|
OB GROWTH(T
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
402T0038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$192.90 |
| Max. Negotiated Rate |
$617.28 |
| Rate for Payer: Aetna Commercial |
$495.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.54
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cigna Commercial |
$533.69
|
| Rate for Payer: First Health Commercial |
$610.85
|
| Rate for Payer: Humana Commercial |
$546.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$527.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$474.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$565.84
|
| Rate for Payer: Ohio Health Group HMO |
$482.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$443.67
|
| Rate for Payer: PHCS Commercial |
$617.28
|
| Rate for Payer: United Healthcare All Payer |
$565.84
|
|
|
OBLIQUE SUPPORT CONNECT
|
Facility
|
IP
|
$4,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.00 |
| Max. Negotiated Rate |
$4,339.20 |
| Rate for Payer: Aetna Commercial |
$3,480.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,525.60
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cigna Commercial |
$3,751.60
|
| Rate for Payer: First Health Commercial |
$4,294.00
|
| Rate for Payer: Humana Commercial |
$3,842.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,706.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,335.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,977.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,932.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,118.80
|
| Rate for Payer: PHCS Commercial |
$4,339.20
|
| Rate for Payer: United Healthcare All Payer |
$3,977.60
|
|
|
OBLIQUE SUPPORT CONNECT
|
Facility
|
OP
|
$4,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.00 |
| Max. Negotiated Rate |
$4,339.20 |
| Rate for Payer: Aetna Commercial |
$3,480.40
|
| Rate for Payer: Anthem Medicaid |
$1,554.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,525.60
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cigna Commercial |
$3,751.60
|
| Rate for Payer: First Health Commercial |
$4,294.00
|
| Rate for Payer: Humana Commercial |
$3,842.00
|
| Rate for Payer: Humana KY Medicaid |
$1,554.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,570.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,706.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,335.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,585.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,977.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,932.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,118.80
|
| Rate for Payer: PHCS Commercial |
$4,339.20
|
| Rate for Payer: United Healthcare All Payer |
$3,977.60
|
|
|
OBLITER OF RT BREAST FAT NECRO
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 19499
|
| Hospital Charge Code |
76102736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Anthem Medicaid |
$325.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$325.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$331.50
|
| Rate for Payer: Molina Healthcare Passport |
$325.00
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$328.25
|
|
|
OBS ADMT/DC SAME DAY LV 1
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$202.01 |
| Rate for Payer: Aetna Commercial |
$202.01
|
| Rate for Payer: Ambetter Exchange |
$91.85
|
| Rate for Payer: Anthem Medicaid |
$102.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.22
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$191.14
|
| Rate for Payer: Healthspan PPO |
$150.17
|
| Rate for Payer: Humana Medicaid |
$102.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.85
|
| Rate for Payer: Molina Healthcare Passport |
$102.79
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.41
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.85
|
|
|
OBS ADMT/DC SAME DAY LV 1(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
762P0008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$202.01 |
| Rate for Payer: Aetna Commercial |
$202.01
|
| Rate for Payer: Ambetter Exchange |
$91.85
|
| Rate for Payer: Anthem Medicaid |
$102.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.22
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$191.14
|
| Rate for Payer: Healthspan PPO |
$150.17
|
| Rate for Payer: Humana Medicaid |
$102.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$180.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.85
|
| Rate for Payer: Molina Healthcare Passport |
$102.79
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.41
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.85
|
|
|
OBS ADMT/DC SAME DAY LV 2
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
76200009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$265.00
|
| Rate for Payer: Ambetter Exchange |
$149.36
|
| Rate for Payer: Anthem Medicaid |
$135.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.23
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Healthspan PPO |
$196.99
|
| Rate for Payer: Humana Medicaid |
$135.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$235.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.38
|
| Rate for Payer: Molina Healthcare Passport |
$135.67
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.17
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.36
|
|
|
OBS ADMT/DC SAME DAY LV 2(P
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
762P0009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$265.00
|
| Rate for Payer: Ambetter Exchange |
$149.36
|
| Rate for Payer: Anthem Medicaid |
$135.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.23
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Healthspan PPO |
$196.99
|
| Rate for Payer: Humana Medicaid |
$135.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$235.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.38
|
| Rate for Payer: Molina Healthcare Passport |
$135.67
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.17
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.36
|
|
|
OBS ADMT/DC SAME DAY LV 3
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
76200010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$329.05 |
| Rate for Payer: Aetna Commercial |
$329.05
|
| Rate for Payer: Ambetter Exchange |
$195.50
|
| Rate for Payer: Anthem Medicaid |
$169.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$195.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$195.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$234.60
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$314.10
|
| Rate for Payer: Healthspan PPO |
$244.60
|
| Rate for Payer: Humana Medicaid |
$169.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$293.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$195.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.71
|
| Rate for Payer: Molina Healthcare Passport |
$169.32
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$254.15
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$195.50
|
|
|
OBS ADMT/DC SAME DAY LV 3(P
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
762P0010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$329.05 |
| Rate for Payer: Aetna Commercial |
$329.05
|
| Rate for Payer: Ambetter Exchange |
$195.50
|
| Rate for Payer: Anthem Medicaid |
$169.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$195.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$195.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$234.60
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$314.10
|
| Rate for Payer: Healthspan PPO |
$244.60
|
| Rate for Payer: Humana Medicaid |
$169.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$293.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$195.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.71
|
| Rate for Payer: Molina Healthcare Passport |
$169.32
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$254.15
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$195.50
|
|
|
OBSERVATION ADDTL HRS EA
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OBSERVATION ADDTL HRS EA
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$16.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$16.51
|
| Rate for Payer: Kentucky WC Medicaid |
$16.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
OBSERVATION INITIAL HOUR
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200024
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$520.52
|
| Rate for Payer: Anthem Medicaid |
$232.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$527.28
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$561.08
|
| Rate for Payer: First Health Commercial |
$642.20
|
| Rate for Payer: Humana Commercial |
$574.60
|
| Rate for Payer: Humana KY Medicaid |
$232.48
|
| Rate for Payer: Kentucky WC Medicaid |
$234.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$554.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$237.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.88
|
| Rate for Payer: Ohio Health Group HMO |
$507.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$466.44
|
| Rate for Payer: PHCS Commercial |
$648.96
|
| Rate for Payer: United Healthcare All Payer |
$594.88
|
|
|
OBSERVATION INITIAL HOUR
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200024
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$520.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$527.28
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$561.08
|
| Rate for Payer: First Health Commercial |
$642.20
|
| Rate for Payer: Humana Commercial |
$574.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$554.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.88
|
| Rate for Payer: Ohio Health Group HMO |
$507.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$466.44
|
| Rate for Payer: PHCS Commercial |
$648.96
|
| Rate for Payer: United Healthcare All Payer |
$594.88
|
|
|
OBS INITIAL ASSESS DIR ADMIT
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$232.48 |
| Max. Negotiated Rate |
$793.09 |
| Rate for Payer: Aetna Commercial |
$520.52
|
| Rate for Payer: Anthem Medicaid |
$232.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$566.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$527.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$793.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.76
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$561.08
|
| Rate for Payer: First Health Commercial |
$642.20
|
| Rate for Payer: Humana Commercial |
$574.60
|
| Rate for Payer: Humana KY Medicaid |
$232.48
|
| Rate for Payer: Humana Medicare Advantage |
$566.49
|
| Rate for Payer: Kentucky WC Medicaid |
$234.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$554.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$237.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.88
|
| Rate for Payer: Ohio Health Group HMO |
$507.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$466.44
|
| Rate for Payer: PHCS Commercial |
$648.96
|
| Rate for Payer: United Healthcare All Payer |
$594.88
|
|
|
OBS INITIAL ASSESS DIR ADMIT
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200012
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$648.96 |
| Rate for Payer: Aetna Commercial |
$520.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$527.28
|
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Cigna Commercial |
$561.08
|
| Rate for Payer: First Health Commercial |
$642.20
|
| Rate for Payer: Humana Commercial |
$574.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$554.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.88
|
| Rate for Payer: Ohio Health Group HMO |
$507.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$466.44
|
| Rate for Payer: PHCS Commercial |
$648.96
|
| Rate for Payer: United Healthcare All Payer |
$594.88
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$620.40 |
| Rate for Payer: Aetna Commercial |
$222.67
|
| Rate for Payer: Ambetter Exchange |
$121.55
|
| Rate for Payer: Anthem Medicaid |
$99.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.86
|
| Rate for Payer: Cash Price |
$517.00
|
| Rate for Payer: Cash Price |
$517.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.61
|
| Rate for Payer: Molina Healthcare Passport |
$99.62
|
| Rate for Payer: Multiplan PHCS |
$620.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.01
|
| Rate for Payer: UHCCP Medicaid |
$361.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.55
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$992.64 |
| Rate for Payer: Aetna Commercial |
$796.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$806.52
|
| Rate for Payer: Cash Price |
$517.00
|
| Rate for Payer: Cigna Commercial |
$858.22
|
| Rate for Payer: First Health Commercial |
$982.30
|
| Rate for Payer: Humana Commercial |
$878.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.92
|
| Rate for Payer: Ohio Health Group HMO |
$775.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.46
|
| Rate for Payer: PHCS Commercial |
$992.64
|
| Rate for Payer: United Healthcare All Payer |
$909.92
|
|
|
OBSTETRICAL ULTRASOUND COMP
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$992.64 |
| Rate for Payer: Aetna Commercial |
$796.18
|
| Rate for Payer: Anthem Medicaid |
$355.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$806.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$517.00
|
| Rate for Payer: Cash Price |
$517.00
|
| Rate for Payer: Cigna Commercial |
$858.22
|
| Rate for Payer: First Health Commercial |
$982.30
|
| Rate for Payer: Humana Commercial |
$878.90
|
| Rate for Payer: Humana KY Medicaid |
$355.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$359.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$847.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$362.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$909.92
|
| Rate for Payer: Ohio Health Group HMO |
$775.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.46
|
| Rate for Payer: PHCS Commercial |
$992.64
|
| Rate for Payer: United Healthcare All Payer |
$909.92
|
|
|
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: Ambetter Exchange |
$121.55
|
| Rate for Payer: Anthem Medicaid |
$99.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.55
|
| 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 |
$158.01
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.55
|
|
|
OBSTETRICAL ULTRASOUND COMP(T
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
402T0033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna Commercial |
$661.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.02
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$712.97
|
| Rate for Payer: First Health Commercial |
$816.05
|
| Rate for Payer: Humana Commercial |
$730.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$704.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.92
|
| Rate for Payer: Ohio Health Group HMO |
$644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$747.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.71
|
| Rate for Payer: PHCS Commercial |
$824.64
|
| Rate for Payer: United Healthcare All Payer |
$755.92
|
|
|
OBSTETRICAL ULTRASOUND COMP(T
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
402T0033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna Commercial |
$661.43
|
| Rate for Payer: Anthem Medicaid |
$295.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$712.97
|
| Rate for Payer: First Health Commercial |
$816.05
|
| Rate for Payer: Humana Commercial |
$730.15
|
| Rate for Payer: Humana KY Medicaid |
$295.41
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$298.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$704.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.92
|
| Rate for Payer: Ohio Health Group HMO |
$644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$747.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.71
|
| Rate for Payer: PHCS Commercial |
$824.64
|
| Rate for Payer: United Healthcare All Payer |
$755.92
|
|
|
OBSTETRIC PANEL
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.32
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
|
OBSTETRIC PANEL
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem Medicaid |
$47.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.81
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| 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 |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.32
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
|
OBSTETRIC PANEL WITH HIV
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
HCPCS 80081
|
| Hospital Charge Code |
30000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.86 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$325.71
|
| Rate for Payer: Anthem Medicaid |
$74.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$74.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$104.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.86
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$351.09
|
| Rate for Payer: First Health Commercial |
$401.85
|
| Rate for Payer: Humana Commercial |
$359.55
|
| 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 |
$346.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$312.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$372.24
|
| Rate for Payer: Ohio Health Group HMO |
$317.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.87
|
| Rate for Payer: PHCS Commercial |
$406.08
|
| Rate for Payer: United Healthcare All Payer |
$372.24
|
|
