|
OBSERVATION INITIAL HOUR
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200024
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OBSERVATION INITIAL HOUR
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200024
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$218.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$218.72
|
| Rate for Payer: Kentucky WC Medicaid |
$220.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OBS INITIAL ASSESS DIR ADMIT
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$777.62 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$218.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$555.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$777.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$749.84
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$218.72
|
| Rate for Payer: Humana Medicare Advantage |
$555.44
|
| Rate for Payer: Kentucky WC Medicaid |
$220.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OBS INITIAL ASSESS DIR ADMIT
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem Medicaid |
$337.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Humana KY Medicaid |
$337.71
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$341.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.42
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$942.72 |
| Rate for Payer: Aetna Commercial |
$756.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.96
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$815.06
|
| Rate for Payer: First Health Commercial |
$932.90
|
| Rate for Payer: Humana Commercial |
$834.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$805.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$724.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$864.16
|
| Rate for Payer: Ohio Health Group HMO |
$736.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.42
|
| Rate for Payer: PHCS Commercial |
$942.72
|
| Rate for Payer: United Healthcare All Payer |
$864.16
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$982.00 |
| Rate for Payer: Aetna Commercial |
$222.67
|
| Rate for Payer: Anthem Medicaid |
$99.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$982.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cash Price |
$491.00
|
| Rate for Payer: Cigna Commercial |
$202.78
|
| Rate for Payer: Healthspan PPO |
$208.65
|
| Rate for Payer: Humana Medicaid |
$99.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.61
|
| Rate for Payer: Molina Healthcare Passport |
$99.62
|
| Rate for Payer: Multiplan PHCS |
$589.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$687.40
|
| Rate for Payer: UHCCP Medicaid |
$343.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.62
|
|
|
OBSTETRICAL ULTRASOUND COMP(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
402P0033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$222.67 |
| Rate for Payer: Aetna Commercial |
$222.67
|
| Rate for Payer: Anthem Medicaid |
$99.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$202.78
|
| Rate for Payer: Healthspan PPO |
$208.65
|
| Rate for Payer: Humana Medicaid |
$99.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.61
|
| Rate for Payer: Molina Healthcare Passport |
$99.62
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.62
|
|
|
OBSTETRICAL ULTRASOUND COMP(T
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
402T0033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$774.72 |
| Rate for Payer: Aetna Commercial |
$621.39
|
| Rate for Payer: Anthem Medicaid |
$277.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$669.81
|
| Rate for Payer: First Health Commercial |
$766.65
|
| Rate for Payer: Humana Commercial |
$685.95
|
| Rate for Payer: Humana KY Medicaid |
$277.53
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$280.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.16
|
| Rate for Payer: Ohio Health Group HMO |
$605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.17
|
| Rate for Payer: PHCS Commercial |
$774.72
|
| Rate for Payer: United Healthcare All Payer |
$710.16
|
|
|
OBSTETRICAL ULTRASOUND COMP(T
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
402T0033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.91 |
| Max. Negotiated Rate |
$774.72 |
| Rate for Payer: Aetna Commercial |
$621.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.46
|
| Rate for Payer: Cash Price |
$403.50
|
| Rate for Payer: Cigna Commercial |
$669.81
|
| Rate for Payer: First Health Commercial |
$766.65
|
| Rate for Payer: Humana Commercial |
$685.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.16
|
| Rate for Payer: Ohio Health Group HMO |
$605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.17
|
| Rate for Payer: PHCS Commercial |
$774.72
|
| Rate for Payer: United Healthcare All Payer |
$710.16
|
|
|
OBSTETRIC PANEL
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.27
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OBSTETRIC PANEL
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$47.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.81
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$47.81
|
| Rate for Payer: Humana Medicare Advantage |
$47.81
|
| Rate for Payer: Kentucky WC Medicaid |
$48.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.27
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
OBSTETRIC PANEL WITH HIV
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 80081
|
| Hospital Charge Code |
30000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$381.12 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem Medicaid |
$74.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$74.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$104.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.86
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Humana KY Medicaid |
$74.86
|
| Rate for Payer: Humana Medicare Advantage |
$74.86
|
| Rate for Payer: Kentucky WC Medicaid |
$75.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.07
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
OBSTETRIC PANEL WITH HIV
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 80081
|
| Hospital Charge Code |
30000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$381.12 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.79
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.07
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
OBST REM. CVC THRU LUMEN
|
Facility
|
IP
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.39 |
| Max. Negotiated Rate |
$2,491.47 |
| Rate for Payer: Aetna Commercial |
$1,998.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.32
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$2,154.08
|
| Rate for Payer: First Health Commercial |
$2,465.52
|
| Rate for Payer: Humana Commercial |
$2,205.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,283.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,946.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$2,491.47
|
| Rate for Payer: United Healthcare All Payer |
$2,283.85
|
|
|
OBST REM. CVC THRU LUMEN
|
Facility
|
OP
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.39 |
| Max. Negotiated Rate |
$2,491.47 |
| Rate for Payer: Aetna Commercial |
$1,998.37
|
| Rate for Payer: Anthem Medicaid |
$892.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$2,154.08
|
| Rate for Payer: First Health Commercial |
$2,465.52
|
| Rate for Payer: Humana Commercial |
$2,205.99
|
| Rate for Payer: Humana KY Medicaid |
$892.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$901.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$910.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,283.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,946.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$2,491.47
|
| Rate for Payer: United Healthcare All Payer |
$2,283.85
|
|
|
OBST REM. CVC THRU LUMEN
|
Professional
|
Both
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$2,595.28 |
| Rate for Payer: Aetna Commercial |
$71.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.21
|
| Rate for Payer: Anthem Medicaid |
$35.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,595.28
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$68.31
|
| Rate for Payer: Healthspan PPO |
$159.44
|
| Rate for Payer: Humana Medicaid |
$35.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.44
|
| Rate for Payer: Molina Healthcare Passport |
$35.73
|
| Rate for Payer: Multiplan PHCS |
$1,557.17
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,816.70
|
| Rate for Payer: UHCCP Medicaid |
$34.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.09
|
|
|
OBST REM. CVC THRU LUMEN(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761P1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$71.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.21
|
| Rate for Payer: Anthem Medicaid |
$35.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$68.31
|
| Rate for Payer: Healthspan PPO |
$159.44
|
| Rate for Payer: Humana Medicaid |
$35.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.44
|
| Rate for Payer: Molina Healthcare Passport |
$35.73
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$34.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.09
|
|
|
OBST REM. CVC THRU LUMEN(T
|
Facility
|
IP
|
$2,395.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761T1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.39 |
| Max. Negotiated Rate |
$2,299.47 |
| Rate for Payer: Aetna Commercial |
$1,844.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.32
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cigna Commercial |
$1,988.08
|
| Rate for Payer: First Health Commercial |
$2,275.52
|
| Rate for Payer: Humana Commercial |
$2,035.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,767.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,107.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.54
|
| Rate for Payer: PHCS Commercial |
$2,299.47
|
| Rate for Payer: United Healthcare All Payer |
$2,107.85
|
|
|
OBST REM. CVC THRU LUMEN(T
|
Facility
|
OP
|
$2,395.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761T1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.39 |
| Max. Negotiated Rate |
$2,299.47 |
| Rate for Payer: Aetna Commercial |
$1,844.37
|
| Rate for Payer: Anthem Medicaid |
$823.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cigna Commercial |
$1,988.08
|
| Rate for Payer: First Health Commercial |
$2,275.52
|
| Rate for Payer: Humana Commercial |
$2,035.99
|
| Rate for Payer: Humana KY Medicaid |
$823.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$832.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,767.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$840.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,107.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.54
|
| Rate for Payer: PHCS Commercial |
$2,299.47
|
| Rate for Payer: United Healthcare All Payer |
$2,107.85
|
|
|
OBSV ACUTE INTENS HEMODIA
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$846.01 |
| Rate for Payer: Aetna Commercial |
$354.97
|
| Rate for Payer: Anthem Medicaid |
$158.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$359.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.79
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cigna Commercial |
$382.63
|
| Rate for Payer: First Health Commercial |
$437.95
|
| Rate for Payer: Humana Commercial |
$391.85
|
| Rate for Payer: Humana KY Medicaid |
$158.54
|
| Rate for Payer: Humana Medicare Advantage |
$604.29
|
| Rate for Payer: Kentucky WC Medicaid |
$160.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$405.68
|
| Rate for Payer: Ohio Health Group HMO |
$345.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.91
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
|
OBSV ACUTE INTENS HEMODIA
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$354.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$359.58
|
| Rate for Payer: Cash Price |
$230.50
|
| Rate for Payer: Cigna Commercial |
$382.63
|
| Rate for Payer: First Health Commercial |
$437.95
|
| Rate for Payer: Humana Commercial |
$391.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$378.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$340.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$405.68
|
| Rate for Payer: Ohio Health Group HMO |
$345.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.91
|
| Rate for Payer: PHCS Commercial |
$442.56
|
| Rate for Payer: United Healthcare All Payer |
$405.68
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$846.01 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem Medicaid |
$134.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.79
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Humana KY Medicaid |
$134.12
|
| Rate for Payer: Humana Medicare Advantage |
$604.29
|
| Rate for Payer: Kentucky WC Medicaid |
$135.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.90
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Professional
|
Both
|
$390.00
|
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$390.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.90
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
