|
650 40MM RETENTVE POLY LNR+3MM
|
Facility
|
IP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
6 FR ANGIO SEAL VIP 610130
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
6 FR ANGIO SEAL VIP 610130
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
6FR AR MOD 100CM
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$163.36 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.73
|
| Rate for Payer: Cash Price |
$85.08
|
| Rate for Payer: Cigna Commercial |
$141.24
|
| Rate for Payer: First Health Commercial |
$161.66
|
| Rate for Payer: Humana Commercial |
$144.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.75
|
| Rate for Payer: Ohio Health Group HMO |
$127.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.42
|
| Rate for Payer: PHCS Commercial |
$163.36
|
| Rate for Payer: United Healthcare All Payer |
$149.75
|
|
|
6FR AR MOD 100CM
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$163.36 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Anthem Medicaid |
$58.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.73
|
| Rate for Payer: Cash Price |
$85.08
|
| Rate for Payer: Cigna Commercial |
$141.24
|
| Rate for Payer: First Health Commercial |
$161.66
|
| Rate for Payer: Humana Commercial |
$144.64
|
| Rate for Payer: Humana KY Medicaid |
$58.52
|
| Rate for Payer: Kentucky WC Medicaid |
$59.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.75
|
| Rate for Payer: Ohio Health Group HMO |
$127.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.42
|
| Rate for Payer: PHCS Commercial |
$163.36
|
| Rate for Payer: United Healthcare All Payer |
$149.75
|
|
|
7 FR SHEATH
|
Facility
|
IP
|
$496.62
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.99 |
| Max. Negotiated Rate |
$476.76 |
| Rate for Payer: Aetna Commercial |
$382.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.36
|
| Rate for Payer: Cash Price |
$248.31
|
| Rate for Payer: Cigna Commercial |
$412.19
|
| Rate for Payer: First Health Commercial |
$471.79
|
| Rate for Payer: Humana Commercial |
$422.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.03
|
| Rate for Payer: Ohio Health Group HMO |
$372.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.67
|
| Rate for Payer: PHCS Commercial |
$476.76
|
| Rate for Payer: United Healthcare All Payer |
$437.03
|
|
|
7 FR SHEATH
|
Facility
|
OP
|
$496.62
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.99 |
| Max. Negotiated Rate |
$476.76 |
| Rate for Payer: Aetna Commercial |
$382.40
|
| Rate for Payer: Anthem Medicaid |
$170.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$387.36
|
| Rate for Payer: Cash Price |
$248.31
|
| Rate for Payer: Cigna Commercial |
$412.19
|
| Rate for Payer: First Health Commercial |
$471.79
|
| Rate for Payer: Humana Commercial |
$422.13
|
| Rate for Payer: Humana KY Medicaid |
$170.79
|
| Rate for Payer: Kentucky WC Medicaid |
$172.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$407.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$437.03
|
| Rate for Payer: Ohio Health Group HMO |
$372.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.67
|
| Rate for Payer: PHCS Commercial |
$476.76
|
| Rate for Payer: United Healthcare All Payer |
$437.03
|
|
|
8FR. ANGIO SEAL VIP 610131
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
8FR. ANGIO SEAL VIP 610131
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Professional
|
Both
|
$396.00
|
|
| Hospital Charge Code |
34000047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Multiplan PHCS |
$237.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.20
|
| Rate for Payer: UHCCP Medicaid |
$138.60
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
340T0047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$304.92
|
| Rate for Payer: Anthem Medicaid |
$136.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.88
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$328.68
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: Humana Commercial |
$336.60
|
| Rate for Payer: Humana KY Medicaid |
$136.18
|
| Rate for Payer: Kentucky WC Medicaid |
$137.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.48
|
| Rate for Payer: Ohio Health Group HMO |
$297.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.24
|
| Rate for Payer: PHCS Commercial |
$380.16
|
| Rate for Payer: United Healthcare All Payer |
$348.48
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
340T0047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$304.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.88
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$328.68
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: Humana Commercial |
$336.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.48
|
| Rate for Payer: Ohio Health Group HMO |
$297.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.24
|
| Rate for Payer: PHCS Commercial |
$380.16
|
| Rate for Payer: United Healthcare All Payer |
$348.48
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34000047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$304.92
|
| Rate for Payer: Anthem Medicaid |
$136.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.88
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$328.68
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: Humana Commercial |
$336.60
|
| Rate for Payer: Humana KY Medicaid |
$136.18
|
| Rate for Payer: Kentucky WC Medicaid |
$137.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.48
|
| Rate for Payer: Ohio Health Group HMO |
$297.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.24
|
| Rate for Payer: PHCS Commercial |
$380.16
|
| Rate for Payer: United Healthcare All Payer |
$348.48
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34000047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$118.80 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$304.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.88
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$328.68
|
| Rate for Payer: First Health Commercial |
$376.20
|
| Rate for Payer: Humana Commercial |
$336.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.48
|
| Rate for Payer: Ohio Health Group HMO |
$297.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.24
|
| Rate for Payer: PHCS Commercial |
$380.16
|
| Rate for Payer: United Healthcare All Payer |
$348.48
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
ABCESS FLUID DRAIN COMPPROC (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
ABCESS FLUID DRAIN COMPPROC (T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
ABCESS FLUID DRAIN COMPPROC (T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320T0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,675.48 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem Medicaid |
$1,675.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$4,043.76
|
| Rate for Payer: First Health Commercial |
$4,628.40
|
| Rate for Payer: Humana Commercial |
$4,141.20
|
| Rate for Payer: Humana KY Medicaid |
$1,675.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,692.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,995.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,595.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,709.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,287.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,238.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,361.68
|
| Rate for Payer: PHCS Commercial |
$4,677.12
|
| Rate for Payer: United Healthcare All Payer |
$4,287.36
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
IP
|
$5,172.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,551.60 |
| Max. Negotiated Rate |
$4,965.12 |
| Rate for Payer: Aetna Commercial |
$3,982.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.16
|
| Rate for Payer: Cash Price |
$2,586.00
|
| Rate for Payer: Cigna Commercial |
$4,292.76
|
| Rate for Payer: First Health Commercial |
$4,913.40
|
| Rate for Payer: Humana Commercial |
$4,396.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,816.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,499.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.68
|
| Rate for Payer: PHCS Commercial |
$4,965.12
|
| Rate for Payer: United Healthcare All Payer |
$4,551.36
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320P0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$760.20 |
| Rate for Payer: Aetna Commercial |
$492.09
|
| Rate for Payer: Ambetter Exchange |
$144.57
|
| Rate for Payer: Anthem Medicaid |
$410.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.48
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$760.20
|
| Rate for Payer: Healthspan PPO |
$461.10
|
| Rate for Payer: Humana Medicaid |
$410.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.14
|
| Rate for Payer: Molina Healthcare Passport |
$410.92
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.94
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.57
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320T0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$4,043.76
|
| Rate for Payer: First Health Commercial |
$4,628.40
|
| Rate for Payer: Humana Commercial |
$4,141.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,995.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,595.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,287.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,238.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,361.68
|
| Rate for Payer: PHCS Commercial |
$4,677.12
|
| Rate for Payer: United Healthcare All Payer |
$4,287.36
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Professional
|
Both
|
$5,172.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.61 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$492.09
|
| Rate for Payer: Ambetter Exchange |
$144.57
|
| Rate for Payer: Anthem Medicaid |
$410.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.48
|
| Rate for Payer: Cash Price |
$2,586.00
|
| Rate for Payer: Cash Price |
$2,586.00
|
| Rate for Payer: Cigna Commercial |
$760.20
|
| Rate for Payer: Healthspan PPO |
$461.10
|
| Rate for Payer: Humana Medicaid |
$410.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.14
|
| Rate for Payer: Molina Healthcare Passport |
$410.92
|
| Rate for Payer: Multiplan PHCS |
$3,103.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.94
|
| Rate for Payer: UHCCP Medicaid |
$1,810.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.57
|
|
