|
OCCIPITAL NERVE BLOCK
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
76102311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.10 |
| Max. Negotiated Rate |
$1,072.32 |
| Rate for Payer: Aetna Commercial |
$860.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.26
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cigna Commercial |
$927.11
|
| Rate for Payer: First Health Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial |
$949.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.96
|
| Rate for Payer: Ohio Health Group HMO |
$837.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$770.73
|
| Rate for Payer: PHCS Commercial |
$1,072.32
|
| Rate for Payer: United Healthcare All Payer |
$982.96
|
|
|
OCCIPITAL NERVE BLOCK
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
76102311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$1,072.32 |
| Rate for Payer: Aetna Commercial |
$860.09
|
| Rate for Payer: Anthem Medicaid |
$384.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cash Price |
$558.50
|
| Rate for Payer: Cigna Commercial |
$927.11
|
| Rate for Payer: First Health Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial |
$949.45
|
| Rate for Payer: Humana KY Medicaid |
$384.14
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$388.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.96
|
| Rate for Payer: Ohio Health Group HMO |
$837.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$770.73
|
| Rate for Payer: PHCS Commercial |
$1,072.32
|
| Rate for Payer: United Healthcare All Payer |
$982.96
|
|
|
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 |
$158.03 |
| Rate for Payer: Aetna Commercial |
$117.37
|
| Rate for Payer: Ambetter Exchange |
$50.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.08
|
| Rate for Payer: Anthem Medicaid |
$56.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.52
|
| 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 |
$56.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.59
|
| Rate for Payer: Molina Healthcare Passport |
$56.46
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.56
|
| Rate for Payer: UHCCP Medicaid |
$33.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.43
|
|
|
OCCIPITAL NERVE BLOCK(T
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
761T2311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$880.32 |
| Rate for Payer: Aetna Commercial |
$706.09
|
| Rate for Payer: Anthem Medicaid |
$315.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: Cigna Commercial |
$761.11
|
| Rate for Payer: First Health Commercial |
$871.15
|
| Rate for Payer: Humana Commercial |
$779.45
|
| Rate for Payer: Humana KY Medicaid |
$315.36
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$318.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$751.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$676.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$321.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$806.96
|
| Rate for Payer: Ohio Health Group HMO |
$687.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$733.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.73
|
| Rate for Payer: PHCS Commercial |
$880.32
|
| Rate for Payer: United Healthcare All Payer |
$806.96
|
|
|
OCCIPITAL NERVE BLOCK(T
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
761T2311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.10 |
| Max. Negotiated Rate |
$880.32 |
| Rate for Payer: Aetna Commercial |
$706.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$715.26
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: Cigna Commercial |
$761.11
|
| Rate for Payer: First Health Commercial |
$871.15
|
| Rate for Payer: Humana Commercial |
$779.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$751.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$676.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$275.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$806.96
|
| Rate for Payer: Ohio Health Group HMO |
$687.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$733.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.73
|
| Rate for Payer: PHCS Commercial |
$880.32
|
| Rate for Payer: United Healthcare All Payer |
$806.96
|
|
|
OCCLUDE FALLOPIAN TUBE(S)
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
76102247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| 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 |
$435.00 |
| 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 |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| 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 |
$870.00 |
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Ambetter Exchange |
$238.45
|
| Rate for Payer: Anthem Medicaid |
$199.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$238.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$238.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.45
|
| 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 |
$309.99
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.45
|
|
|
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 |
$870.00 |
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Ambetter Exchange |
$238.45
|
| Rate for Payer: Anthem Medicaid |
$199.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$238.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$238.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.45
|
| 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 |
$309.99
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.45
|
|
|
OCCULDER BALLOON CATH 34FR
|
Facility
|
IP
|
$1,816.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.02 |
| Max. Negotiated Rate |
$1,744.05 |
| Rate for Payer: Aetna Commercial |
$1,398.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.04
|
| Rate for Payer: Cash Price |
$908.36
|
| Rate for Payer: Cigna Commercial |
$1,507.88
|
| Rate for Payer: First Health Commercial |
$1,725.88
|
| Rate for Payer: Humana Commercial |
$1,544.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.54
|
| Rate for Payer: PHCS Commercial |
$1,744.05
|
| Rate for Payer: United Healthcare All Payer |
$1,598.71
|
|
|
OCCULDER BALLOON CATH 34FR
|
Facility
|
OP
|
$1,816.72
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.02 |
| Max. Negotiated Rate |
$1,744.05 |
| Rate for Payer: Aetna Commercial |
$1,398.87
|
| Rate for Payer: Anthem Medicaid |
$624.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.04
|
| Rate for Payer: Cash Price |
$908.36
|
| Rate for Payer: Cigna Commercial |
$1,507.88
|
| Rate for Payer: First Health Commercial |
$1,725.88
|
| Rate for Payer: Humana Commercial |
$1,544.21
|
| Rate for Payer: Humana KY Medicaid |
$624.77
|
| Rate for Payer: Kentucky WC Medicaid |
$631.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.54
|
| Rate for Payer: PHCS Commercial |
$1,744.05
|
| Rate for Payer: United Healthcare All Payer |
$1,598.71
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$31.80 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Ambetter Exchange |
$4.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.26
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: Healthspan PPO |
$3.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.38
|
| Rate for Payer: Multiplan PHCS |
$31.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.69
|
| Rate for Payer: UHCCP Medicaid |
$18.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.38
|
|
|
OCCULT BLD FEC 1-3 SIM SCREEN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
30000250
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$4.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| 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 |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OCCULT BLOOD 1-3
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OCCULT BLOOD 1-3
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Ambetter Exchange |
$4.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: Healthspan PPO |
$3.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.23
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$25.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.23
|
|
|
OCCULT BLOOD 1-3
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 82272
|
| Hospital Charge Code |
30000253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$4.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$4.23
|
| Rate for Payer: Humana Medicare Advantage |
$4.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
OCELOT 6F 110CM
|
Facility
|
IP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCELOT 6F 110CM
|
Facility
|
OP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem Medicaid |
$4,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Humana KY Medicaid |
$4,352.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCELOT/MVRX 6F 110CM
|
Facility
|
IP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCELOT/MVRX 6F 110CM
|
Facility
|
OP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem Medicaid |
$4,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Humana KY Medicaid |
$4,352.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCELOT/PIXL 5F 135CM
|
Facility
|
OP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem Medicaid |
$4,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Humana KY Medicaid |
$4,352.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCELOT/PIXL 5F 135CM
|
Facility
|
IP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
OCREVUS 1mg (300mg Vial)
|
Facility
|
IP
|
$112,493.23
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
25002260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33,747.97 |
| Max. Negotiated Rate |
$107,993.50 |
| Rate for Payer: Aetna Commercial |
$86,619.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87,744.72
|
| Rate for Payer: Cash Price |
$56,246.61
|
| Rate for Payer: Cigna Commercial |
$93,369.38
|
| Rate for Payer: First Health Commercial |
$106,868.57
|
| Rate for Payer: Humana Commercial |
$95,619.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92,244.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83,020.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,747.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$98,994.04
|
| Rate for Payer: Ohio Health Group HMO |
$84,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89,994.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97,869.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77,620.33
|
| Rate for Payer: PHCS Commercial |
$107,993.50
|
| Rate for Payer: United Healthcare All Payer |
$98,994.04
|
|
|
OCREVUS 1mg (300mg Vial)
|
Facility
|
OP
|
$112,493.23
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
25002260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$107,993.50 |
| Rate for Payer: Aetna Commercial |
$86,619.79
|
| Rate for Payer: Anthem Medicaid |
$38,686.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$59.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87,744.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$83.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$80.59
|
| Rate for Payer: Cash Price |
$56,246.61
|
| Rate for Payer: Cash Price |
$56,246.61
|
| Rate for Payer: Cigna Commercial |
$93,369.38
|
| Rate for Payer: First Health Commercial |
$106,868.57
|
| Rate for Payer: Humana Commercial |
$95,619.25
|
| Rate for Payer: Humana KY Medicaid |
$38,686.42
|
| Rate for Payer: Humana Medicare Advantage |
$59.70
|
| Rate for Payer: Kentucky WC Medicaid |
$39,080.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92,244.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83,020.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,462.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$98,994.04
|
| Rate for Payer: Ohio Health Group HMO |
$84,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89,994.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97,869.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77,620.33
|
| Rate for Payer: PHCS Commercial |
$107,993.50
|
| Rate for Payer: United Healthcare All Payer |
$98,994.04
|
|
