|
GTR SHORT W CABLES 23*53
|
Facility
|
OP
|
$11,634.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,490.43 |
| Max. Negotiated Rate |
$11,169.39 |
| Rate for Payer: Aetna Commercial |
$8,958.78
|
| Rate for Payer: Anthem Medicaid |
$4,001.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,075.13
|
| Rate for Payer: Cash Price |
$5,817.39
|
| Rate for Payer: Cigna Commercial |
$9,656.87
|
| Rate for Payer: First Health Commercial |
$11,053.04
|
| Rate for Payer: Humana Commercial |
$9,889.56
|
| Rate for Payer: Humana KY Medicaid |
$4,001.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,041.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,540.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,586.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,490.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,081.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,238.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,726.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,307.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,122.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,028.00
|
| Rate for Payer: PHCS Commercial |
$11,169.39
|
| Rate for Payer: United Healthcare All Payer |
$10,238.61
|
|
|
G TUBE CHANGE
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
76101793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,043.52 |
| Rate for Payer: Aetna Commercial |
$836.99
|
| Rate for Payer: Anthem Medicaid |
$373.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$543.50
|
| Rate for Payer: Cash Price |
$543.50
|
| Rate for Payer: Cigna Commercial |
$902.21
|
| Rate for Payer: First Health Commercial |
$1,032.65
|
| Rate for Payer: Humana Commercial |
$923.95
|
| Rate for Payer: Humana KY Medicaid |
$373.82
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$377.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$891.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.56
|
| Rate for Payer: Ohio Health Group HMO |
$815.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.03
|
| Rate for Payer: PHCS Commercial |
$1,043.52
|
| Rate for Payer: United Healthcare All Payer |
$956.56
|
|
|
G TUBE CHANGE
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
45000267
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$813.12 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Anthem Medicaid |
$291.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$660.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$703.01
|
| Rate for Payer: First Health Commercial |
$804.65
|
| Rate for Payer: Humana Commercial |
$719.95
|
| Rate for Payer: Humana KY Medicaid |
$291.28
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$294.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.36
|
| Rate for Payer: Ohio Health Group HMO |
$635.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.43
|
| Rate for Payer: PHCS Commercial |
$813.12
|
| Rate for Payer: United Healthcare All Payer |
$745.36
|
|
|
G TUBE CHANGE
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
76101793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$652.20 |
| Rate for Payer: Ambetter Exchange |
$35.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.89
|
| Rate for Payer: Anthem Medicaid |
$167.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.90
|
| Rate for Payer: Cash Price |
$543.50
|
| Rate for Payer: Cash Price |
$543.50
|
| Rate for Payer: Cigna Commercial |
$350.08
|
| Rate for Payer: Humana Medicaid |
$167.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.56
|
| Rate for Payer: Molina Healthcare Passport |
$167.22
|
| Rate for Payer: Multiplan PHCS |
$652.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.48
|
| Rate for Payer: UHCCP Medicaid |
$32.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.75
|
|
|
G TUBE CHANGE
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
76101793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$1,043.52 |
| Rate for Payer: Aetna Commercial |
$836.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.86
|
| Rate for Payer: Cash Price |
$543.50
|
| Rate for Payer: Cigna Commercial |
$902.21
|
| Rate for Payer: First Health Commercial |
$1,032.65
|
| Rate for Payer: Humana Commercial |
$923.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$891.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$802.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.56
|
| Rate for Payer: Ohio Health Group HMO |
$815.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$945.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.03
|
| Rate for Payer: PHCS Commercial |
$1,043.52
|
| Rate for Payer: United Healthcare All Payer |
$956.56
|
|
|
G TUBE CHANGE
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
45000267
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$813.12 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$660.66
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$703.01
|
| Rate for Payer: First Health Commercial |
$804.65
|
| Rate for Payer: Humana Commercial |
$719.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.36
|
| Rate for Payer: Ohio Health Group HMO |
$635.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.43
|
| Rate for Payer: PHCS Commercial |
$813.12
|
| Rate for Payer: United Healthcare All Payer |
$745.36
|
|
|
G TUBE CHANGE(P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
761P1793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$350.08 |
| Rate for Payer: Ambetter Exchange |
$35.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.89
|
| Rate for Payer: Anthem Medicaid |
$167.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.90
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$350.08
|
| Rate for Payer: Humana Medicaid |
$167.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.56
|
| Rate for Payer: Molina Healthcare Passport |
$167.22
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.48
|
| Rate for Payer: UHCCP Medicaid |
$32.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.75
|
|
|
G TUBE CHANGE(T
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
761T1793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$813.12 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Anthem Medicaid |
$291.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$660.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$703.01
|
| Rate for Payer: First Health Commercial |
$804.65
|
| Rate for Payer: Humana Commercial |
$719.95
|
| Rate for Payer: Humana KY Medicaid |
$291.28
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$294.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.36
|
| Rate for Payer: Ohio Health Group HMO |
$635.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.43
|
| Rate for Payer: PHCS Commercial |
$813.12
|
| Rate for Payer: United Healthcare All Payer |
$745.36
|
|
|
G TUBE CHANGE(T
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
761T1793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$813.12 |
| Rate for Payer: Aetna Commercial |
$652.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$660.66
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cigna Commercial |
$703.01
|
| Rate for Payer: First Health Commercial |
$804.65
|
| Rate for Payer: Humana Commercial |
$719.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$694.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$745.36
|
| Rate for Payer: Ohio Health Group HMO |
$635.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.43
|
| Rate for Payer: PHCS Commercial |
$813.12
|
| Rate for Payer: United Healthcare All Payer |
$745.36
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
OP
|
$2,571.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
76102007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,468.16 |
| Rate for Payer: Aetna Commercial |
$1,979.67
|
| Rate for Payer: Anthem Medicaid |
$884.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,005.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,285.50
|
| Rate for Payer: Cash Price |
$1,285.50
|
| Rate for Payer: Cigna Commercial |
$2,133.93
|
| Rate for Payer: First Health Commercial |
$2,442.45
|
| Rate for Payer: Humana Commercial |
$2,185.35
|
| Rate for Payer: Humana KY Medicaid |
$884.17
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$893.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,108.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,897.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$901.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,262.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,928.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,056.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,236.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,773.99
|
| Rate for Payer: PHCS Commercial |
$2,468.16
|
| Rate for Payer: United Healthcare All Payer |
$2,262.48
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Professional
|
Both
|
$2,571.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
76102007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$1,542.60 |
| Rate for Payer: Aetna Commercial |
$109.37
|
| Rate for Payer: Ambetter Exchange |
$61.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$605.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.05
|
| Rate for Payer: Cash Price |
$1,285.50
|
| Rate for Payer: Cash Price |
$1,285.50
|
| Rate for Payer: Cigna Commercial |
$99.63
|
| Rate for Payer: Healthspan PPO |
$895.64
|
| Rate for Payer: Humana Medicaid |
$605.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.67
|
| Rate for Payer: Molina Healthcare Passport |
$605.56
|
| Rate for Payer: Multiplan PHCS |
$1,542.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.22
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$611.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.71
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
761P2007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$895.64 |
| Rate for Payer: Aetna Commercial |
$109.37
|
| Rate for Payer: Ambetter Exchange |
$61.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$605.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.05
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cash Price |
$497.50
|
| Rate for Payer: Cigna Commercial |
$99.63
|
| Rate for Payer: Healthspan PPO |
$895.64
|
| Rate for Payer: Humana Medicaid |
$605.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.67
|
| Rate for Payer: Molina Healthcare Passport |
$605.56
|
| Rate for Payer: Multiplan PHCS |
$597.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.22
|
| Rate for Payer: UHCCP Medicaid |
$64.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$611.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.71
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
761T2007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.99 |
| Max. Negotiated Rate |
$1,512.96 |
| Rate for Payer: Aetna Commercial |
$1,213.52
|
| Rate for Payer: Anthem Medicaid |
$541.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cigna Commercial |
$1,308.08
|
| Rate for Payer: First Health Commercial |
$1,497.20
|
| Rate for Payer: Humana Commercial |
$1,339.60
|
| Rate for Payer: Humana KY Medicaid |
$541.99
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.44
|
| Rate for Payer: PHCS Commercial |
$1,512.96
|
| Rate for Payer: United Healthcare All Payer |
$1,386.88
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
45000275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$541.99 |
| Max. Negotiated Rate |
$1,512.96 |
| Rate for Payer: Aetna Commercial |
$1,213.52
|
| Rate for Payer: Anthem Medicaid |
$541.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cigna Commercial |
$1,308.08
|
| Rate for Payer: First Health Commercial |
$1,497.20
|
| Rate for Payer: Humana Commercial |
$1,339.60
|
| Rate for Payer: Humana KY Medicaid |
$541.99
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.44
|
| Rate for Payer: PHCS Commercial |
$1,512.96
|
| Rate for Payer: United Healthcare All Payer |
$1,386.88
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
761T2007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.80 |
| Max. Negotiated Rate |
$1,512.96 |
| Rate for Payer: Aetna Commercial |
$1,213.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.28
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cigna Commercial |
$1,308.08
|
| Rate for Payer: First Health Commercial |
$1,497.20
|
| Rate for Payer: Humana Commercial |
$1,339.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.44
|
| Rate for Payer: PHCS Commercial |
$1,512.96
|
| Rate for Payer: United Healthcare All Payer |
$1,386.88
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
45000275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.80 |
| Max. Negotiated Rate |
$1,512.96 |
| Rate for Payer: Aetna Commercial |
$1,213.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.28
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cigna Commercial |
$1,308.08
|
| Rate for Payer: First Health Commercial |
$1,497.20
|
| Rate for Payer: Humana Commercial |
$1,339.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.44
|
| Rate for Payer: PHCS Commercial |
$1,512.96
|
| Rate for Payer: United Healthcare All Payer |
$1,386.88
|
|
|
GTUBE CHNGE W FLUORO INCLD INJ
|
Facility
|
IP
|
$2,571.00
|
|
|
Service Code
|
HCPCS 49450
|
| Hospital Charge Code |
76102007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$771.30 |
| Max. Negotiated Rate |
$2,468.16 |
| Rate for Payer: Aetna Commercial |
$1,979.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,005.38
|
| Rate for Payer: Cash Price |
$1,285.50
|
| Rate for Payer: Cigna Commercial |
$2,133.93
|
| Rate for Payer: First Health Commercial |
$2,442.45
|
| Rate for Payer: Humana Commercial |
$2,185.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,108.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,897.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$771.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,262.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,928.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,056.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,236.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,773.99
|
| Rate for Payer: PHCS Commercial |
$2,468.16
|
| Rate for Payer: United Healthcare All Payer |
$2,262.48
|
|
|
GUAIFENESIN 100mg/5mL UD 5mL
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 121174400
|
| Hospital Charge Code |
25004317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna Commercial |
$1.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.30
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.39
|
| Rate for Payer: First Health Commercial |
$1.59
|
| Rate for Payer: Humana Commercial |
$1.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.47
|
| Rate for Payer: Ohio Health Group HMO |
$1.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Payer |
$1.47
|
|
|
GUAIFENESIN 100mg/5mL UD 5mL
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 121174400
|
| Hospital Charge Code |
25004317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: Aetna Commercial |
$1.29
|
| Rate for Payer: Anthem Medicaid |
$0.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.30
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna Commercial |
$1.39
|
| Rate for Payer: First Health Commercial |
$1.59
|
| Rate for Payer: Humana Commercial |
$1.42
|
| Rate for Payer: Humana KY Medicaid |
$0.57
|
| Rate for Payer: Kentucky WC Medicaid |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.47
|
| Rate for Payer: Ohio Health Group HMO |
$1.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Payer |
$1.47
|
|
|
GUARDWIRE 2.5-5.0
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
GUARDWIRE 2.5-5.0
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
GUARDWIRE 3.0-6.0
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
GUARDWIRE 3.0-6.0
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
GUIDANCE FOR RADJ TX DLVR
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$1,506.24 |
| Rate for Payer: Aetna Commercial |
$1,208.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,223.82
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$1,302.27
|
| Rate for Payer: First Health Commercial |
$1,490.55
|
| Rate for Payer: Humana Commercial |
$1,333.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,286.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,157.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,380.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,176.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,082.61
|
| Rate for Payer: PHCS Commercial |
$1,506.24
|
| Rate for Payer: United Healthcare All Payer |
$1,380.72
|
|
|
GUIDANCE FOR RADJ TX DLVR
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$1,506.24 |
| Rate for Payer: Aetna Commercial |
$1,208.13
|
| Rate for Payer: Anthem Medicaid |
$539.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,223.82
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$1,302.27
|
| Rate for Payer: First Health Commercial |
$1,490.55
|
| Rate for Payer: Humana Commercial |
$1,333.65
|
| Rate for Payer: Humana KY Medicaid |
$539.58
|
| Rate for Payer: Kentucky WC Medicaid |
$545.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,286.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,157.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,380.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,176.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,082.61
|
| Rate for Payer: PHCS Commercial |
$1,506.24
|
| Rate for Payer: United Healthcare All Payer |
$1,380.72
|
|
