|
OBSTETRIC PANEL WITH HIV
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
HCPCS 80081
|
| Hospital Charge Code |
30000015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.90 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$325.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.67
|
| 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: 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 |
$126.90
|
| 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
|
|
|
OBST REM. CVC THRU LUMEN
|
Facility
|
OP
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.52 |
| Max. Negotiated Rate |
$2,491.47 |
| Rate for Payer: Aetna Commercial |
$1,998.37
|
| Rate for Payer: Anthem Medicaid |
$892.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$2,154.08
|
| Rate for Payer: First Health Commercial |
$2,465.52
|
| Rate for Payer: Humana Commercial |
$2,205.99
|
| Rate for Payer: Humana KY Medicaid |
$892.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$901.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$910.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,283.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,946.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,076.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,790.74
|
| Rate for Payer: PHCS Commercial |
$2,491.47
|
| Rate for Payer: United Healthcare All Payer |
$2,283.85
|
|
|
OBST REM. CVC THRU LUMEN
|
Facility
|
IP
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.58 |
| Max. Negotiated Rate |
$2,491.47 |
| Rate for Payer: Aetna Commercial |
$1,998.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.32
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$2,154.08
|
| Rate for Payer: First Health Commercial |
$2,465.52
|
| Rate for Payer: Humana Commercial |
$2,205.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,283.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,946.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,076.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,790.74
|
| Rate for Payer: PHCS Commercial |
$2,491.47
|
| Rate for Payer: United Healthcare All Payer |
$2,283.85
|
|
|
OBST REM. CVC THRU LUMEN
|
Professional
|
Both
|
$2,595.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
76101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$1,557.17 |
| Rate for Payer: Aetna Commercial |
$71.48
|
| Rate for Payer: Ambetter Exchange |
$42.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.21
|
| Rate for Payer: Anthem Medicaid |
$136.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.25
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cash Price |
$1,297.64
|
| Rate for Payer: Cigna Commercial |
$68.31
|
| Rate for Payer: Healthspan PPO |
$159.44
|
| Rate for Payer: Humana Medicaid |
$136.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.44
|
| Rate for Payer: Molina Healthcare Passport |
$136.71
|
| Rate for Payer: Multiplan PHCS |
$1,557.17
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.52
|
| Rate for Payer: UHCCP Medicaid |
$34.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.71
|
|
|
OBST REM. CVC THRU LUMEN(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761P1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.21 |
| Max. Negotiated Rate |
$159.44 |
| Rate for Payer: Aetna Commercial |
$71.48
|
| Rate for Payer: Ambetter Exchange |
$42.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.21
|
| Rate for Payer: Anthem Medicaid |
$136.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$68.31
|
| Rate for Payer: Healthspan PPO |
$159.44
|
| Rate for Payer: Humana Medicaid |
$136.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.44
|
| Rate for Payer: Molina Healthcare Passport |
$136.71
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.52
|
| Rate for Payer: UHCCP Medicaid |
$34.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.71
|
|
|
OBST REM. CVC THRU LUMEN(T
|
Facility
|
OP
|
$2,395.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761T1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.74 |
| Max. Negotiated Rate |
$2,299.47 |
| Rate for Payer: Aetna Commercial |
$1,844.37
|
| Rate for Payer: Anthem Medicaid |
$823.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cigna Commercial |
$1,988.08
|
| Rate for Payer: First Health Commercial |
$2,275.52
|
| Rate for Payer: Humana Commercial |
$2,035.99
|
| Rate for Payer: Humana KY Medicaid |
$823.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$832.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,767.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$840.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,107.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,916.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,083.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.74
|
| Rate for Payer: PHCS Commercial |
$2,299.47
|
| Rate for Payer: United Healthcare All Payer |
$2,107.85
|
|
|
OBST REM. CVC THRU LUMEN(T
|
Facility
|
IP
|
$2,395.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
761T1495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$718.58 |
| Max. Negotiated Rate |
$2,299.47 |
| Rate for Payer: Aetna Commercial |
$1,844.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,868.32
|
| Rate for Payer: Cash Price |
$1,197.64
|
| Rate for Payer: Cigna Commercial |
$1,988.08
|
| Rate for Payer: First Health Commercial |
$2,275.52
|
| Rate for Payer: Humana Commercial |
$2,035.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,964.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,767.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,107.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,796.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,916.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,083.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.74
|
| Rate for Payer: PHCS Commercial |
$2,299.47
|
| Rate for Payer: United Healthcare All Payer |
$2,107.85
|
|
|
OBSV ACUTE INTENS HEMODIA
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$147.30 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.79
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
OBSV ACUTE INTENS HEMODIA
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$168.85 |
| Max. Negotiated Rate |
$905.14 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem Medicaid |
$168.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$646.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$905.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$872.82
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Humana KY Medicaid |
$168.85
|
| Rate for Payer: Humana Medicare Advantage |
$646.53
|
| Rate for Payer: Kentucky WC Medicaid |
$170.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$775.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.79
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
OBSV ACUTE INTENS HEMODIA
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$294.60 |
| Rate for Payer: Aetna Commercial |
$104.33
|
| Rate for Payer: Ambetter Exchange |
$66.46
|
| Rate for Payer: Anthem Medicaid |
$78.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.75
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$95.23
|
| Rate for Payer: Healthspan PPO |
$85.37
|
| Rate for Payer: Humana Medicaid |
$78.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.75
|
| Rate for Payer: Molina Healthcare Passport |
$78.19
|
| Rate for Payer: Multiplan PHCS |
$294.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$86.40
|
| Rate for Payer: UHCCP Medicaid |
$171.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.46
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$905.14 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem Medicaid |
$137.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$646.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$905.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$872.82
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Humana KY Medicaid |
$137.90
|
| Rate for Payer: Humana Medicare Advantage |
$646.53
|
| Rate for Payer: Kentucky WC Medicaid |
$139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$775.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$120.30 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
OBSV ACUTE UNIT HEMODIA
|
Professional
|
Both
|
$401.00
|
|
| Hospital Charge Code |
88000004
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$140.35 |
| Max. Negotiated Rate |
$280.70 |
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Multiplan PHCS |
$240.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.70
|
| Rate for Payer: UHCCP Medicaid |
$140.35
|
|
|
OBTURATOR 17FR
|
Facility
|
IP
|
$3,587.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.21 |
| Max. Negotiated Rate |
$3,443.88 |
| Rate for Payer: Aetna Commercial |
$2,762.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,798.16
|
| Rate for Payer: Cash Price |
$1,793.69
|
| Rate for Payer: Cigna Commercial |
$2,977.53
|
| Rate for Payer: First Health Commercial |
$3,408.01
|
| Rate for Payer: Humana Commercial |
$3,049.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,941.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,647.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,156.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,690.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,869.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,121.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.29
|
| Rate for Payer: PHCS Commercial |
$3,443.88
|
| Rate for Payer: United Healthcare All Payer |
$3,156.89
|
|
|
OBTURATOR 17FR
|
Facility
|
OP
|
$3,587.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.21 |
| Max. Negotiated Rate |
$3,443.88 |
| Rate for Payer: Aetna Commercial |
$2,762.28
|
| Rate for Payer: Anthem Medicaid |
$1,233.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,798.16
|
| Rate for Payer: Cash Price |
$1,793.69
|
| Rate for Payer: Cigna Commercial |
$2,977.53
|
| Rate for Payer: First Health Commercial |
$3,408.01
|
| Rate for Payer: Humana Commercial |
$3,049.27
|
| Rate for Payer: Humana KY Medicaid |
$1,233.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,246.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,941.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,647.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,258.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,156.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,690.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,869.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,121.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.29
|
| Rate for Payer: PHCS Commercial |
$3,443.88
|
| Rate for Payer: United Healthcare All Payer |
$3,156.89
|
|
|
OBTURATOR AS TIBIAL D12MM
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
OBTURATOR AS TIBIAL D12MM
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
OBTURATOR AS TIBIAL D14MM
|
Facility
|
IP
|
$4,681.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.35 |
| Max. Negotiated Rate |
$4,493.93 |
| Rate for Payer: Aetna Commercial |
$3,604.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.32
|
| Rate for Payer: Cash Price |
$2,340.59
|
| Rate for Payer: Cigna Commercial |
$3,885.38
|
| Rate for Payer: First Health Commercial |
$4,447.12
|
| Rate for Payer: Humana Commercial |
$3,979.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,510.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,744.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,072.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.01
|
| Rate for Payer: PHCS Commercial |
$4,493.93
|
| Rate for Payer: United Healthcare All Payer |
$4,119.44
|
|
|
OBTURATOR AS TIBIAL D14MM
|
Facility
|
OP
|
$4,681.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.35 |
| Max. Negotiated Rate |
$4,493.93 |
| Rate for Payer: Aetna Commercial |
$3,604.51
|
| Rate for Payer: Anthem Medicaid |
$1,609.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.32
|
| Rate for Payer: Cash Price |
$2,340.59
|
| Rate for Payer: Cigna Commercial |
$3,885.38
|
| Rate for Payer: First Health Commercial |
$4,447.12
|
| Rate for Payer: Humana Commercial |
$3,979.00
|
| Rate for Payer: Humana KY Medicaid |
$1,609.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,626.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,642.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,510.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,744.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,072.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.01
|
| Rate for Payer: PHCS Commercial |
$4,493.93
|
| Rate for Payer: United Healthcare All Payer |
$4,119.44
|
|
|
OB ULTRASOUND LIMITED
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$477.60 |
| Rate for Payer: Aetna Commercial |
$139.02
|
| Rate for Payer: Ambetter Exchange |
$73.34
|
| Rate for Payer: Anthem Medicaid |
$66.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.01
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$73.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.82
|
| Rate for Payer: Molina Healthcare Passport |
$66.49
|
| Rate for Payer: Multiplan PHCS |
$477.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.34
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.34
|
|
|
OB ULTRASOUND LIMITED
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$764.16 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem Medicaid |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Humana KY Medicaid |
$273.74
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$276.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
OB ULTRASOUND LIMITED
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$764.16 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
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 |
$139.02 |
| Rate for Payer: Aetna Commercial |
$139.02
|
| Rate for Payer: Ambetter Exchange |
$73.34
|
| Rate for Payer: Anthem Medicaid |
$66.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$73.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.34
|
| 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 |
$95.34
|
| Rate for Payer: UHCCP Medicaid |
$57.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.34
|
|
|
OB ULTRASOUND LIMITED(T
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
402T0037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$217.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$217.00
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$219.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
OB ULTRASOUND LIMITED(T
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
402T0037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
