| Hospital Charge Code |
94000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$18.57
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
ALLERGY INJ SINGLE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
ALLERGY INJ SINGLE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$18.57
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
ALLERGY INJ SINGLE
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 95115
|
| Hospital Charge Code |
94000001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$13.49
|
| Rate for Payer: Ambetter Exchange |
$9.47
|
| Rate for Payer: Anthem Medicaid |
$10.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.36
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$20.43
|
| Rate for Payer: Healthspan PPO |
$18.15
|
| Rate for Payer: Humana Medicaid |
$10.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.75
|
| Rate for Payer: Molina Healthcare Passport |
$10.54
|
| Rate for Payer: Multiplan PHCS |
$32.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.31
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.47
|
|
|
ALLERGY PATCH TESTS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
761P2638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Ambetter Exchange |
$4.46
|
| Rate for Payer: Anthem Medicaid |
$5.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.35
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: Healthspan PPO |
$10.60
|
| Rate for Payer: Humana Medicaid |
$5.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5.45
|
| Rate for Payer: Molina Healthcare Passport |
$5.34
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.80
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.46
|
|
|
ALLERGY PATCH TESTS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Ambetter Exchange |
$4.46
|
| Rate for Payer: Anthem Medicaid |
$5.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.35
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$11.05
|
| Rate for Payer: Healthspan PPO |
$10.60
|
| Rate for Payer: Humana Medicaid |
$5.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$5.45
|
| Rate for Payer: Molina Healthcare Passport |
$5.34
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.80
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.46
|
|
|
ALLERGY PATCH TESTS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ALLERGY PATCH TESTS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 95044
|
| Hospital Charge Code |
76102638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$1,316.07 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$940.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,316.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.07
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Humana Medicare Advantage |
$940.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ALLGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 29867
|
| Hospital Charge Code |
76102813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
ALLGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 29867
|
| Hospital Charge Code |
76102813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
ALLGRFT IMPLNT KNEE W/SCOPE
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 29867
|
| Hospital Charge Code |
76102813
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$2,064.10 |
| Rate for Payer: Aetna Commercial |
$1,873.76
|
| Rate for Payer: Ambetter Exchange |
$1,215.55
|
| Rate for Payer: Anthem Medicaid |
$913.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,215.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,215.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,458.66
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$2,064.10
|
| Rate for Payer: Healthspan PPO |
$1,697.22
|
| Rate for Payer: Humana Medicaid |
$913.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,591.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,215.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$931.46
|
| Rate for Payer: Molina Healthcare Passport |
$913.20
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,580.21
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$922.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,215.55
|
|
|
ALLODERM MATRIX GRAFT 8X16
|
Facility
|
OP
|
$17,760.70
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,328.21 |
| Max. Negotiated Rate |
$17,050.27 |
| Rate for Payer: Aetna Commercial |
$13,675.74
|
| Rate for Payer: Anthem Medicaid |
$6,107.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,853.35
|
| Rate for Payer: Cash Price |
$8,880.35
|
| Rate for Payer: Cigna Commercial |
$14,741.38
|
| Rate for Payer: First Health Commercial |
$16,872.67
|
| Rate for Payer: Humana Commercial |
$15,096.59
|
| Rate for Payer: Humana KY Medicaid |
$6,107.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,170.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,563.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,107.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,328.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,230.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,629.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,320.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,208.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,451.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,254.88
|
| Rate for Payer: PHCS Commercial |
$17,050.27
|
| Rate for Payer: United Healthcare All Payer |
$15,629.42
|
|
|
ALLODERM MATRIX GRAFT 8X16
|
Facility
|
IP
|
$17,760.70
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,328.21 |
| Max. Negotiated Rate |
$17,050.27 |
| Rate for Payer: Aetna Commercial |
$13,675.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,853.35
|
| Rate for Payer: Cash Price |
$8,880.35
|
| Rate for Payer: Cigna Commercial |
$14,741.38
|
| Rate for Payer: First Health Commercial |
$16,872.67
|
| Rate for Payer: Humana Commercial |
$15,096.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,563.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,107.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,328.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,629.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,320.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,208.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,451.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,254.88
|
| Rate for Payer: PHCS Commercial |
$17,050.27
|
| Rate for Payer: United Healthcare All Payer |
$15,629.42
|
|
|
ALLOGRAFT PATCH 4CMX4CM
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
ALLOGRAFT PATCH 4CMX4CM
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
ALLOGRAFT PLACENTA MATRIX 80MG
|
Facility
|
OP
|
$8,397.44
|
|
|
Service Code
|
HCPCS V2790
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.23 |
| Max. Negotiated Rate |
$8,061.54 |
| Rate for Payer: Aetna Commercial |
$6,466.03
|
| Rate for Payer: Anthem Medicaid |
$2,887.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,550.00
|
| Rate for Payer: Cash Price |
$4,198.72
|
| Rate for Payer: Cigna Commercial |
$6,969.88
|
| Rate for Payer: First Health Commercial |
$7,977.57
|
| Rate for Payer: Humana Commercial |
$7,137.82
|
| Rate for Payer: Humana KY Medicaid |
$2,887.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,917.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,885.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,197.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,519.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,945.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,389.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,298.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,717.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,305.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,794.23
|
| Rate for Payer: PHCS Commercial |
$8,061.54
|
| Rate for Payer: United Healthcare All Payer |
$7,389.75
|
|
|
ALLOGRAFT PLACENTA MATRIX 80MG
|
Facility
|
IP
|
$8,397.44
|
|
|
Service Code
|
HCPCS V2790
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.23 |
| Max. Negotiated Rate |
$8,061.54 |
| Rate for Payer: Aetna Commercial |
$6,466.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,550.00
|
| Rate for Payer: Cash Price |
$4,198.72
|
| Rate for Payer: Cigna Commercial |
$6,969.88
|
| Rate for Payer: First Health Commercial |
$7,977.57
|
| Rate for Payer: Humana Commercial |
$7,137.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,885.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,197.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,519.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,389.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,298.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,717.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,305.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,794.23
|
| Rate for Payer: PHCS Commercial |
$8,061.54
|
| Rate for Payer: United Healthcare All Payer |
$7,389.75
|
|
|
ALLOGRAFT PLACENT MATRIX 180MG
|
Facility
|
IP
|
$14,187.04
|
|
|
Service Code
|
HCPCS V2790
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.11 |
| Max. Negotiated Rate |
$13,619.56 |
| Rate for Payer: Aetna Commercial |
$10,924.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,065.89
|
| Rate for Payer: Cash Price |
$7,093.52
|
| Rate for Payer: Cigna Commercial |
$11,775.24
|
| Rate for Payer: First Health Commercial |
$13,477.69
|
| Rate for Payer: Humana Commercial |
$12,058.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,633.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,470.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,256.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,484.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,640.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,349.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,342.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,789.06
|
| Rate for Payer: PHCS Commercial |
$13,619.56
|
| Rate for Payer: United Healthcare All Payer |
$12,484.60
|
|
|
ALLOGRAFT PLACENT MATRIX 180MG
|
Facility
|
OP
|
$14,187.04
|
|
|
Service Code
|
HCPCS V2790
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.11 |
| Max. Negotiated Rate |
$13,619.56 |
| Rate for Payer: Aetna Commercial |
$10,924.02
|
| Rate for Payer: Anthem Medicaid |
$4,878.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,065.89
|
| Rate for Payer: Cash Price |
$7,093.52
|
| Rate for Payer: Cigna Commercial |
$11,775.24
|
| Rate for Payer: First Health Commercial |
$13,477.69
|
| Rate for Payer: Humana Commercial |
$12,058.98
|
| Rate for Payer: Humana KY Medicaid |
$4,878.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,928.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,633.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,470.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,256.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,976.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,484.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,640.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,349.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,342.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,789.06
|
| Rate for Payer: PHCS Commercial |
$13,619.56
|
| Rate for Payer: United Healthcare All Payer |
$12,484.60
|
|
