|
RSP HUM SOCKET INSRT SZ36M STD
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ36M STD
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET SHELL +8
|
Facility
|
OP
|
$8,910.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.31 |
| Max. Negotiated Rate |
$8,553.70 |
| Rate for Payer: Aetna Commercial |
$6,860.78
|
| Rate for Payer: Anthem Medicaid |
$3,064.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,949.88
|
| Rate for Payer: Cash Price |
$4,455.05
|
| Rate for Payer: Cigna Commercial |
$7,395.38
|
| Rate for Payer: First Health Commercial |
$8,464.60
|
| Rate for Payer: Humana Commercial |
$7,573.58
|
| Rate for Payer: Humana KY Medicaid |
$3,064.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,840.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,762.13
|
| Rate for Payer: PHCS Commercial |
$8,553.70
|
| Rate for Payer: United Healthcare All Payer |
$7,840.89
|
|
|
RSP HUM SOCKET SHELL +8
|
Facility
|
IP
|
$8,910.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.31 |
| Max. Negotiated Rate |
$8,553.70 |
| Rate for Payer: Aetna Commercial |
$6,860.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,949.88
|
| Rate for Payer: Cash Price |
$4,455.05
|
| Rate for Payer: Cigna Commercial |
$7,395.38
|
| Rate for Payer: First Health Commercial |
$8,464.60
|
| Rate for Payer: Humana Commercial |
$7,573.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,840.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,762.13
|
| Rate for Payer: PHCS Commercial |
$8,553.70
|
| Rate for Payer: United Healthcare All Payer |
$7,840.89
|
|
|
RSP MONOBLOCK REV HUM 6*175
|
Facility
|
OP
|
$30,541.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,970.42 |
| Max. Negotiated Rate |
$29,320.06 |
| Rate for Payer: Aetna Commercial |
$23,517.13
|
| Rate for Payer: Anthem Medicaid |
$10,503.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,822.55
|
| Rate for Payer: Cash Price |
$15,270.87
|
| Rate for Payer: Cigna Commercial |
$25,349.64
|
| Rate for Payer: First Health Commercial |
$29,014.64
|
| Rate for Payer: Humana Commercial |
$25,960.47
|
| Rate for Payer: Humana KY Medicaid |
$10,503.30
|
| Rate for Payer: Kentucky WC Medicaid |
$10,610.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,044.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,539.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,162.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,714.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,876.72
|
| Rate for Payer: Ohio Health Group HMO |
$22,906.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,108.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,970.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.94
|
| Rate for Payer: PHCS Commercial |
$29,320.06
|
| Rate for Payer: United Healthcare All Payer |
$26,876.72
|
|
|
RSP MONOBLOCK REV HUM 6*175
|
Facility
|
IP
|
$30,541.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,970.42 |
| Max. Negotiated Rate |
$29,320.06 |
| Rate for Payer: Aetna Commercial |
$23,517.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,822.55
|
| Rate for Payer: Cash Price |
$15,270.87
|
| Rate for Payer: Cigna Commercial |
$25,349.64
|
| Rate for Payer: First Health Commercial |
$29,014.64
|
| Rate for Payer: Humana Commercial |
$25,960.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,044.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,539.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,162.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,876.72
|
| Rate for Payer: Ohio Health Group HMO |
$22,906.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,108.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,970.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.94
|
| Rate for Payer: PHCS Commercial |
$29,320.06
|
| Rate for Payer: United Healthcare All Payer |
$26,876.72
|
|
|
RSP MONOBLOCK STEM SZ 6
|
Facility
|
OP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem Medicaid |
$8,932.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Humana KY Medicaid |
$8,932.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,023.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,111.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSP MONOBLOCK STEM SZ 6
|
Facility
|
IP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSP MONOBLOCK STEM SZ 7
|
Facility
|
OP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem Medicaid |
$8,932.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Humana KY Medicaid |
$8,932.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,023.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,111.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSP MONOBLOCK STEM SZ 7
|
Facility
|
IP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSP MONOBLOCK STEM SZ 8
|
Facility
|
OP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem Medicaid |
$8,932.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Humana KY Medicaid |
$8,932.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,023.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,111.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSP MONOBLOCK STEM SZ 8
|
Facility
|
IP
|
$25,973.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.57 |
| Max. Negotiated Rate |
$24,934.70 |
| Rate for Payer: Aetna Commercial |
$19,999.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,259.45
|
| Rate for Payer: Cash Price |
$12,986.83
|
| Rate for Payer: Cigna Commercial |
$21,558.13
|
| Rate for Payer: First Health Commercial |
$24,674.97
|
| Rate for Payer: Humana Commercial |
$22,077.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,298.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,168.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,792.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,856.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,480.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,194.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,376.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,051.83
|
| Rate for Payer: PHCS Commercial |
$24,934.70
|
| Rate for Payer: United Healthcare All Payer |
$22,856.81
|
|
|
RSV ANTIGEN SCREEN
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
RSV ANTIGEN SCREEN
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$71.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.10
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$71.19
|
| Rate for Payer: Humana Medicare Advantage |
$13.10
|
| Rate for Payer: Kentucky WC Medicaid |
$71.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
RSV ANTIGEN SCREEN
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 87807
|
| Hospital Charge Code |
30001412
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$207.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$16.89
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Multiplan PHCS |
$124.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.90
|
| Rate for Payer: UHCCP Medicaid |
$72.45
|
|
|
RSV A RT PCR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$41.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$41.96
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$42.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RSV A RT PCR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RSV B RT PCR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$41.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$41.96
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$42.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RSV B RT PCR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
30001402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
RT AXILLA US
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
RT AXILLA US
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
RT AXILLA US
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
RT AXILLA US(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
RT AXILLA US(T
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
RT AXILLA US(T
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
