|
IR FNA BX W/FLUOR GDN EA AD (T
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
761T2781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.14
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem Medicaid |
$240.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Humana KY Medicaid |
$240.04
|
| Rate for Payer: Kentucky WC Medicaid |
$242.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$244.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.38
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.38
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
IR FNA BX W/US GDN EA ADDL
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76102779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$698.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$40.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$698.00
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$40.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.53
|
| Rate for Payer: Molina Healthcare Passport |
$40.72
|
| Rate for Payer: Multiplan PHCS |
$418.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.60
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.13
|
|
|
IR FNA BX W/US GDN EA ADDL (P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761P2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$40.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.00
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$40.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.53
|
| Rate for Payer: Molina Healthcare Passport |
$40.72
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.50
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.13
|
|
|
IR FNA BX W/US GDN EA ADDL (T
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
IR FNA BX W/US GDN EA ADDL (T
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T2779
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
IR LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
76102542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
IR LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
76102542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
IR LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$2,734.00
|
|
| Hospital Charge Code |
76102543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem Medicaid |
$940.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Humana KY Medicaid |
$940.22
|
| Rate for Payer: Kentucky WC Medicaid |
$949.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$959.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
IR LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$2,734.00
|
|
| Hospital Charge Code |
76102543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
IR LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$3,989.00
|
|
| Hospital Charge Code |
76102544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem Medicaid |
$1,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Humana KY Medicaid |
$1,371.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
IR LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$3,989.00
|
|
| Hospital Charge Code |
76102544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
IR LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
76102545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
IR LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
76102545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem Medicaid |
$1,465.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Humana KY Medicaid |
$1,465.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
IRON BINDING CAPACITY
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.74
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$8.74
|
| Rate for Payer: Kentucky WC Medicaid |
$8.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
IRON BINDING CAPACITY
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$7.67
|
| Rate for Payer: Healthspan PPO |
$9.16
|
| Rate for Payer: Multiplan PHCS |
$44.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.80
|
| Rate for Payer: UHCCP Medicaid |
$25.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.24
|
|
|
IRON BINDING CAPACITY
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
30000432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.42
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
IRON MAN WIRE 300CM
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
IRON MAN WIRE 300CM
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
IRON SERUM
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
IRON SERUM
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$5.78
|
| Rate for Payer: Healthspan PPO |
$6.79
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.60
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.88
|
|
|
IRON SERUM
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.63
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
IR PLMT URETERAL STENT
|
Professional
|
Both
|
$7,676.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.98 |
| Max. Negotiated Rate |
$7,676.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$178.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,676.00
|
| Rate for Payer: Cash Price |
$3,838.00
|
| Rate for Payer: Cash Price |
$3,838.00
|
| Rate for Payer: Cigna Commercial |
$365.04
|
| Rate for Payer: Humana Medicaid |
$178.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.23
|
| Rate for Payer: Molina Healthcare Passport |
$178.66
|
| Rate for Payer: Multiplan PHCS |
$4,605.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,373.20
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.45
|
|
|
IR PLMT URETERAL STENT
|
Facility
|
OP
|
$7,676.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$997.88 |
| Max. Negotiated Rate |
$7,368.96 |
| Rate for Payer: Aetna Commercial |
$5,910.52
|
| Rate for Payer: Anthem Medicaid |
$2,639.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$3,838.00
|
| Rate for Payer: Cash Price |
$3,838.00
|
| Rate for Payer: Cigna Commercial |
$6,371.08
|
| Rate for Payer: First Health Commercial |
$7,292.20
|
| Rate for Payer: Humana Commercial |
$6,524.60
|
| Rate for Payer: Humana KY Medicaid |
$2,639.78
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,757.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.56
|
| Rate for Payer: PHCS Commercial |
$7,368.96
|
| Rate for Payer: United Healthcare All Payer |
$6,754.88
|
|
