|
SCALP COOL PLMT MNTR RMVL
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.98
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
SCALP COOL PLMT MNTR RMVL
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
SCALP COOL PLMT MNTR RMVL
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 0663T
|
| Hospital Charge Code |
76102919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.44 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Anthem Medicaid |
$223.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,911.00
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cigna Commercial |
$475.13
|
| Rate for Payer: Healthspan PPO |
$291.18
|
| Rate for Payer: Humana Medicaid |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.92
|
| Rate for Payer: Molina Healthcare Passport |
$223.45
|
| Rate for Payer: Multiplan PHCS |
$1,146.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,337.70
|
| Rate for Payer: UHCCP Medicaid |
$668.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.68
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$1,834.56 |
| Rate for Payer: Aetna Commercial |
$1,471.47
|
| Rate for Payer: Anthem Medicaid |
$657.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.58
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cigna Commercial |
$1,586.13
|
| Rate for Payer: First Health Commercial |
$1,815.45
|
| Rate for Payer: Humana Commercial |
$1,624.35
|
| Rate for Payer: Humana KY Medicaid |
$657.19
|
| Rate for Payer: Kentucky WC Medicaid |
$663.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.41
|
| Rate for Payer: PHCS Commercial |
$1,834.56
|
| Rate for Payer: United Healthcare All Payer |
$1,681.68
|
|
|
SCAN FOR NEEDLE BIOPSY
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$1,834.56 |
| Rate for Payer: Aetna Commercial |
$1,471.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.58
|
| Rate for Payer: Cash Price |
$955.50
|
| Rate for Payer: Cigna Commercial |
$1,586.13
|
| Rate for Payer: First Health Commercial |
$1,815.45
|
| Rate for Payer: Humana Commercial |
$1,624.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.41
|
| Rate for Payer: PHCS Commercial |
$1,834.56
|
| Rate for Payer: United Healthcare All Payer |
$1,681.68
|
|
|
SCAN FOR NEEDLE BIOPSY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350P0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$475.13 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Anthem Medicaid |
$223.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$475.13
|
| Rate for Payer: Healthspan PPO |
$291.18
|
| Rate for Payer: Humana Medicaid |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.92
|
| Rate for Payer: Molina Healthcare Passport |
$223.45
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.68
|
|
|
SCAN FOR NEEDLE BIOPSY(T
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350T0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$228.93 |
| Max. Negotiated Rate |
$1,690.56 |
| Rate for Payer: Aetna Commercial |
$1,355.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.58
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$1,461.63
|
| Rate for Payer: First Health Commercial |
$1,672.95
|
| Rate for Payer: Humana Commercial |
$1,496.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,444.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.91
|
| Rate for Payer: PHCS Commercial |
$1,690.56
|
| Rate for Payer: United Healthcare All Payer |
$1,549.68
|
|
|
SCAN FOR NEEDLE BIOPSY(T
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
HCPCS 77012
|
| Hospital Charge Code |
350T0017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$228.93 |
| Max. Negotiated Rate |
$1,690.56 |
| Rate for Payer: Aetna Commercial |
$1,355.97
|
| Rate for Payer: Anthem Medicaid |
$605.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.58
|
| Rate for Payer: Cash Price |
$880.50
|
| Rate for Payer: Cigna Commercial |
$1,461.63
|
| Rate for Payer: First Health Commercial |
$1,672.95
|
| Rate for Payer: Humana Commercial |
$1,496.85
|
| Rate for Payer: Humana KY Medicaid |
$605.61
|
| Rate for Payer: Kentucky WC Medicaid |
$611.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,444.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.91
|
| Rate for Payer: PHCS Commercial |
$1,690.56
|
| Rate for Payer: United Healthcare All Payer |
$1,549.68
|
|
|
SCAN PROC CRANIAL EXTRA
|
Professional
|
Both
|
$3,394.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
76102288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$3,394.74 |
| Rate for Payer: Aetna Commercial |
$351.31
|
| Rate for Payer: Anthem Medicaid |
$173.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,394.74
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cigna Commercial |
$350.94
|
| Rate for Payer: Healthspan PPO |
$205.93
|
| Rate for Payer: Humana Medicaid |
$173.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$259.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.04
|
| Rate for Payer: Molina Healthcare Passport |
$173.57
|
| Rate for Payer: Multiplan PHCS |
$2,036.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,376.32
|
| Rate for Payer: UHCCP Medicaid |
$1,188.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.31
|
|
|
SCAN PROC CRANIAL EXTRA
|
Facility
|
OP
|
$3,394.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
76102288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.32 |
| Max. Negotiated Rate |
$3,258.95 |
| Rate for Payer: Aetna Commercial |
$2,613.95
|
| Rate for Payer: Anthem Medicaid |
$1,167.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,647.90
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cigna Commercial |
$2,817.63
|
| Rate for Payer: First Health Commercial |
$3,225.00
|
| Rate for Payer: Humana Commercial |
$2,885.53
|
| Rate for Payer: Humana KY Medicaid |
$1,167.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,179.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,190.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.37
|
| Rate for Payer: PHCS Commercial |
$3,258.95
|
| Rate for Payer: United Healthcare All Payer |
$2,987.37
|
|
|
SCAN PROC CRANIAL EXTRA
|
Facility
|
IP
|
$3,394.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
76102288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.32 |
| Max. Negotiated Rate |
$3,258.95 |
| Rate for Payer: Aetna Commercial |
$2,613.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,647.90
|
| Rate for Payer: Cash Price |
$1,697.37
|
| Rate for Payer: Cigna Commercial |
$2,817.63
|
| Rate for Payer: First Health Commercial |
$3,225.00
|
| Rate for Payer: Humana Commercial |
$2,885.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,783.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,505.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,018.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,987.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,546.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.37
|
| Rate for Payer: PHCS Commercial |
$3,258.95
|
| Rate for Payer: United Healthcare All Payer |
$2,987.37
|
|
|
SCAN PROC CRANIAL EXTRA(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
761P2288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$351.31
|
| Rate for Payer: Anthem Medicaid |
$173.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$350.94
|
| Rate for Payer: Healthspan PPO |
$205.93
|
| Rate for Payer: Humana Medicaid |
$173.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$259.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.04
|
| Rate for Payer: Molina Healthcare Passport |
$173.57
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.31
|
|
|
SCAN PROC CRANIAL EXTRA(T
|
Facility
|
OP
|
$2,894.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
761T2288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.32 |
| Max. Negotiated Rate |
$2,778.95 |
| Rate for Payer: Aetna Commercial |
$2,228.95
|
| Rate for Payer: Anthem Medicaid |
$995.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,257.90
|
| Rate for Payer: Cash Price |
$1,447.37
|
| Rate for Payer: Cigna Commercial |
$2,402.63
|
| Rate for Payer: First Health Commercial |
$2,750.00
|
| Rate for Payer: Humana Commercial |
$2,460.53
|
| Rate for Payer: Humana KY Medicaid |
$995.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,005.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,373.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,136.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$868.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,015.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,547.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,171.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.37
|
| Rate for Payer: PHCS Commercial |
$2,778.95
|
| Rate for Payer: United Healthcare All Payer |
$2,547.37
|
|
|
SCAN PROC CRANIAL EXTRA(T
|
Facility
|
IP
|
$2,894.74
|
|
|
Service Code
|
HCPCS 61782
|
| Hospital Charge Code |
761T2288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.32 |
| Max. Negotiated Rate |
$2,778.95 |
| Rate for Payer: Aetna Commercial |
$2,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,257.90
|
| Rate for Payer: Cash Price |
$1,447.37
|
| Rate for Payer: Cigna Commercial |
$2,402.63
|
| Rate for Payer: First Health Commercial |
$2,750.00
|
| Rate for Payer: Humana Commercial |
$2,460.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,373.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,136.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$868.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,547.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,171.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$376.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.37
|
| Rate for Payer: PHCS Commercial |
$2,778.95
|
| Rate for Payer: United Healthcare All Payer |
$2,547.37
|
|
|
SCARGUARD
|
Professional
|
Both
|
$50.00
|
|
| Hospital Charge Code |
22200020
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
|
|
SC EUPHORA RX BALLOON 1.50*10
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SC EUPHORA RX BALLOON 1.50*10
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SC EUPHORA RX BALLOON 2.00*10
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SC EUPHORA RX BALLOON 2.00*10
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SC EUPHORA RX BALLOON 2.00*12
|
Facility
|
OP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem Medicaid |
$388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Humana KY Medicaid |
$388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$392.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SC EUPHORA RX BALLOON 2.00*12
|
Facility
|
IP
|
$1,129.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$1,084.32 |
| Rate for Payer: Aetna Commercial |
$869.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.01
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: First Health Commercial |
$1,073.02
|
| Rate for Payer: Humana Commercial |
$960.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.96
|
| Rate for Payer: Ohio Health Group HMO |
$847.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.14
|
| Rate for Payer: PHCS Commercial |
$1,084.32
|
| Rate for Payer: United Healthcare All Payer |
$993.96
|
|
|
SC EUPHORA RX BALLOON 2.00*15
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SC EUPHORA RX BALLOON 2.00*15
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
SC EUPHORA RX BALLOON 2.00*20
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
