|
ANOSCOPY REMOVE FOR BODY
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
76102630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.65
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
761P2630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.28 |
| Max. Negotiated Rate |
$247.12 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Ambetter Exchange |
$80.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.28
|
| Rate for Payer: Anthem Medicaid |
$75.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$96.62
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$124.65
|
| Rate for Payer: Healthspan PPO |
$247.12
|
| Rate for Payer: Humana Medicaid |
$75.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.44
|
| Rate for Payer: Molina Healthcare Passport |
$75.92
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.68
|
| Rate for Payer: UHCCP Medicaid |
$75.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.52
|
|
|
ANOSCOPY REMOVE FOR BODY
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
76102630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.01 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$98.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$98.01
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.65
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ANOSCOPY - REMOVE LESION
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANOSCOPY - REMOVE LESION
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$117.21
|
| Rate for Payer: Ambetter Exchange |
$75.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.04
|
| Rate for Payer: Anthem Medicaid |
$65.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.08
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$113.49
|
| Rate for Payer: Healthspan PPO |
$244.19
|
| Rate for Payer: Humana Medicaid |
$65.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.48
|
| Rate for Payer: Molina Healthcare Passport |
$65.18
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.67
|
| Rate for Payer: UHCCP Medicaid |
$65.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.90
|
|
|
ANOSCOPY - REMOVE LESION
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
76101928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| 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 |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ANOSCOPY - REMOVE LESION(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 46610
|
| Hospital Charge Code |
761P1928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$117.21
|
| Rate for Payer: Ambetter Exchange |
$75.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.04
|
| Rate for Payer: Anthem Medicaid |
$65.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.08
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$113.49
|
| Rate for Payer: Healthspan PPO |
$244.19
|
| Rate for Payer: Humana Medicaid |
$65.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.48
|
| Rate for Payer: Molina Healthcare Passport |
$65.18
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.67
|
| Rate for Payer: UHCCP Medicaid |
$65.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.90
|
|
|
ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 46606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
ANSCOPE REMOV LESION
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$399.36 |
| Rate for Payer: Aetna Commercial |
$320.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$324.48
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$345.28
|
| Rate for Payer: First Health Commercial |
$395.20
|
| Rate for Payer: Humana Commercial |
$353.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.08
|
| Rate for Payer: Ohio Health Group HMO |
$312.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.04
|
| Rate for Payer: PHCS Commercial |
$399.36
|
| Rate for Payer: United Healthcare All Payer |
$366.08
|
|
|
ANSCOPE REMOV LESION
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$295.65 |
| Rate for Payer: Aetna Commercial |
$146.67
|
| Rate for Payer: Ambetter Exchange |
$91.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.22
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$193.89
|
| Rate for Payer: Healthspan PPO |
$295.65
|
| Rate for Payer: Humana Medicaid |
$110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.03
|
| Rate for Payer: Molina Healthcare Passport |
$110.81
|
| Rate for Payer: Multiplan PHCS |
$249.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.33
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.02
|
|
|
ANSCOPE REMOV LESION
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
76101930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$320.32
|
| Rate for Payer: Anthem Medicaid |
$143.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$324.48
|
| 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 |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$345.28
|
| Rate for Payer: First Health Commercial |
$395.20
|
| Rate for Payer: Humana Commercial |
$353.60
|
| Rate for Payer: Humana KY Medicaid |
$143.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$144.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.08
|
| Rate for Payer: Ohio Health Group HMO |
$312.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.04
|
| Rate for Payer: PHCS Commercial |
$399.36
|
| Rate for Payer: United Healthcare All Payer |
$366.08
|
|
|
ANSCOPE REMOV LESION(P
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 46612
|
| Hospital Charge Code |
761P1930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$295.65 |
| Rate for Payer: Aetna Commercial |
$146.67
|
| Rate for Payer: Ambetter Exchange |
$91.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.22
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cigna Commercial |
$193.89
|
| Rate for Payer: Healthspan PPO |
$295.65
|
| Rate for Payer: Humana Medicaid |
$110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.03
|
| Rate for Payer: Molina Healthcare Passport |
$110.81
|
| Rate for Payer: Multiplan PHCS |
$249.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.33
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.02
|
|
|
ANSEL GUIDE SHEATH 6FR 90CM
|
Facility
|
IP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
ANSEL GUIDE SHEATH 6FR 90CM
|
Facility
|
OP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem Medicaid |
$644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Humana KY Medicaid |
$644.40
|
| Rate for Payer: Kentucky WC Medicaid |
$650.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
ANSEL GUIDE SHEATH 7FR 90CM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ANSEL GUIDE SHEATH 7FR 90CM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ANSEL SHEATH 5F
|
Facility
|
IP
|
$1,896.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.02 |
| Max. Negotiated Rate |
$1,820.88 |
| Rate for Payer: Aetna Commercial |
$1,460.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.46
|
| Rate for Payer: Cash Price |
$948.38
|
| Rate for Payer: Cigna Commercial |
$1,574.30
|
| Rate for Payer: First Health Commercial |
$1,801.91
|
| Rate for Payer: Humana Commercial |
$1,612.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.76
|
| Rate for Payer: PHCS Commercial |
$1,820.88
|
| Rate for Payer: United Healthcare All Payer |
$1,669.14
|
|
|
ANSEL SHEATH 5F
|
Facility
|
OP
|
$1,896.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.02 |
| Max. Negotiated Rate |
$1,820.88 |
| Rate for Payer: Aetna Commercial |
$1,460.50
|
| Rate for Payer: Anthem Medicaid |
$652.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,479.46
|
| Rate for Payer: Cash Price |
$948.38
|
| Rate for Payer: Cigna Commercial |
$1,574.30
|
| Rate for Payer: First Health Commercial |
$1,801.91
|
| Rate for Payer: Humana Commercial |
$1,612.24
|
| Rate for Payer: Humana KY Medicaid |
$652.29
|
| Rate for Payer: Kentucky WC Medicaid |
$658.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.76
|
| Rate for Payer: PHCS Commercial |
$1,820.88
|
| Rate for Payer: United Healthcare All Payer |
$1,669.14
|
|
|
ANSEL SHEATH 6F 45CM
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
ANSEL SHEATH 6F 45CM
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
ANSEL SHEATH HI FLEX 5F
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ANSEL SHEATH HI FLEX 5F
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ANTACID CHOICE (MI-ACID)(15ML)
|
Facility
|
IP
|
$11.78
|
|
|
Service Code
|
NDC 121176230
|
| Hospital Charge Code |
25002836
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.19
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: Cigna Commercial |
$9.78
|
| Rate for Payer: First Health Commercial |
$11.19
|
| Rate for Payer: Humana Commercial |
$10.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.37
|
| Rate for Payer: Ohio Health Group HMO |
$8.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.13
|
| Rate for Payer: PHCS Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Payer |
$10.37
|
|
|
ANTACID CHOICE (MI-ACID)(15ML)
|
Facility
|
OP
|
$11.78
|
|
|
Service Code
|
NDC 121176230
|
| Hospital Charge Code |
25002836
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Anthem Medicaid |
$4.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.19
|
| Rate for Payer: Cash Price |
$5.89
|
| Rate for Payer: Cigna Commercial |
$9.78
|
| Rate for Payer: First Health Commercial |
$11.19
|
| Rate for Payer: Humana Commercial |
$10.01
|
| Rate for Payer: Humana KY Medicaid |
$4.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.37
|
| Rate for Payer: Ohio Health Group HMO |
$8.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.13
|
| Rate for Payer: PHCS Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Payer |
$10.37
|
|
|
ANTEPARTUM CARE 4-6 VISITS
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
72000019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Aetna Commercial |
$564.50
|
| Rate for Payer: Ambetter Exchange |
$414.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$414.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.39
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$643.14
|
| Rate for Payer: Healthspan PPO |
$510.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$427.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$414.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.49
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$538.84
|
| Rate for Payer: UHCCP Medicaid |
$233.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.49
|
|
