|
ARTICUL/EZE HIP BALL 32MM 5
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ARTICUL/EZE HIP BALL 32MM 5
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ARTICUL/EZE HIP BALL 32MM 9
|
Facility
|
OP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem Medicaid |
$1,593.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Humana KY Medicaid |
$1,593.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE HIP BALL 32MM 9
|
Facility
|
IP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE METAL FEM HD 36MM1
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ARTICUL/EZE METAL FEM HD 36MM1
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ARTICULEZE METAL HIP BALL 36M
|
Facility
|
OP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem Medicaid |
$2,265.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Humana KY Medicaid |
$2,265.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,288.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,311.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
ARTICULEZE METAL HIP BALL 36M
|
Facility
|
IP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
ARTICULEZE M HEAD 36MM +5
|
Facility
|
IP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
ARTICULEZE M HEAD 36MM +5
|
Facility
|
OP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem Medicaid |
$2,265.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Humana KY Medicaid |
$2,265.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,288.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,311.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
ARTIFICIAL INSEMINATION
|
Professional
|
Both
|
$492.50
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.87 |
| Max. Negotiated Rate |
$492.50 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$492.50
|
| Rate for Payer: Cash Price |
$246.25
|
| Rate for Payer: Cash Price |
$246.25
|
| Rate for Payer: Cigna Commercial |
$133.17
|
| Rate for Payer: Healthspan PPO |
$126.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.87
|
| Rate for Payer: Multiplan PHCS |
$295.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$344.75
|
| Rate for Payer: UHCCP Medicaid |
$172.38
|
|
|
ARTIFICIAL INSEMINATION
|
Facility
|
OP
|
$492.50
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$472.80 |
| Rate for Payer: Aetna Commercial |
$379.22
|
| Rate for Payer: Anthem Medicaid |
$169.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$246.25
|
| Rate for Payer: Cash Price |
$246.25
|
| Rate for Payer: Cigna Commercial |
$408.78
|
| Rate for Payer: First Health Commercial |
$467.88
|
| Rate for Payer: Humana Commercial |
$418.62
|
| Rate for Payer: Humana KY Medicaid |
$169.37
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$171.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.40
|
| Rate for Payer: Ohio Health Group HMO |
$369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.68
|
| Rate for Payer: PHCS Commercial |
$472.80
|
| Rate for Payer: United Healthcare All Payer |
$433.40
|
|
|
ARTIFICIAL INSEMINATION
|
Facility
|
IP
|
$492.50
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$472.80 |
| Rate for Payer: Aetna Commercial |
$379.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.15
|
| Rate for Payer: Cash Price |
$246.25
|
| Rate for Payer: Cigna Commercial |
$408.78
|
| Rate for Payer: First Health Commercial |
$467.88
|
| Rate for Payer: Humana Commercial |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.40
|
| Rate for Payer: Ohio Health Group HMO |
$369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.68
|
| Rate for Payer: PHCS Commercial |
$472.80
|
| Rate for Payer: United Healthcare All Payer |
$433.40
|
|
|
ARTIFICIAL INSEMINATION(P
|
Professional
|
Both
|
$143.50
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
761P2222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.22 |
| Max. Negotiated Rate |
$143.50 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.50
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cigna Commercial |
$133.17
|
| Rate for Payer: Healthspan PPO |
$126.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.87
|
| Rate for Payer: Multiplan PHCS |
$86.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.45
|
| Rate for Payer: UHCCP Medicaid |
$50.22
|
|
|
ARTIFICIAL INSEMINATION(T
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
761T2222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
ARTIFICIAL INSEMINATION(T
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
761T2222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
ARTIFICIAL TEARS OINT (3-5GM)
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
25000260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Anthem Medicaid |
$0.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.16
|
| Rate for Payer: First Health Commercial |
$0.18
|
| Rate for Payer: Humana Commercial |
$0.16
|
| Rate for Payer: Humana KY Medicaid |
$0.07
|
| Rate for Payer: Kentucky WC Medicaid |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.17
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Payer |
$0.17
|
|
|
ARTIFICIAL TEARS OINT (3-5GM)
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
25000260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.16
|
| Rate for Payer: First Health Commercial |
$0.18
|
| Rate for Payer: Humana Commercial |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.17
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Payer |
$0.17
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921P0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$370.93 |
| Rate for Payer: Aetna Commercial |
$347.25
|
| Rate for Payer: Anthem Medicaid |
$100.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$280.04
|
| Rate for Payer: Healthspan PPO |
$370.93
|
| Rate for Payer: Humana Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.05
|
| Rate for Payer: Molina Healthcare Passport |
$100.05
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.05
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.07 |
| Max. Negotiated Rate |
$805.44 |
| Rate for Payer: Aetna Commercial |
$646.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$654.42
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$696.37
|
| Rate for Payer: First Health Commercial |
$797.05
|
| Rate for Payer: Humana Commercial |
$713.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$738.32
|
| Rate for Payer: Ohio Health Group HMO |
$629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.09
|
| Rate for Payer: PHCS Commercial |
$805.44
|
| Rate for Payer: United Healthcare All Payer |
$738.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$839.00 |
| Rate for Payer: Aetna Commercial |
$347.25
|
| Rate for Payer: Anthem Medicaid |
$100.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$839.00
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$280.04
|
| Rate for Payer: Healthspan PPO |
$370.93
|
| Rate for Payer: Humana Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.05
|
| Rate for Payer: Molina Healthcare Passport |
$100.05
|
| Rate for Payer: Multiplan PHCS |
$503.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$587.30
|
| Rate for Payer: UHCCP Medicaid |
$293.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.05
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921T0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.84
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921T0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem Medicaid |
$228.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Humana KY Medicaid |
$228.35
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$230.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.84
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.07 |
| Max. Negotiated Rate |
$805.44 |
| Rate for Payer: Aetna Commercial |
$646.03
|
| Rate for Payer: Anthem Medicaid |
$288.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$654.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$696.37
|
| Rate for Payer: First Health Commercial |
$797.05
|
| Rate for Payer: Humana Commercial |
$713.15
|
| Rate for Payer: Humana KY Medicaid |
$288.53
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$291.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$738.32
|
| Rate for Payer: Ohio Health Group HMO |
$629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.09
|
| Rate for Payer: PHCS Commercial |
$805.44
|
| Rate for Payer: United Healthcare All Payer |
$738.32
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$105.95 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.65
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
