|
PORT DRAW
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
76101492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
PORT FLUSH
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
45000312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem Medicaid |
$79.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Humana KY Medicaid |
$79.78
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$80.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.92
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
PORT FLUSH
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
45000312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.92
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
PORT IMAGE ADDITIONAL SITE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 77417
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.70
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
PORT IMAGE ADDITIONAL SITE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 77417
|
| Hospital Charge Code |
33300027
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem Medicaid |
$92.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Humana KY Medicaid |
$92.85
|
| Rate for Payer: Kentucky WC Medicaid |
$93.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.70
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
PORT POWERLINE DUAL LUMEN 5FR
|
Facility
|
OP
|
$3,431.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.05 |
| Max. Negotiated Rate |
$3,293.88 |
| Rate for Payer: Aetna Commercial |
$2,641.96
|
| Rate for Payer: Anthem Medicaid |
$1,179.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.27
|
| Rate for Payer: Cash Price |
$1,715.56
|
| Rate for Payer: Cigna Commercial |
$2,847.83
|
| Rate for Payer: First Health Commercial |
$3,259.56
|
| Rate for Payer: Humana Commercial |
$2,916.45
|
| Rate for Payer: Humana KY Medicaid |
$1,179.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,019.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,573.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.65
|
| Rate for Payer: PHCS Commercial |
$3,293.88
|
| Rate for Payer: United Healthcare All Payer |
$3,019.39
|
|
|
PORT POWERLINE DUAL LUMEN 5FR
|
Facility
|
IP
|
$3,431.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.05 |
| Max. Negotiated Rate |
$3,293.88 |
| Rate for Payer: Aetna Commercial |
$2,641.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.27
|
| Rate for Payer: Cash Price |
$1,715.56
|
| Rate for Payer: Cigna Commercial |
$2,847.83
|
| Rate for Payer: First Health Commercial |
$3,259.56
|
| Rate for Payer: Humana Commercial |
$2,916.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,019.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,573.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.65
|
| Rate for Payer: PHCS Commercial |
$3,293.88
|
| Rate for Payer: United Healthcare All Payer |
$3,019.39
|
|
|
PORT POWERLINE SINGLE LUMEN 5F
|
Facility
|
OP
|
$3,177.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.08 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Aetna Commercial |
$2,446.71
|
| Rate for Payer: Anthem Medicaid |
$1,092.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.49
|
| Rate for Payer: Cash Price |
$1,588.78
|
| Rate for Payer: Cigna Commercial |
$2,637.37
|
| Rate for Payer: First Health Commercial |
$3,018.67
|
| Rate for Payer: Humana Commercial |
$2,700.92
|
| Rate for Payer: Humana KY Medicaid |
$1,092.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,103.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,345.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,114.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,796.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,383.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.04
|
| Rate for Payer: PHCS Commercial |
$3,050.45
|
| Rate for Payer: United Healthcare All Payer |
$2,796.24
|
|
|
PORT POWERLINE SINGLE LUMEN 5F
|
Facility
|
IP
|
$3,177.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.08 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Aetna Commercial |
$2,446.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.49
|
| Rate for Payer: Cash Price |
$1,588.78
|
| Rate for Payer: Cigna Commercial |
$2,637.37
|
| Rate for Payer: First Health Commercial |
$3,018.67
|
| Rate for Payer: Humana Commercial |
$2,700.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,345.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,796.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,383.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.04
|
| Rate for Payer: PHCS Commercial |
$3,050.45
|
| Rate for Payer: United Healthcare All Payer |
$2,796.24
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$86.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$86.66
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$87.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.12
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem Medicaid |
$27.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$252.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$85.55
|
| Rate for Payer: Healthspan PPO |
$73.40
|
| Rate for Payer: Humana Medicaid |
$27.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.30
|
| Rate for Payer: Molina Healthcare Passport |
$27.75
|
| Rate for Payer: Multiplan PHCS |
$151.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.40
|
| Rate for Payer: UHCCP Medicaid |
$88.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.03
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.12
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
POSITIONAL NYSTAGMUS TEST(P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
470P0006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$89.69 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem Medicaid |
$27.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$85.55
|
| Rate for Payer: Healthspan PPO |
$73.40
|
| Rate for Payer: Humana Medicaid |
$27.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.30
|
| Rate for Payer: Molina Healthcare Passport |
$27.75
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.03
|
|
|
POSITIONAL NYSTAGMUS TEST(T
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
470T0006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
POSITIONAL NYSTAGMUS TEST(T
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 92542
|
| Hospital Charge Code |
470T0006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$57.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$57.43
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$58.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
POST BOW HFN 2M 10MMX32CM LT
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX32CM LT
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX32CM RT
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX32CM RT
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX34CM LT
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX34CM LT
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX34CM RT
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
|
|
POST BOW HFN 2M 10MMX34CM RT
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX36CM LT
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
POST BOW HFN 2M 10MMX36CM LT
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
