|
HEEL LT (OS CALCIS) 2V
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$242.40 |
| Rate for Payer: Aetna Commercial |
$39.73
|
| Rate for Payer: Ambetter Exchange |
$25.59
|
| Rate for Payer: Anthem Medicaid |
$19.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.71
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$39.18
|
| Rate for Payer: Healthspan PPO |
$37.23
|
| Rate for Payer: Humana Medicaid |
$19.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.00
|
| Rate for Payer: Molina Healthcare Passport |
$19.61
|
| Rate for Payer: Multiplan PHCS |
$242.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$141.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.59
|
|
|
HEEL LT (OS CALCIS) 2V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
320P0111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna Commercial |
$39.73
|
| Rate for Payer: Ambetter Exchange |
$25.59
|
| Rate for Payer: Anthem Medicaid |
$19.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.71
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$39.18
|
| Rate for Payer: Healthspan PPO |
$37.23
|
| Rate for Payer: Humana Medicaid |
$19.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.00
|
| Rate for Payer: Molina Healthcare Passport |
$19.61
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.59
|
|
|
HEEL LT (OS CALCIS) 2V(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
320T0111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
HEEL LT (OS CALCIS) 2V(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
320T0111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
HELICOBACTER PYLORI SCREEN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001263
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
HELICOBACTER PYLORI SCREEN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001263
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
HELMINITHOSPORIUM HALODES IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
HELMINITHOSPORIUM HALODES IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
HEMABATE (CARBOPROSTTROME 1ML)
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
NDC 9085605
|
| Hospital Charge Code |
25003095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$545.28 |
| Rate for Payer: Aetna Commercial |
$437.36
|
| Rate for Payer: Anthem Medicaid |
$195.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.04
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cigna Commercial |
$471.44
|
| Rate for Payer: First Health Commercial |
$539.60
|
| Rate for Payer: Humana Commercial |
$482.80
|
| Rate for Payer: Humana KY Medicaid |
$195.34
|
| Rate for Payer: Kentucky WC Medicaid |
$197.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.84
|
| Rate for Payer: Ohio Health Group HMO |
$426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.92
|
| Rate for Payer: PHCS Commercial |
$545.28
|
| Rate for Payer: United Healthcare All Payer |
$499.84
|
|
|
HEMABATE (CARBOPROSTTROME 1ML)
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
NDC 9085605
|
| Hospital Charge Code |
25003095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$545.28 |
| Rate for Payer: Aetna Commercial |
$437.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.04
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cigna Commercial |
$471.44
|
| Rate for Payer: First Health Commercial |
$539.60
|
| Rate for Payer: Humana Commercial |
$482.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$465.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$499.84
|
| Rate for Payer: Ohio Health Group HMO |
$426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$454.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.92
|
| Rate for Payer: PHCS Commercial |
$545.28
|
| Rate for Payer: United Healthcare All Payer |
$499.84
|
|
|
HEMASHLD CARDIO PATCH 0.3*6.0
|
Facility
|
OP
|
$1,915.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.68 |
| Max. Negotiated Rate |
$1,838.98 |
| Rate for Payer: Aetna Commercial |
$1,475.01
|
| Rate for Payer: Anthem Medicaid |
$658.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.17
|
| Rate for Payer: Cash Price |
$957.80
|
| Rate for Payer: Cigna Commercial |
$1,589.95
|
| Rate for Payer: First Health Commercial |
$1,819.82
|
| Rate for Payer: Humana Commercial |
$1,628.26
|
| Rate for Payer: Humana KY Medicaid |
$658.77
|
| Rate for Payer: Kentucky WC Medicaid |
$665.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.76
|
| Rate for Payer: PHCS Commercial |
$1,838.98
|
| Rate for Payer: United Healthcare All Payer |
$1,685.73
|
|
|
HEMASHLD CARDIO PATCH 0.3*6.0
|
Facility
|
IP
|
$1,915.60
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.68 |
| Max. Negotiated Rate |
$1,838.98 |
| Rate for Payer: Aetna Commercial |
$1,475.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.17
|
| Rate for Payer: Cash Price |
$957.80
|
| Rate for Payer: Cigna Commercial |
$1,589.95
|
| Rate for Payer: First Health Commercial |
$1,819.82
|
| Rate for Payer: Humana Commercial |
$1,628.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.76
|
| Rate for Payer: PHCS Commercial |
$1,838.98
|
| Rate for Payer: United Healthcare All Payer |
$1,685.73
|
|
|
HEMATOCRIT-OTHER THAN SPUN
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
30000567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HEMATOCRIT-OTHER THAN SPUN
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
30000567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$2.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$2.37
|
| Rate for Payer: Humana Medicare Advantage |
$2.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HEM ECTOM INT & EXT EXTENSIVE
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
76101921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
HEM ECTOM INT & EXT EXTENSIVE
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
76101921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
HEM ECTOM INT & EXT EXTENSIVE
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
76101921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.78 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$646.20
|
| Rate for Payer: Ambetter Exchange |
$457.09
|
| Rate for Payer: Anthem Medicaid |
$389.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$548.51
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$583.63
|
| Rate for Payer: Healthspan PPO |
$544.95
|
| Rate for Payer: Humana Medicaid |
$389.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.58
|
| Rate for Payer: Molina Healthcare Passport |
$389.78
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.22
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.09
|
|
|
HEM ECTOM INT & EXT EXTENSIV(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
761P1921
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.78 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$646.20
|
| Rate for Payer: Ambetter Exchange |
$457.09
|
| Rate for Payer: Anthem Medicaid |
$389.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$548.51
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$583.63
|
| Rate for Payer: Healthspan PPO |
$544.95
|
| Rate for Payer: Humana Medicaid |
$389.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.58
|
| Rate for Payer: Molina Healthcare Passport |
$389.78
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.22
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.09
|
|
|
HEMI-CAP 12MM ARTCMP 1.0M*1.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.0M*1.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.0M*2.0M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.0M*2.0M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.5M*2.0M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.5M*2.0M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 1.5M*2.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
