|
INTMD RPR S/TR/EXT >30.0 CM
|
Facility
|
OP
|
$2,423.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
761T2582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.99 |
| Max. Negotiated Rate |
$2,326.08 |
| Rate for Payer: Aetna Commercial |
$1,865.71
|
| Rate for Payer: Anthem Medicaid |
$833.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,889.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cash Price |
$1,211.50
|
| Rate for Payer: Cigna Commercial |
$2,011.09
|
| Rate for Payer: First Health Commercial |
$2,301.85
|
| Rate for Payer: Humana Commercial |
$2,059.55
|
| Rate for Payer: Humana KY Medicaid |
$833.27
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$841.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,986.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,788.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$849.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,132.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.13
|
| Rate for Payer: PHCS Commercial |
$2,326.08
|
| Rate for Payer: United Healthcare All Payer |
$2,132.24
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
761P2582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.50 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$464.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.50
|
| Rate for Payer: Anthem Medicaid |
$230.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$444.78
|
| Rate for Payer: Healthspan PPO |
$507.37
|
| Rate for Payer: Humana Medicaid |
$230.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.71
|
| Rate for Payer: Molina Healthcare Passport |
$230.11
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$175.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$232.41
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Professional
|
Both
|
$3,053.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
76102582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.50 |
| Max. Negotiated Rate |
$3,053.00 |
| Rate for Payer: Aetna Commercial |
$464.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.50
|
| Rate for Payer: Anthem Medicaid |
$230.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,053.00
|
| Rate for Payer: Cash Price |
$1,526.50
|
| Rate for Payer: Cash Price |
$1,526.50
|
| Rate for Payer: Cigna Commercial |
$444.78
|
| Rate for Payer: Healthspan PPO |
$507.37
|
| Rate for Payer: Humana Medicaid |
$230.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$234.71
|
| Rate for Payer: Molina Healthcare Passport |
$230.11
|
| Rate for Payer: Multiplan PHCS |
$1,831.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,137.10
|
| Rate for Payer: UHCCP Medicaid |
$175.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$232.41
|
|
|
INTMD RPR S/TR/EXT >30.0 CM
|
Facility
|
IP
|
$3,053.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
76102582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.89 |
| Max. Negotiated Rate |
$2,930.88 |
| Rate for Payer: Aetna Commercial |
$2,350.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.34
|
| Rate for Payer: Cash Price |
$1,526.50
|
| Rate for Payer: Cigna Commercial |
$2,533.99
|
| Rate for Payer: First Health Commercial |
$2,900.35
|
| Rate for Payer: Humana Commercial |
$2,595.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,503.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,686.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,289.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$946.43
|
| Rate for Payer: PHCS Commercial |
$2,930.88
|
| Rate for Payer: United Healthcare All Payer |
$2,686.64
|
|
|
INTMD WND REPAIR FACE/MM
|
Facility
|
IP
|
$2,299.17
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.89 |
| Max. Negotiated Rate |
$2,207.20 |
| Rate for Payer: Aetna Commercial |
$1,770.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,793.35
|
| Rate for Payer: Cash Price |
$1,149.59
|
| Rate for Payer: Cigna Commercial |
$1,908.31
|
| Rate for Payer: First Health Commercial |
$2,184.21
|
| Rate for Payer: Humana Commercial |
$1,954.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,885.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,696.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,023.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,724.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$459.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.74
|
| Rate for Payer: PHCS Commercial |
$2,207.20
|
| Rate for Payer: United Healthcare All Payer |
$2,023.27
|
|
|
INTMD WND REPAIR FACE/MM
|
Facility
|
OP
|
$2,299.17
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.89 |
| Max. Negotiated Rate |
$2,207.20 |
| Rate for Payer: Aetna Commercial |
$1,770.36
|
| Rate for Payer: Anthem Medicaid |
$790.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,793.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$1,149.59
|
| Rate for Payer: Cash Price |
$1,149.59
|
| Rate for Payer: Cigna Commercial |
$1,908.31
|
| Rate for Payer: First Health Commercial |
$2,184.21
|
| Rate for Payer: Humana Commercial |
$1,954.29
|
| Rate for Payer: Humana KY Medicaid |
$790.68
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$798.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,885.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,696.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,023.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,724.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$459.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$298.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$712.74
|
| Rate for Payer: PHCS Commercial |
$2,207.20
|
| Rate for Payer: United Healthcare All Payer |
$2,023.27
|
|
|
INTMD WND REPAIR FACE/MM
|
Professional
|
Both
|
$2,299.17
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.87 |
| Max. Negotiated Rate |
$2,299.17 |
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.87
|
| Rate for Payer: Anthem Medicaid |
$292.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,299.17
|
| Rate for Payer: Cash Price |
$1,149.59
|
| Rate for Payer: Cash Price |
$1,149.59
|
| Rate for Payer: Cigna Commercial |
$471.46
|
| Rate for Payer: Healthspan PPO |
$555.80
|
| Rate for Payer: Humana Medicaid |
$292.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.90
|
| Rate for Payer: Molina Healthcare Passport |
$292.06
|
| Rate for Payer: Multiplan PHCS |
$1,379.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,609.42
|
| Rate for Payer: UHCCP Medicaid |
$205.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.98
|
|
|
INTMD WND REPAIR FACE/MM(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
761P0148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.87 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$492.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.87
|
| Rate for Payer: Anthem Medicaid |
$292.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$471.46
|
| Rate for Payer: Healthspan PPO |
$555.80
|
| Rate for Payer: Humana Medicaid |
$292.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.90
|
| Rate for Payer: Molina Healthcare Passport |
$292.06
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$205.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.98
|
|
|
INTMD WND REPAIR FACE/MM(T
|
Facility
|
IP
|
$1,199.17
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
761T0148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$1,151.20 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.35
|
| Rate for Payer: Cash Price |
$599.58
|
| Rate for Payer: Cigna Commercial |
$995.31
|
| Rate for Payer: First Health Commercial |
$1,139.21
|
| Rate for Payer: Humana Commercial |
$1,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.27
|
| Rate for Payer: Ohio Health Group HMO |
$899.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.74
|
| Rate for Payer: PHCS Commercial |
$1,151.20
|
| Rate for Payer: United Healthcare All Payer |
$1,055.27
|
|
|
INTMD WND REPAIR FACE/MM(T
|
Facility
|
OP
|
$1,199.17
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
761T0148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.89 |
| Max. Negotiated Rate |
$1,151.20 |
| Rate for Payer: Aetna Commercial |
$923.36
|
| Rate for Payer: Anthem Medicaid |
$412.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$599.58
|
| Rate for Payer: Cash Price |
$599.58
|
| Rate for Payer: Cigna Commercial |
$995.31
|
| Rate for Payer: First Health Commercial |
$1,139.21
|
| Rate for Payer: Humana Commercial |
$1,019.29
|
| Rate for Payer: Humana KY Medicaid |
$412.39
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$416.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.27
|
| Rate for Payer: Ohio Health Group HMO |
$899.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.74
|
| Rate for Payer: PHCS Commercial |
$1,151.20
|
| Rate for Payer: United Healthcare All Payer |
$1,055.27
|
|
|
INTRAABDOMINAL PRESSURE TES(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320P0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$400.70 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Anthem Medicaid |
$75.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$400.70
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$75.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.63
|
| Rate for Payer: Molina Healthcare Passport |
$75.13
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.88
|
|
|
INTRAABDOMINAL PRESSURE TES(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320T0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
INTRAABDOMINAL PRESSURE TES(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320T0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Anthem Medicaid |
$75.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$649.00
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$400.70
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$75.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.63
|
| Rate for Payer: Molina Healthcare Passport |
$75.13
|
| Rate for Payer: Multiplan PHCS |
$389.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$454.30
|
| Rate for Payer: UHCCP Medicaid |
$227.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.88
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$623.04 |
| Rate for Payer: Aetna Commercial |
$499.73
|
| Rate for Payer: Anthem Medicaid |
$223.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.22
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$538.67
|
| Rate for Payer: First Health Commercial |
$616.55
|
| Rate for Payer: Humana Commercial |
$551.65
|
| Rate for Payer: Humana KY Medicaid |
$223.19
|
| Rate for Payer: Kentucky WC Medicaid |
$225.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$532.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$571.12
|
| Rate for Payer: Ohio Health Group HMO |
$486.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.19
|
| Rate for Payer: PHCS Commercial |
$623.04
|
| Rate for Payer: United Healthcare All Payer |
$571.12
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$623.04 |
| Rate for Payer: Aetna Commercial |
$499.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.22
|
| Rate for Payer: Cash Price |
$324.50
|
| Rate for Payer: Cigna Commercial |
$538.67
|
| Rate for Payer: First Health Commercial |
$616.55
|
| Rate for Payer: Humana Commercial |
$551.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$532.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$571.12
|
| Rate for Payer: Ohio Health Group HMO |
$486.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.19
|
| Rate for Payer: PHCS Commercial |
$623.04
|
| Rate for Payer: United Healthcare All Payer |
$571.12
|
|
|
INTRACRAN ANGIOPLSTY W/STEN(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
761P2287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,298.43 |
| Rate for Payer: Aetna Commercial |
$2,298.43
|
| Rate for Payer: Anthem Medicaid |
$1,105.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,160.33
|
| Rate for Payer: Healthspan PPO |
$1,794.56
|
| Rate for Payer: Humana Medicaid |
$1,105.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,792.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,127.96
|
| Rate for Payer: Molina Healthcare Passport |
$1,105.84
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,116.90
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,298.43 |
| Rate for Payer: Aetna Commercial |
$2,298.43
|
| Rate for Payer: Anthem Medicaid |
$1,105.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,160.33
|
| Rate for Payer: Healthspan PPO |
$1,794.56
|
| Rate for Payer: Humana Medicaid |
$1,105.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,792.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,127.96
|
| Rate for Payer: Molina Healthcare Passport |
$1,105.84
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,116.90
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,098.61 |
| Rate for Payer: Aetna Commercial |
$2,098.61
|
| Rate for Payer: Anthem Medicaid |
$1,056.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,974.15
|
| Rate for Payer: Healthspan PPO |
$1,638.54
|
| Rate for Payer: Humana Medicaid |
$1,056.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,662.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,077.98
|
| Rate for Payer: Molina Healthcare Passport |
$1,056.84
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,067.41
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
INTRACRANIAL ANGIOPLASTY(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
761P2286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,098.61 |
| Rate for Payer: Aetna Commercial |
$2,098.61
|
| Rate for Payer: Anthem Medicaid |
$1,056.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,974.15
|
| Rate for Payer: Healthspan PPO |
$1,638.54
|
| Rate for Payer: Humana Medicaid |
$1,056.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,662.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,077.98
|
| Rate for Payer: Molina Healthcare Passport |
$1,056.84
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,067.41
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$11,890.06
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$8,068.26 |
| Max. Negotiated Rate |
$11,890.06 |
| Rate for Payer: Anthem Medicaid |
$8,068.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,492.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,890.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,465.42
|
| Rate for Payer: Humana KY Medicaid |
$8,068.26
|
| Rate for Payer: Humana Medicare Advantage |
$8,492.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,148.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,191.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,229.62
|
|
