|
OB US DETAILED ADDL FETUS
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 76812
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.62 |
| Max. Negotiated Rate |
$834.00 |
| Rate for Payer: Aetna Commercial |
$235.43
|
| Rate for Payer: Anthem Medicaid |
$106.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$834.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$246.31
|
| Rate for Payer: Healthspan PPO |
$220.60
|
| Rate for Payer: Humana Medicaid |
$106.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.75
|
| Rate for Payer: Molina Healthcare Passport |
$106.62
|
| Rate for Payer: Multiplan PHCS |
$500.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.80
|
| Rate for Payer: UHCCP Medicaid |
$291.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.69
|
|
|
OB US DETAILED ADDL FETUS
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
OB US DETAILED ADDL FETUS(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76812
|
| Hospital Charge Code |
402P0036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$246.31 |
| Rate for Payer: Aetna Commercial |
$235.43
|
| Rate for Payer: Anthem Medicaid |
$106.62
|
| 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 |
$246.31
|
| Rate for Payer: Healthspan PPO |
$220.60
|
| Rate for Payer: Humana Medicaid |
$106.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.75
|
| Rate for Payer: Molina Healthcare Passport |
$106.62
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.69
|
|
|
OB US DETAILED ADDL FETUS(T
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
HCPCS 76812
|
| Hospital Charge Code |
402T0036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.54
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
OB US DETAILED ADDL FETUS(T
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
HCPCS 76812
|
| Hospital Charge Code |
402T0036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem Medicaid |
$218.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Humana KY Medicaid |
$218.03
|
| Rate for Payer: Kentucky WC Medicaid |
$220.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.54
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
OB US DETAILED SNGL FETUS
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$324.92
|
| Rate for Payer: Anthem Medicaid |
$139.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,248.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$347.14
|
| Rate for Payer: Healthspan PPO |
$304.46
|
| Rate for Payer: Humana Medicaid |
$139.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.08
|
| Rate for Payer: Molina Healthcare Passport |
$139.29
|
| Rate for Payer: Multiplan PHCS |
$748.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$873.60
|
| Rate for Payer: UHCCP Medicaid |
$436.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.68
|
|
|
OB US DETAILED SNGL FETUS
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$162.24 |
| Max. Negotiated Rate |
$1,198.08 |
| Rate for Payer: Aetna Commercial |
$960.96
|
| Rate for Payer: Anthem Medicaid |
$429.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$973.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,035.84
|
| Rate for Payer: First Health Commercial |
$1,185.60
|
| Rate for Payer: Humana Commercial |
$1,060.80
|
| Rate for Payer: Humana KY Medicaid |
$429.19
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$433.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,023.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$921.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$437.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,098.24
|
| Rate for Payer: Ohio Health Group HMO |
$936.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.88
|
| Rate for Payer: PHCS Commercial |
$1,198.08
|
| Rate for Payer: United Healthcare All Payer |
$1,098.24
|
|
|
OB US DETAILED SNGL FETUS
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$162.24 |
| Max. Negotiated Rate |
$1,198.08 |
| Rate for Payer: Aetna Commercial |
$960.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$973.44
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$1,035.84
|
| Rate for Payer: First Health Commercial |
$1,185.60
|
| Rate for Payer: Humana Commercial |
$1,060.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,023.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$921.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,098.24
|
| Rate for Payer: Ohio Health Group HMO |
$936.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.88
|
| Rate for Payer: PHCS Commercial |
$1,198.08
|
| Rate for Payer: United Healthcare All Payer |
$1,098.24
|
|
|
OB US DETAILED SNGL FETUS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
402P0035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$347.14 |
| Rate for Payer: Aetna Commercial |
$324.92
|
| Rate for Payer: Anthem Medicaid |
$139.29
|
| 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 |
$347.14
|
| Rate for Payer: Healthspan PPO |
$304.46
|
| Rate for Payer: Humana Medicaid |
$139.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$142.08
|
| Rate for Payer: Molina Healthcare Passport |
$139.29
|
| 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 |
$140.68
|
|
|
OB US DETAILED SNGL FETUS(T
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
402T0035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$123.24 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem Medicaid |
$326.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Humana KY Medicaid |
$326.02
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$329.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.88
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
OB US DETAILED SNGL FETUS(T
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
402T0035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$123.24 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$293.88
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
OCCIPITAL NERVE BLOCK
|
Facility
|
OP
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
76102311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.93 |
| Max. Negotiated Rate |
$1,018.56 |
| Rate for Payer: Aetna Commercial |
$816.97
|
| Rate for Payer: Anthem Medicaid |
$364.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$827.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$530.50
|
| Rate for Payer: Cash Price |
$530.50
|
| Rate for Payer: Cigna Commercial |
$880.63
|
| Rate for Payer: First Health Commercial |
$1,007.95
|
| Rate for Payer: Humana Commercial |
$901.85
|
| Rate for Payer: Humana KY Medicaid |
$364.88
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$368.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$933.68
|
| Rate for Payer: Ohio Health Group HMO |
$795.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.91
|
| Rate for Payer: PHCS Commercial |
$1,018.56
|
| Rate for Payer: United Healthcare All Payer |
$933.68
|
|
|
OCCIPITAL NERVE BLOCK
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
76102311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$1,061.00 |
| Rate for Payer: Aetna Commercial |
$117.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.08
|
| Rate for Payer: Anthem Medicaid |
$42.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,061.00
|
| Rate for Payer: Cash Price |
$530.50
|
| Rate for Payer: Cash Price |
$530.50
|
| Rate for Payer: Cigna Commercial |
$158.03
|
| Rate for Payer: Healthspan PPO |
$124.59
|
| Rate for Payer: Humana Medicaid |
$42.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.83
|
| Rate for Payer: Molina Healthcare Passport |
$42.97
|
| Rate for Payer: Multiplan PHCS |
$636.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.70
|
| Rate for Payer: UHCCP Medicaid |
$33.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.40
|
|
|
OCCIPITAL NERVE BLOCK
|
Facility
|
IP
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
76102311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.93 |
| Max. Negotiated Rate |
$1,018.56 |
| Rate for Payer: Aetna Commercial |
$816.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$827.58
|
| Rate for Payer: Cash Price |
$530.50
|
| Rate for Payer: Cigna Commercial |
$880.63
|
| Rate for Payer: First Health Commercial |
$1,007.95
|
| Rate for Payer: Humana Commercial |
$901.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$933.68
|
| Rate for Payer: Ohio Health Group HMO |
$795.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.91
|
| Rate for Payer: PHCS Commercial |
$1,018.56
|
| Rate for Payer: United Healthcare All Payer |
$933.68
|
|
|
OCCIPITAL NERVE BLOCK(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
761P2311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.08 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$117.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.08
|
| Rate for Payer: Anthem Medicaid |
$42.97
|
| 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 |
$158.03
|
| Rate for Payer: Healthspan PPO |
$124.59
|
| Rate for Payer: Humana Medicaid |
$42.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.83
|
| Rate for Payer: Molina Healthcare Passport |
$42.97
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$33.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.40
|
|
|
OCCIPITAL NERVE BLOCK(T
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
761T2311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem Medicaid |
$296.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Humana KY Medicaid |
$296.10
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$299.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.91
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
OCCIPITAL NERVE BLOCK(T
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
761T2311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.91
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
OCCLUDE FALLOPIAN TUBE(S)
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
76102247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
OCCLUDE FALLOPIAN TUBE(S)
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
76102247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
OCCLUDE FALLOPIAN TUBE(S)
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
76102247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.53 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Anthem Medicaid |
$199.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$383.15
|
| Rate for Payer: Healthspan PPO |
$364.96
|
| Rate for Payer: Humana Medicaid |
$199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.52
|
| Rate for Payer: Molina Healthcare Passport |
$199.53
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.53
|
|
|
OCCLUDE FALLOPIAN TUBE(S)(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
761P2247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.53 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Anthem Medicaid |
$199.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$383.15
|
| Rate for Payer: Healthspan PPO |
$364.96
|
| Rate for Payer: Humana Medicaid |
$199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.52
|
| Rate for Payer: Molina Healthcare Passport |
$199.53
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.53
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$4.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$4.38
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.81
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$51.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: Healthspan PPO |
$3.40
|
| Rate for Payer: Multiplan PHCS |
$30.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.70
|
| Rate for Payer: UHCCP Medicaid |
$17.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.63
|
|
|
OCCULT BLOOD 1-3
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
