|
ANA ANTI NUCLEAR ANTIBODY IFA
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
30000975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$12.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$12.09
|
| Rate for Payer: Humana Medicare Advantage |
$12.09
|
| Rate for Payer: Kentucky WC Medicaid |
$12.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
ANAEROBIC CULTURE
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Ambetter Exchange |
$9.47
|
| 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 |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$9.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.47
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.31
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.47
|
|
|
ANAEROBIC CULTURE
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
ANAEROBIC CULTURE
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$9.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
ANAFRANIL 50MG CAPSULE
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 51672401206
|
| Hospital Charge Code |
25000223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
ANAFRANIL 50MG CAPSULE
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 51672401206
|
| Hospital Charge Code |
25000223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
ANAFRANIL (CLOMIPRAM 25MG/1CAP
|
Facility
|
IP
|
$78.95
|
|
|
Service Code
|
NDC 406990603
|
| Hospital Charge Code |
25000222
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Aetna Commercial |
$60.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.58
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.53
|
| Rate for Payer: First Health Commercial |
$75.00
|
| Rate for Payer: Humana Commercial |
$67.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.48
|
| Rate for Payer: PHCS Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
ANAFRANIL (CLOMIPRAM 25MG/1CAP
|
Facility
|
OP
|
$78.95
|
|
|
Service Code
|
NDC 406990603
|
| Hospital Charge Code |
25000222
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Aetna Commercial |
$60.79
|
| Rate for Payer: Anthem Medicaid |
$27.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.58
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.53
|
| Rate for Payer: First Health Commercial |
$75.00
|
| Rate for Payer: Humana Commercial |
$67.11
|
| Rate for Payer: Humana KY Medicaid |
$27.15
|
| Rate for Payer: Kentucky WC Medicaid |
$27.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.48
|
| Rate for Payer: PHCS Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
25000224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
25000224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ANALPRAM HC 2.5% CREAM 4 GRAM
|
Facility
|
OP
|
$24.53
|
|
|
Service Code
|
NDC 45802047265
|
| Hospital Charge Code |
25000225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem Medicaid |
$8.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Humana KY Medicaid |
$8.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
ANALPRAM HC 2.5% CREAM 4 GRAM
|
Facility
|
IP
|
$24.53
|
|
|
Service Code
|
NDC 45802047265
|
| Hospital Charge Code |
25000225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Ambetter Exchange |
$32.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.00
|
| Rate for Payer: Anthem Medicaid |
$96.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.07
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$213.06
|
| Rate for Payer: Healthspan PPO |
$115.01
|
| Rate for Payer: Humana Medicaid |
$96.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.36
|
| Rate for Payer: Molina Healthcare Passport |
$96.43
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.33
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.56
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ANAL SP INF PMP W/REPRG&FIL(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761P2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Ambetter Exchange |
$32.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.00
|
| Rate for Payer: Anthem Medicaid |
$96.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.07
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$213.06
|
| Rate for Payer: Healthspan PPO |
$115.01
|
| Rate for Payer: Humana Medicaid |
$96.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.36
|
| Rate for Payer: Molina Healthcare Passport |
$96.43
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.33
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.56
|
|
|
ANAL SP INF PMP W/REPRG&FIL(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761T2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ANAL SP INF PMP W/REPRG&FIL(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761T2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$639.36 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem Medicaid |
$229.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$519.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Humana KY Medicaid |
$229.04
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$231.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna Commercial |
$314.34
|
| Rate for Payer: Ambetter Exchange |
$59.01
|
| Rate for Payer: Anthem Medicaid |
$75.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.81
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$308.36
|
| Rate for Payer: Healthspan PPO |
$251.34
|
| Rate for Payer: Humana Medicaid |
$75.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.97
|
| Rate for Payer: Molina Healthcare Passport |
$75.46
|
| Rate for Payer: Multiplan PHCS |
$399.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.71
|
| Rate for Payer: UHCCP Medicaid |
$233.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.01
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$639.36 |
| Rate for Payer: Aetna Commercial |
$512.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$519.48
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$552.78
|
| Rate for Payer: First Health Commercial |
$632.70
|
| Rate for Payer: Humana Commercial |
$566.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$491.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.08
|
| Rate for Payer: Ohio Health Group HMO |
$499.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$532.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$579.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$459.54
|
| Rate for Payer: PHCS Commercial |
$639.36
|
| Rate for Payer: United Healthcare All Payer |
$586.08
|
|
|
ANAL/URINARY MUSCLE STUDY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320P0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$314.34 |
| Rate for Payer: Aetna Commercial |
$314.34
|
| Rate for Payer: Ambetter Exchange |
$59.01
|
| Rate for Payer: Anthem Medicaid |
$75.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$308.36
|
| Rate for Payer: Healthspan PPO |
$251.34
|
| Rate for Payer: Humana Medicaid |
$75.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.97
|
| Rate for Payer: Molina Healthcare Passport |
$75.46
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.71
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.01
|
|
|
ANAL/URINARY MUSCLE STUDY(T
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320T0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$447.36 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Anthem Medicaid |
$160.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$386.78
|
| Rate for Payer: First Health Commercial |
$442.70
|
| Rate for Payer: Humana Commercial |
$396.10
|
| Rate for Payer: Humana KY Medicaid |
$160.26
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$161.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.08
|
| Rate for Payer: Ohio Health Group HMO |
$349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.54
|
| Rate for Payer: PHCS Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Payer |
$410.08
|
|
|
ANAL/URINARY MUSCLE STUDY(T
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320T0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$139.80 |
| Max. Negotiated Rate |
$447.36 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.48
|
| Rate for Payer: Cash Price |
$233.00
|
| Rate for Payer: Cigna Commercial |
$386.78
|
| Rate for Payer: First Health Commercial |
$442.70
|
| Rate for Payer: Humana Commercial |
$396.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.08
|
| Rate for Payer: Ohio Health Group HMO |
$349.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$321.54
|
| Rate for Payer: PHCS Commercial |
$447.36
|
| Rate for Payer: United Healthcare All Payer |
$410.08
|
|
|
ANALYZE NEURO WITHOUT PROGRAMI
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
