|
OBTURATOR 17FR
|
Facility
|
IP
|
$3,681.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.60 |
| Max. Negotiated Rate |
$3,534.29 |
| Rate for Payer: Aetna Commercial |
$2,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,871.61
|
| Rate for Payer: Cash Price |
$1,840.78
|
| Rate for Payer: Cigna Commercial |
$3,055.69
|
| Rate for Payer: First Health Commercial |
$3,497.47
|
| Rate for Payer: Humana Commercial |
$3,129.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,018.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,716.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,239.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,761.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.28
|
| Rate for Payer: PHCS Commercial |
$3,534.29
|
| Rate for Payer: United Healthcare All Payer |
$3,239.76
|
|
|
OBTURATOR 17FR
|
Facility
|
OP
|
$3,681.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.60 |
| Max. Negotiated Rate |
$3,534.29 |
| Rate for Payer: Aetna Commercial |
$2,834.79
|
| Rate for Payer: Anthem Medicaid |
$1,266.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,871.61
|
| Rate for Payer: Cash Price |
$1,840.78
|
| Rate for Payer: Cigna Commercial |
$3,055.69
|
| Rate for Payer: First Health Commercial |
$3,497.47
|
| Rate for Payer: Humana Commercial |
$3,129.32
|
| Rate for Payer: Humana KY Medicaid |
$1,266.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,278.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,018.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,716.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,291.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,239.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,761.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.28
|
| Rate for Payer: PHCS Commercial |
$3,534.29
|
| Rate for Payer: United Healthcare All Payer |
$3,239.76
|
|
|
OBTURATOR AS TIBIAL D12MM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
OBTURATOR AS TIBIAL D12MM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
OBTURATOR AS TIBIAL D14MM
|
Facility
|
OP
|
$4,702.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.32 |
| Max. Negotiated Rate |
$4,514.33 |
| Rate for Payer: Aetna Commercial |
$3,620.87
|
| Rate for Payer: Anthem Medicaid |
$1,617.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.90
|
| Rate for Payer: Cash Price |
$2,351.22
|
| Rate for Payer: Cigna Commercial |
$3,903.02
|
| Rate for Payer: First Health Commercial |
$4,467.31
|
| Rate for Payer: Humana Commercial |
$3,997.07
|
| Rate for Payer: Humana KY Medicaid |
$1,617.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,633.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,855.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,649.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,138.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,526.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.75
|
| Rate for Payer: PHCS Commercial |
$4,514.33
|
| Rate for Payer: United Healthcare All Payer |
$4,138.14
|
|
|
OBTURATOR AS TIBIAL D14MM
|
Facility
|
IP
|
$4,702.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.32 |
| Max. Negotiated Rate |
$4,514.33 |
| Rate for Payer: Aetna Commercial |
$3,620.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.90
|
| Rate for Payer: Cash Price |
$2,351.22
|
| Rate for Payer: Cigna Commercial |
$3,903.02
|
| Rate for Payer: First Health Commercial |
$4,467.31
|
| Rate for Payer: Humana Commercial |
$3,997.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,855.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,138.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,526.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.75
|
| Rate for Payer: PHCS Commercial |
$4,514.33
|
| Rate for Payer: United Healthcare All Payer |
$4,138.14
|
|
|
OB ULTRASOUND LIMITED
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$726.72 |
| Rate for Payer: Aetna Commercial |
$582.89
|
| Rate for Payer: Anthem Medicaid |
$260.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$628.31
|
| Rate for Payer: First Health Commercial |
$719.15
|
| Rate for Payer: Humana Commercial |
$643.45
|
| Rate for Payer: Humana KY Medicaid |
$260.33
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$262.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.16
|
| Rate for Payer: Ohio Health Group HMO |
$567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.67
|
| Rate for Payer: PHCS Commercial |
$726.72
|
| Rate for Payer: United Healthcare All Payer |
$666.16
|
|
|
OB ULTRASOUND LIMITED
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$757.00 |
| Rate for Payer: Aetna Commercial |
$139.02
|
| Rate for Payer: Anthem Medicaid |
$66.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.00
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$132.58
|
| Rate for Payer: Healthspan PPO |
$130.26
|
| Rate for Payer: Humana Medicaid |
$66.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.82
|
| Rate for Payer: Molina Healthcare Passport |
$66.49
|
| Rate for Payer: Multiplan PHCS |
$454.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$529.90
|
| Rate for Payer: UHCCP Medicaid |
$264.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.15
|
|
|
OB ULTRASOUND LIMITED
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$726.72 |
| Rate for Payer: Aetna Commercial |
$582.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.46
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$628.31
|
| Rate for Payer: First Health Commercial |
$719.15
|
| Rate for Payer: Humana Commercial |
$643.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.16
|
| Rate for Payer: Ohio Health Group HMO |
$567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.67
|
| Rate for Payer: PHCS Commercial |
$726.72
|
| Rate for Payer: United Healthcare All Payer |
$666.16
|
|
|
OB ULTRASOUND LIMITED(P
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
402P0037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$139.02
|
| Rate for Payer: Anthem Medicaid |
$66.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$132.58
|
| Rate for Payer: Healthspan PPO |
$130.26
|
| Rate for Payer: Humana Medicaid |
$66.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.82
|
| Rate for Payer: Molina Healthcare Passport |
$66.49
|
| Rate for Payer: Multiplan PHCS |
$99.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.50
|
| Rate for Payer: UHCCP Medicaid |
$57.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.15
|
|
|
OB ULTRASOUND LIMITED(T
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
402T0037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.52
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
OB ULTRASOUND LIMITED(T
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
402T0037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$568.32 |
| Rate for Payer: Aetna Commercial |
$455.84
|
| Rate for Payer: Anthem Medicaid |
$203.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$461.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cigna Commercial |
$491.36
|
| Rate for Payer: First Health Commercial |
$562.40
|
| Rate for Payer: Humana Commercial |
$503.20
|
| Rate for Payer: Humana KY Medicaid |
$203.59
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$205.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$485.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.96
|
| Rate for Payer: Ohio Health Group HMO |
$444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.52
|
| Rate for Payer: PHCS Commercial |
$568.32
|
| Rate for Payer: United Healthcare All Payer |
$520.96
|
|
|
OB US < 14 WKS ADDL FETUS
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: Aetna Commercial |
$116.57
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$507.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$121.73
|
| Rate for Payer: Healthspan PPO |
$109.23
|
| Rate for Payer: Humana Medicaid |
$53.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.55
|
| Rate for Payer: Molina Healthcare Passport |
$53.48
|
| Rate for Payer: Multiplan PHCS |
$304.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$354.90
|
| Rate for Payer: UHCCP Medicaid |
$177.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.01
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem Medicaid |
$174.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Humana KY Medicaid |
$174.36
|
| Rate for Payer: Kentucky WC Medicaid |
$176.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
OB US < 14 WKS ADDL FETUS
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
OB US >/= 14 WKS ADDL FETUS
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$159.63
|
| Rate for Payer: Anthem Medicaid |
$197.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$872.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$146.10
|
| Rate for Payer: Healthspan PPO |
$149.58
|
| Rate for Payer: Humana Medicaid |
$197.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.89
|
| Rate for Payer: Molina Healthcare Passport |
$197.93
|
| Rate for Payer: Multiplan PHCS |
$523.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$610.40
|
| Rate for Payer: UHCCP Medicaid |
$305.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.91
|
|
|
OB US >/= 14 WKS ADDL FETUS
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$837.12 |
| Rate for Payer: Aetna Commercial |
$671.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$680.16
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$723.76
|
| Rate for Payer: First Health Commercial |
$828.40
|
| Rate for Payer: Humana Commercial |
$741.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$715.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$643.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$767.36
|
| Rate for Payer: Ohio Health Group HMO |
$654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.32
|
| Rate for Payer: PHCS Commercial |
$837.12
|
| Rate for Payer: United Healthcare All Payer |
$767.36
|
|
|
OB US >/= 14 WKS ADDL FETUS
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$837.12 |
| Rate for Payer: Aetna Commercial |
$671.44
|
| Rate for Payer: Anthem Medicaid |
$299.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$680.16
|
| Rate for Payer: Cash Price |
$436.00
|
| Rate for Payer: Cigna Commercial |
$723.76
|
| Rate for Payer: First Health Commercial |
$828.40
|
| Rate for Payer: Humana Commercial |
$741.20
|
| Rate for Payer: Humana KY Medicaid |
$299.88
|
| Rate for Payer: Kentucky WC Medicaid |
$302.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$715.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$643.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$767.36
|
| Rate for Payer: Ohio Health Group HMO |
$654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.32
|
| Rate for Payer: PHCS Commercial |
$837.12
|
| Rate for Payer: United Healthcare All Payer |
$767.36
|
|
|
OB US < 14 WKS ADDL FETUS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
402P0032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$116.57
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| 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 |
$121.73
|
| Rate for Payer: Healthspan PPO |
$109.23
|
| Rate for Payer: Humana Medicaid |
$53.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.55
|
| Rate for Payer: Molina Healthcare Passport |
$53.48
|
| 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 |
$54.01
|
|
|
OB US >/= 14 WKS ADDL FETUS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
402P0034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$159.63
|
| Rate for Payer: Anthem Medicaid |
$197.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$146.10
|
| Rate for Payer: Healthspan PPO |
$149.58
|
| Rate for Payer: Humana Medicaid |
$197.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.89
|
| Rate for Payer: Molina Healthcare Passport |
$197.93
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.91
|
|
|
OB US < 14 WKS ADDL FETUS(T
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
402T0032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem Medicaid |
$122.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Humana KY Medicaid |
$122.77
|
| Rate for Payer: Kentucky WC Medicaid |
$124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.67
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
OB US < 14 WKS ADDL FETUS(T
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS 76802
|
| Hospital Charge Code |
402T0032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.67
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
OB US >/= 14 WKS ADDL FETUS(T
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
402T0034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.32
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
OB US >/= 14 WKS ADDL FETUS(T
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 76810
|
| Hospital Charge Code |
402T0034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem Medicaid |
$196.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Humana KY Medicaid |
$196.71
|
| Rate for Payer: Kentucky WC Medicaid |
$198.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.32
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
OB US DETAILED ADDL FETUS
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
HCPCS 76812
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$800.64 |
| Rate for Payer: Aetna Commercial |
$642.18
|
| Rate for Payer: Anthem Medicaid |
$286.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$650.52
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$692.22
|
| Rate for Payer: First Health Commercial |
$792.30
|
| Rate for Payer: Humana Commercial |
$708.90
|
| Rate for Payer: Humana KY Medicaid |
$286.81
|
| Rate for Payer: Kentucky WC Medicaid |
$289.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$683.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$615.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$733.92
|
| Rate for Payer: Ohio Health Group HMO |
$625.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.54
|
| Rate for Payer: PHCS Commercial |
$800.64
|
| Rate for Payer: United Healthcare All Payer |
$733.92
|
|
