|
MECHANICAL TRACTION
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
MECHANICAL TRACTION
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Professional
|
Both
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$1,093.77 |
| Rate for Payer: Aetna Commercial |
$275.00
|
| Rate for Payer: Anthem Medicaid |
$70.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,093.77
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$189.41
|
| Rate for Payer: Healthspan PPO |
$257.68
|
| Rate for Payer: Humana Medicaid |
$70.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.76
|
| Rate for Payer: Molina Healthcare Passport |
$70.35
|
| Rate for Payer: Multiplan PHCS |
$656.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$765.64
|
| Rate for Payer: UHCCP Medicaid |
$382.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.05
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Facility
|
IP
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.19 |
| Max. Negotiated Rate |
$1,050.02 |
| Rate for Payer: Aetna Commercial |
$842.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.14
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$907.83
|
| Rate for Payer: First Health Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial |
$929.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$896.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.52
|
| Rate for Payer: Ohio Health Group HMO |
$820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.07
|
| Rate for Payer: PHCS Commercial |
$1,050.02
|
| Rate for Payer: United Healthcare All Payer |
$962.52
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Facility
|
OP
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.19 |
| Max. Negotiated Rate |
$1,050.02 |
| Rate for Payer: Aetna Commercial |
$842.20
|
| Rate for Payer: Anthem Medicaid |
$376.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.14
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$907.83
|
| Rate for Payer: First Health Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial |
$929.70
|
| Rate for Payer: Humana KY Medicaid |
$376.15
|
| Rate for Payer: Kentucky WC Medicaid |
$379.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$896.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.52
|
| Rate for Payer: Ohio Health Group HMO |
$820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.07
|
| Rate for Payer: PHCS Commercial |
$1,050.02
|
| Rate for Payer: United Healthcare All Payer |
$962.52
|
|
|
MECH REMVL PERICTH OBSTMAT(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
761P2442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$275.00
|
| Rate for Payer: Anthem Medicaid |
$70.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$189.41
|
| Rate for Payer: Healthspan PPO |
$257.68
|
| Rate for Payer: Humana Medicaid |
$70.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.76
|
| Rate for Payer: Molina Healthcare Passport |
$70.35
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.05
|
|
|
MECH REMVL PERICTH OBSTMAT(T
|
Facility
|
IP
|
$868.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
761T2442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$834.02 |
| Rate for Payer: Aetna Commercial |
$668.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$677.64
|
| Rate for Payer: Cash Price |
$434.38
|
| Rate for Payer: Cigna Commercial |
$721.08
|
| Rate for Payer: First Health Commercial |
$825.33
|
| Rate for Payer: Humana Commercial |
$738.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.52
|
| Rate for Payer: Ohio Health Group HMO |
$651.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.32
|
| Rate for Payer: PHCS Commercial |
$834.02
|
| Rate for Payer: United Healthcare All Payer |
$764.52
|
|
|
MECH REMVL PERICTH OBSTMAT(T
|
Facility
|
OP
|
$868.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
761T2442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$834.02 |
| Rate for Payer: Aetna Commercial |
$668.95
|
| Rate for Payer: Anthem Medicaid |
$298.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$677.64
|
| Rate for Payer: Cash Price |
$434.38
|
| Rate for Payer: Cigna Commercial |
$721.08
|
| Rate for Payer: First Health Commercial |
$825.33
|
| Rate for Payer: Humana Commercial |
$738.45
|
| Rate for Payer: Humana KY Medicaid |
$298.77
|
| Rate for Payer: Kentucky WC Medicaid |
$301.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$304.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.52
|
| Rate for Payer: Ohio Health Group HMO |
$651.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.32
|
| Rate for Payer: PHCS Commercial |
$834.02
|
| Rate for Payer: United Healthcare All Payer |
$764.52
|
|
|
MECKELS DIVERT EXAM
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
MECKELS DIVERT EXAM
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
MECKELS DIVERT EXAM
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$418.68
|
| Rate for Payer: Anthem Medicaid |
$111.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: Healthspan PPO |
$418.46
|
| Rate for Payer: Humana Medicaid |
$111.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.87
|
| Rate for Payer: Molina Healthcare Passport |
$111.64
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.60
|
| Rate for Payer: UHCCP Medicaid |
$261.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.76
|
|
|
MECKELS DIVERT EXAM(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
340P0013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$418.68 |
| Rate for Payer: Aetna Commercial |
$418.68
|
| Rate for Payer: Anthem Medicaid |
$111.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: Healthspan PPO |
$418.46
|
| Rate for Payer: Humana Medicaid |
$111.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.87
|
| Rate for Payer: Molina Healthcare Passport |
$111.64
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.76
|
|
|
MECKELS DIVERT EXAM(T
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
340T0013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.44
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$496.34
|
| Rate for Payer: First Health Commercial |
$568.10
|
| Rate for Payer: Humana Commercial |
$508.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$490.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$441.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$526.24
|
| Rate for Payer: Ohio Health Group HMO |
$448.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.38
|
| Rate for Payer: PHCS Commercial |
$574.08
|
| Rate for Payer: United Healthcare All Payer |
$526.24
|
|
|
MECKELS DIVERT EXAM(T
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
340T0013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Anthem Medicaid |
$205.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$496.34
|
| Rate for Payer: First Health Commercial |
$568.10
|
| Rate for Payer: Humana Commercial |
$508.30
|
| Rate for Payer: Humana KY Medicaid |
$205.65
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$207.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$490.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$441.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$209.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$526.24
|
| Rate for Payer: Ohio Health Group HMO |
$448.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.38
|
| Rate for Payer: PHCS Commercial |
$574.08
|
| Rate for Payer: United Healthcare All Payer |
$526.24
|
|
|
MEDIALISED RETN HUM CUP DIA 36
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
MEDIALISED RETN HUM CUP DIA 36
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
MEDIALISED RETN HUM CUP DIA 42
|
Facility
|
OP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem Medicaid |
$2,702.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Humana KY Medicaid |
$2,702.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
MEDIALISED RETN HUM CUP DIA 42
|
Facility
|
IP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
MEDIASTINOSCPY W/LMPH NOD B(P
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
761P1620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Anthem Medicaid |
$330.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$746.72
|
| Rate for Payer: Humana Medicaid |
$330.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$337.27
|
| Rate for Payer: Molina Healthcare Passport |
$330.66
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.97
|
|
|
MEDIASTINOSCPY W/LMPH NOD BX
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
76101620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Anthem Medicaid |
$330.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$746.72
|
| Rate for Payer: Humana Medicaid |
$330.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$337.27
|
| Rate for Payer: Molina Healthcare Passport |
$330.66
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.97
|
|
|
MEDIASTINOSCPY W/LMPH NOD BX
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
76101620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Humana KY Medicaid |
$285.44
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
MEDIASTINOSCPY W/LMPH NOD BX
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
76101620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
MEDIASTINOSCPY W/MEDSTNL BX
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 39401
|
| Hospital Charge Code |
76101619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
MEDIASTINOSCPY W/MEDSTNL BX
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 39401
|
| Hospital Charge Code |
76101619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
MEDIASTINOSCPY W/MEDSTNL BX
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 39401
|
| Hospital Charge Code |
76101619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Anthem Medicaid |
$253.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$571.22
|
| Rate for Payer: Humana Medicaid |
$253.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$404.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.16
|
| Rate for Payer: Molina Healthcare Passport |
$253.10
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$217.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.63
|
|
