|
PARACENTESIS WITH IMAGING
|
Facility
|
OP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem Medicaid |
$933.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Humana KY Medicaid |
$933.34
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$942.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$952.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
| Rate for Payer: United Healthcare All Payer |
$2,388.32
|
|
|
PARACENTESIS WITH IMAGING (P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761P2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
|
|
PARACENTESIS WITH IMAGING (T
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
| Rate for Payer: United Healthcare All Payer |
$1,860.32
|
|
|
PARACENTESIS WITH IMAGING (T
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$2,029.44 |
| Rate for Payer: Aetna Commercial |
$1,627.78
|
| Rate for Payer: Anthem Medicaid |
$727.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,754.62
|
| Rate for Payer: First Health Commercial |
$2,008.30
|
| Rate for Payer: Humana Commercial |
$1,796.90
|
| Rate for Payer: Humana KY Medicaid |
$727.00
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$734.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.34
|
| Rate for Payer: PHCS Commercial |
$2,029.44
|
| Rate for Payer: United Healthcare All Payer |
$1,860.32
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
PARAGARD IUD
|
Facility
|
OP
|
$3,210.31
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
25002484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$417.34 |
| Max. Negotiated Rate |
$3,081.90 |
| Rate for Payer: Aetna Commercial |
$2,471.94
|
| Rate for Payer: Anthem Medicaid |
$1,104.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.04
|
| Rate for Payer: Cash Price |
$1,605.15
|
| Rate for Payer: Cigna Commercial |
$2,664.56
|
| Rate for Payer: First Health Commercial |
$3,049.79
|
| Rate for Payer: Humana Commercial |
$2,728.76
|
| Rate for Payer: Humana KY Medicaid |
$1,104.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,115.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,632.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,369.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,126.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,825.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,407.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.20
|
| Rate for Payer: PHCS Commercial |
$3,081.90
|
| Rate for Payer: United Healthcare All Payer |
$2,825.07
|
|
|
PARAGARD IUD
|
Facility
|
IP
|
$3,210.31
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
25002484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$417.34 |
| Max. Negotiated Rate |
$3,081.90 |
| Rate for Payer: Aetna Commercial |
$2,471.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.04
|
| Rate for Payer: Cash Price |
$1,605.15
|
| Rate for Payer: Cigna Commercial |
$2,664.56
|
| Rate for Payer: First Health Commercial |
$3,049.79
|
| Rate for Payer: Humana Commercial |
$2,728.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,632.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,369.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,825.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,407.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.20
|
| Rate for Payer: PHCS Commercial |
$3,081.90
|
| Rate for Payer: United Healthcare All Payer |
$2,825.07
|
|
|
PARAGARD T380A
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
636T0072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARAGARD T380A
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
25002484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARAGARD T380A
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARAGARD T380A
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
25002484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARAGARD T380A
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,281.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,279.38
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$612.50
|
|
|
PARAGARD T380A
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARAGARD T380A
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
636T0072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
PARASITE IDENTIFICATION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
30001313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
PARASITE IDENTIFICATION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
30001313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$4.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$4.31
|
| Rate for Payer: Humana Medicare Advantage |
$4.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
PARATHYRD PLANAR W/WO SUBTRJ
|
Facility
|
IP
|
$1,766.10
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
34000075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$1,695.46 |
| Rate for Payer: Aetna Commercial |
$1,359.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.56
|
| Rate for Payer: Cash Price |
$883.05
|
| Rate for Payer: Cigna Commercial |
$1,465.86
|
| Rate for Payer: First Health Commercial |
$1,677.80
|
| Rate for Payer: Humana Commercial |
$1,501.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.49
|
| Rate for Payer: PHCS Commercial |
$1,695.46
|
| Rate for Payer: United Healthcare All Payer |
$1,554.17
|
|
|
PARATHYRD PLANAR W/WO SUBTRJ
|
Facility
|
OP
|
$1,766.10
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
34000075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$1,695.46 |
| Rate for Payer: Aetna Commercial |
$1,359.90
|
| Rate for Payer: Anthem Medicaid |
$607.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$883.05
|
| Rate for Payer: Cash Price |
$883.05
|
| Rate for Payer: Cigna Commercial |
$1,465.86
|
| Rate for Payer: First Health Commercial |
$1,677.80
|
| Rate for Payer: Humana Commercial |
$1,501.18
|
| Rate for Payer: Humana KY Medicaid |
$607.36
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$613.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.49
|
| Rate for Payer: PHCS Commercial |
$1,695.46
|
| Rate for Payer: United Healthcare All Payer |
$1,554.17
|
|
|
PARATHYRD PLANAR W/WO SUBTRJ
|
Professional
|
Both
|
$1,766.10
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
34000075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$1,766.10 |
| Rate for Payer: Anthem Medicaid |
$279.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,766.10
|
| Rate for Payer: Cash Price |
$883.05
|
| Rate for Payer: Cash Price |
$883.05
|
| Rate for Payer: Cigna Commercial |
$589.37
|
| Rate for Payer: Healthspan PPO |
$400.56
|
| Rate for Payer: Humana Medicaid |
$279.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.82
|
| Rate for Payer: Molina Healthcare Passport |
$279.24
|
| Rate for Payer: Multiplan PHCS |
$1,059.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,236.27
|
| Rate for Payer: UHCCP Medicaid |
$618.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.03
|
|
|
PARATHYRD PLANAR W/WO SUBTR(P
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
340P0075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$589.37 |
| Rate for Payer: Anthem Medicaid |
$279.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$589.37
|
| Rate for Payer: Healthspan PPO |
$400.56
|
| Rate for Payer: Humana Medicaid |
$279.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.82
|
| Rate for Payer: Molina Healthcare Passport |
$279.24
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.00
|
| Rate for Payer: UHCCP Medicaid |
$49.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.03
|
|
|
PARATHYRD PLANAR W/WO SUBTR(T
|
Facility
|
OP
|
$1,626.10
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
340T0075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$211.39 |
| Max. Negotiated Rate |
$1,561.06 |
| Rate for Payer: Aetna Commercial |
$1,252.10
|
| Rate for Payer: Anthem Medicaid |
$559.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,268.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$813.05
|
| Rate for Payer: Cash Price |
$813.05
|
| Rate for Payer: Cigna Commercial |
$1,349.66
|
| Rate for Payer: First Health Commercial |
$1,544.80
|
| Rate for Payer: Humana Commercial |
$1,382.18
|
| Rate for Payer: Humana KY Medicaid |
$559.22
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$564.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,333.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,200.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$570.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,430.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,219.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$504.09
|
| Rate for Payer: PHCS Commercial |
$1,561.06
|
| Rate for Payer: United Healthcare All Payer |
$1,430.97
|
|
|
PARATHYRD PLANAR W/WO SUBTR(T
|
Facility
|
IP
|
$1,626.10
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
340T0075
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$211.39 |
| Max. Negotiated Rate |
$1,561.06 |
| Rate for Payer: Aetna Commercial |
$1,252.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,268.36
|
| Rate for Payer: Cash Price |
$813.05
|
| Rate for Payer: Cigna Commercial |
$1,349.66
|
| Rate for Payer: First Health Commercial |
$1,544.80
|
| Rate for Payer: Humana Commercial |
$1,382.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,333.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,200.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$487.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,430.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,219.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$504.09
|
| Rate for Payer: PHCS Commercial |
$1,561.06
|
| Rate for Payer: United Healthcare All Payer |
$1,430.97
|
|
