|
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: Ambetter Exchange |
$197.86
|
| Rate for Payer: Anthem Medicaid |
$70.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.43
|
| 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 |
$257.69
|
| Rate for Payer: Humana Medicaid |
$70.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.86
|
| 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 |
$257.22
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.86
|
|
|
MECH REMVL PERICTH OBSTMAT(T
|
Facility
|
OP
|
$868.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
761T2442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.63 |
| 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 |
$695.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$755.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.45
|
| Rate for Payer: PHCS Commercial |
$834.02
|
| Rate for Payer: United Healthcare All Payer |
$764.52
|
|
|
MECH REMVL PERICTH OBSTMAT(T
|
Facility
|
IP
|
$868.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
761T2442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.63 |
| 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 |
$695.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$755.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.45
|
| Rate for Payer: PHCS Commercial |
$834.02
|
| Rate for Payer: United Healthcare All Payer |
$764.52
|
|
|
MECKELS DIVERT EXAM
|
Facility
|
OP
|
$769.30
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$264.56 |
| Max. Negotiated Rate |
$738.53 |
| Rate for Payer: Aetna Commercial |
$592.36
|
| Rate for Payer: Anthem Medicaid |
$264.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$384.65
|
| Rate for Payer: Cash Price |
$384.65
|
| Rate for Payer: Cigna Commercial |
$638.52
|
| Rate for Payer: First Health Commercial |
$730.84
|
| Rate for Payer: Humana Commercial |
$653.90
|
| Rate for Payer: Humana KY Medicaid |
$264.56
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$267.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.98
|
| Rate for Payer: Ohio Health Group HMO |
$576.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.82
|
| Rate for Payer: PHCS Commercial |
$738.53
|
| Rate for Payer: United Healthcare All Payer |
$676.98
|
|
|
MECKELS DIVERT EXAM
|
Facility
|
IP
|
$769.30
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$230.79 |
| Max. Negotiated Rate |
$738.53 |
| Rate for Payer: Aetna Commercial |
$592.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.05
|
| Rate for Payer: Cash Price |
$384.65
|
| Rate for Payer: Cigna Commercial |
$638.52
|
| Rate for Payer: First Health Commercial |
$730.84
|
| Rate for Payer: Humana Commercial |
$653.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.98
|
| Rate for Payer: Ohio Health Group HMO |
$576.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.82
|
| Rate for Payer: PHCS Commercial |
$738.53
|
| Rate for Payer: United Healthcare All Payer |
$676.98
|
|
|
MECKELS DIVERT EXAM
|
Professional
|
Both
|
$769.30
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
34000013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$461.58 |
| Rate for Payer: Aetna Commercial |
$418.68
|
| Rate for Payer: Ambetter Exchange |
$263.06
|
| Rate for Payer: Anthem Medicaid |
$111.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$263.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$263.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$315.67
|
| Rate for Payer: Cash Price |
$384.65
|
| Rate for Payer: Cash Price |
$384.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$263.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.87
|
| Rate for Payer: Molina Healthcare Passport |
$111.64
|
| Rate for Payer: Multiplan PHCS |
$461.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$341.98
|
| Rate for Payer: UHCCP Medicaid |
$269.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$263.06
|
|
|
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: Ambetter Exchange |
$263.06
|
| Rate for Payer: Anthem Medicaid |
$111.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$263.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$263.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$315.67
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$263.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.06
|
| 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 |
$341.98
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$263.06
|
|
|
MECKELS DIVERT EXAM(T
|
Facility
|
IP
|
$619.30
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
340T0013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$185.79 |
| Max. Negotiated Rate |
$594.53 |
| Rate for Payer: Aetna Commercial |
$476.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.05
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cigna Commercial |
$514.02
|
| Rate for Payer: First Health Commercial |
$588.34
|
| Rate for Payer: Humana Commercial |
$526.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$507.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$544.98
|
| Rate for Payer: Ohio Health Group HMO |
$464.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.32
|
| Rate for Payer: PHCS Commercial |
$594.53
|
| Rate for Payer: United Healthcare All Payer |
$544.98
|
|
|
MECKELS DIVERT EXAM(T
|
Facility
|
OP
|
$619.30
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
340T0013
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$212.98 |
| Max. Negotiated Rate |
$594.53 |
| Rate for Payer: Aetna Commercial |
$476.86
|
| Rate for Payer: Anthem Medicaid |
$212.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cash Price |
$309.65
|
| Rate for Payer: Cigna Commercial |
$514.02
|
| Rate for Payer: First Health Commercial |
$588.34
|
| Rate for Payer: Humana Commercial |
$526.40
|
| Rate for Payer: Humana KY Medicaid |
$212.98
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$215.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$507.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$544.98
|
| Rate for Payer: Ohio Health Group HMO |
$464.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.32
|
| Rate for Payer: PHCS Commercial |
$594.53
|
| Rate for Payer: United Healthcare All Payer |
$544.98
|
|
|
MEDIALISED RETN HUM CUP DIA 36
|
Facility
|
OP
|
$7,599.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.70 |
| Max. Negotiated Rate |
$7,295.04 |
| Rate for Payer: Aetna Commercial |
$5,851.23
|
| Rate for Payer: Anthem Medicaid |
$2,613.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.22
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: Cigna Commercial |
$6,307.17
|
| Rate for Payer: First Health Commercial |
$7,219.05
|
| Rate for Payer: Humana Commercial |
$6,459.15
|
| Rate for Payer: Humana KY Medicaid |
$2,613.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,611.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,243.31
|
| Rate for Payer: PHCS Commercial |
$7,295.04
|
| Rate for Payer: United Healthcare All Payer |
$6,687.12
|
|
|
MEDIALISED RETN HUM CUP DIA 36
|
Facility
|
IP
|
$7,599.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.70 |
| Max. Negotiated Rate |
$7,295.04 |
| Rate for Payer: Aetna Commercial |
$5,851.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.22
|
| Rate for Payer: Cash Price |
$3,799.50
|
| Rate for Payer: Cigna Commercial |
$6,307.17
|
| Rate for Payer: First Health Commercial |
$7,219.05
|
| Rate for Payer: Humana Commercial |
$6,459.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,611.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,243.31
|
| Rate for Payer: PHCS Commercial |
$7,295.04
|
| Rate for Payer: United Healthcare All Payer |
$6,687.12
|
|
|
MEDIALISED RETN HUM CUP DIA 42
|
Facility
|
IP
|
$8,058.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.67 |
| Max. Negotiated Rate |
$7,736.54 |
| Rate for Payer: Aetna Commercial |
$6,205.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.94
|
| Rate for Payer: Cash Price |
$4,029.45
|
| Rate for Payer: Cigna Commercial |
$6,688.89
|
| Rate for Payer: First Health Commercial |
$7,655.95
|
| Rate for Payer: Humana Commercial |
$6,850.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,608.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,044.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,447.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,011.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.64
|
| Rate for Payer: PHCS Commercial |
$7,736.54
|
| Rate for Payer: United Healthcare All Payer |
$7,091.83
|
|
|
MEDIALISED RETN HUM CUP DIA 42
|
Facility
|
OP
|
$8,058.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.67 |
| Max. Negotiated Rate |
$7,736.54 |
| Rate for Payer: Aetna Commercial |
$6,205.35
|
| Rate for Payer: Anthem Medicaid |
$2,771.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,285.94
|
| Rate for Payer: Cash Price |
$4,029.45
|
| Rate for Payer: Cigna Commercial |
$6,688.89
|
| Rate for Payer: First Health Commercial |
$7,655.95
|
| Rate for Payer: Humana Commercial |
$6,850.06
|
| Rate for Payer: Humana KY Medicaid |
$2,771.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,608.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,947.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,827.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,091.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,044.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,447.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,011.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,560.64
|
| Rate for Payer: PHCS Commercial |
$7,736.54
|
| Rate for Payer: United Healthcare All Payer |
$7,091.83
|
|
|
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 |
$746.72 |
| Rate for Payer: Ambetter Exchange |
$380.58
|
| Rate for Payer: Anthem Medicaid |
$330.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$380.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.58
|
| 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 |
$494.75
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.58
|
|
|
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 |
$746.72 |
| Rate for Payer: Ambetter Exchange |
$380.58
|
| Rate for Payer: Anthem Medicaid |
$330.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$380.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.58
|
| 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 |
$494.75
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.58
|
|
|
MEDIASTINOSCPY W/LMPH NOD BX
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
76101620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.00 |
| 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 |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.70
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
MEDIASTINOSCPY W/LMPH NOD BX
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 39402
|
| Hospital Charge Code |
76101620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.44 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| 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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.70
|
| 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 |
$213.22 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| 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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| 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 |
$186.00 |
| 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 |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| 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 |
$571.22 |
| Rate for Payer: Ambetter Exchange |
$291.30
|
| Rate for Payer: Anthem Medicaid |
$253.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$291.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$291.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$349.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$291.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.30
|
| 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 |
$378.69
|
| Rate for Payer: UHCCP Medicaid |
$217.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$291.30
|
|
|
MEDIASTINOSCPY W/MEDSTNL BX(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 39401
|
| Hospital Charge Code |
761P1619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$571.22 |
| Rate for Payer: Ambetter Exchange |
$291.30
|
| Rate for Payer: Anthem Medicaid |
$253.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$291.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$291.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$349.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$291.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.30
|
| 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 |
$378.69
|
| Rate for Payer: UHCCP Medicaid |
$217.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$291.30
|
|
|
MEDIASTINOTOMY
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 39000
|
| Hospital Charge Code |
76101615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$761.27 |
| Rate for Payer: Aetna Commercial |
$739.27
|
| Rate for Payer: Ambetter Exchange |
$476.63
|
| Rate for Payer: Anthem Medicaid |
$336.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$571.96
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$761.27
|
| Rate for Payer: Healthspan PPO |
$591.12
|
| Rate for Payer: Humana Medicaid |
$336.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$653.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.83
|
| Rate for Payer: Molina Healthcare Passport |
$336.11
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.62
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.63
|
|
|
MEDIASTINOTOMY
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 39000
|
| Hospital Charge Code |
76101615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
MEDIASTINOTOMY
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 39000
|
| Hospital Charge Code |
76101615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
MEDIASTINOTOMY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 39000
|
| Hospital Charge Code |
761P1615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.11 |
| Max. Negotiated Rate |
$761.27 |
| Rate for Payer: Aetna Commercial |
$739.27
|
| Rate for Payer: Ambetter Exchange |
$476.63
|
| Rate for Payer: Anthem Medicaid |
$336.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$571.96
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$761.27
|
| Rate for Payer: Healthspan PPO |
$591.12
|
| Rate for Payer: Humana Medicaid |
$336.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$653.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.83
|
| Rate for Payer: Molina Healthcare Passport |
$336.11
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.62
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.63
|
|
