|
BILATERAL ILIAC ANGIOGRAM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
76102536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
BILATERAL ILIAC ANGIOGRAM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
76102536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
BILATERAL ILIAC ANGIOGRAM
|
Facility
|
IP
|
$3,045.00
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$2,923.20 |
| Rate for Payer: Aetna Commercial |
$2,344.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,375.10
|
| Rate for Payer: Cash Price |
$1,522.50
|
| Rate for Payer: Cigna Commercial |
$2,527.35
|
| Rate for Payer: First Health Commercial |
$2,892.75
|
| Rate for Payer: Humana Commercial |
$2,588.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,496.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,247.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,679.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,283.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.95
|
| Rate for Payer: PHCS Commercial |
$2,923.20
|
| Rate for Payer: United Healthcare All Payer |
$2,679.60
|
|
|
BILATERAL ILIAC ANGIOGRAM
|
Facility
|
OP
|
$3,045.00
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$2,923.20 |
| Rate for Payer: Aetna Commercial |
$2,344.65
|
| Rate for Payer: Anthem Medicaid |
$1,047.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,375.10
|
| Rate for Payer: Cash Price |
$1,522.50
|
| Rate for Payer: Cigna Commercial |
$2,527.35
|
| Rate for Payer: First Health Commercial |
$2,892.75
|
| Rate for Payer: Humana Commercial |
$2,588.25
|
| Rate for Payer: Humana KY Medicaid |
$1,047.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,057.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,496.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,247.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,068.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,679.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,283.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.95
|
| Rate for Payer: PHCS Commercial |
$2,923.20
|
| Rate for Payer: United Healthcare All Payer |
$2,679.60
|
|
|
BILATERAL MALE BRST REDCTN-80
|
Professional
|
Both
|
$937.50
|
|
| Hospital Charge Code |
22200382
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$328.12 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$937.50
|
| Rate for Payer: Cash Price |
$468.75
|
| Rate for Payer: Multiplan PHCS |
$562.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.25
|
| Rate for Payer: UHCCP Medicaid |
$328.12
|
|
|
BILATERAL MALE BRST REDUCTION
|
Professional
|
Both
|
$1,875.00
|
|
| Hospital Charge Code |
22200071
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$79,764.22
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$54,125.72 |
| Max. Negotiated Rate |
$79,764.22 |
| Rate for Payer: Anthem Medicaid |
$54,125.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$56,974.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$79,764.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$76,915.49
|
| Rate for Payer: Humana KY Medicaid |
$54,125.72
|
| Rate for Payer: Humana Medicare Advantage |
$56,974.44
|
| Rate for Payer: Kentucky WC Medicaid |
$54,666.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68,369.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$55,208.23
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$33,296.61
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$22,594.13 |
| Max. Negotiated Rate |
$33,296.61 |
| Rate for Payer: Anthem Medicaid |
$22,594.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,783.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33,296.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$32,107.44
|
| Rate for Payer: Humana KY Medicaid |
$22,594.13
|
| Rate for Payer: Humana Medicare Advantage |
$23,783.29
|
| Rate for Payer: Kentucky WC Medicaid |
$22,820.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,539.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,046.01
|
|
|
BILATERAL SCREENING WITH CAD
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40100013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$643.00 |
| Rate for Payer: Anthem Medicaid |
$103.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$643.00
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cigna Commercial |
$214.76
|
| Rate for Payer: Humana Medicaid |
$103.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.40
|
| Rate for Payer: Molina Healthcare Passport |
$103.33
|
| Rate for Payer: Multiplan PHCS |
$385.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.10
|
| Rate for Payer: UHCCP Medicaid |
$225.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.36
|
|
|
BILATERAL SCREENING WITH CAD
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40100013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$83.59 |
| Max. Negotiated Rate |
$617.28 |
| Rate for Payer: Aetna Commercial |
$495.11
|
| Rate for Payer: Anthem Medicaid |
$221.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.54
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cigna Commercial |
$533.69
|
| Rate for Payer: First Health Commercial |
$610.85
|
| Rate for Payer: Humana Commercial |
$546.55
|
| Rate for Payer: Humana KY Medicaid |
$221.13
|
| Rate for Payer: Kentucky WC Medicaid |
$223.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$527.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$474.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$225.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$565.84
|
| Rate for Payer: Ohio Health Group HMO |
$482.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.33
|
| Rate for Payer: PHCS Commercial |
$617.28
|
| Rate for Payer: United Healthcare All Payer |
$565.84
|
|
|
BILATERAL SCREENING WITH CAD
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40100013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$83.59 |
| Max. Negotiated Rate |
$617.28 |
| Rate for Payer: Aetna Commercial |
$495.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$501.54
|
| Rate for Payer: Cash Price |
$321.50
|
| Rate for Payer: Cigna Commercial |
$533.69
|
| Rate for Payer: First Health Commercial |
$610.85
|
| Rate for Payer: Humana Commercial |
$546.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$527.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$474.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$565.84
|
| Rate for Payer: Ohio Health Group HMO |
$482.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.33
|
| Rate for Payer: PHCS Commercial |
$617.28
|
| Rate for Payer: United Healthcare All Payer |
$565.84
|
|
|
BILATERAL SCREENING WITH CAD(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
401P0013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Anthem Medicaid |
$103.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$214.76
|
| Rate for Payer: Humana Medicaid |
$103.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.40
|
| Rate for Payer: Molina Healthcare Passport |
$103.33
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.36
|
|
|
BILATERAL SCREENING WITH CAD(T
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
401T0013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Kentucky WC Medicaid |
$145.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.58
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
BILATERAL SCREENING WITH CAD(T
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
401T0013
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.58
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
BILAT FOLLOWUP PROC W/CAD
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Anthem Medicaid |
$126.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$851.00
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$266.31
|
| Rate for Payer: Humana Medicaid |
$126.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.68
|
| Rate for Payer: Molina Healthcare Passport |
$126.16
|
| Rate for Payer: Multiplan PHCS |
$510.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.70
|
| Rate for Payer: UHCCP Medicaid |
$297.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.42
|
|
|
BILAT FOLLOWUP PROC W/CAD
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.81
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
BILAT FOLLOWUP PROC W/CAD
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem Medicaid |
$292.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Humana KY Medicaid |
$292.66
|
| Rate for Payer: Kentucky WC Medicaid |
$295.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.81
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
BILAT FOLLOWUP PROC W/CAD(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
401P0009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$266.31 |
| Rate for Payer: Anthem Medicaid |
$126.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$266.31
|
| Rate for Payer: Humana Medicaid |
$126.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.68
|
| Rate for Payer: Molina Healthcare Passport |
$126.16
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.42
|
|
|
BILAT FOLLOWUP PROC W/CAD(T
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
401T0009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$576.96 |
| Rate for Payer: Aetna Commercial |
$462.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.78
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$498.83
|
| Rate for Payer: First Health Commercial |
$570.95
|
| Rate for Payer: Humana Commercial |
$510.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$443.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.88
|
| Rate for Payer: Ohio Health Group HMO |
$450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.31
|
| Rate for Payer: PHCS Commercial |
$576.96
|
| Rate for Payer: United Healthcare All Payer |
$528.88
|
|
|
BILAT FOLLOWUP PROC W/CAD(T
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
401T0009
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$576.96 |
| Rate for Payer: Aetna Commercial |
$462.77
|
| Rate for Payer: Anthem Medicaid |
$206.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.78
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$498.83
|
| Rate for Payer: First Health Commercial |
$570.95
|
| Rate for Payer: Humana Commercial |
$510.85
|
| Rate for Payer: Humana KY Medicaid |
$206.68
|
| Rate for Payer: Kentucky WC Medicaid |
$208.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$443.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.88
|
| Rate for Payer: Ohio Health Group HMO |
$450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.31
|
| Rate for Payer: PHCS Commercial |
$576.96
|
| Rate for Payer: United Healthcare All Payer |
$528.88
|
|
|
BILAT MAT VIEW W/CAD
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: United Healthcare All Payer |
$748.88
|
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.81
|
| Rate for Payer: PHCS Commercial |
$816.96
|
|
|
BILAT MAT VIEW W/CAD
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Anthem Medicaid |
$126.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$851.00
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$266.31
|
| Rate for Payer: Humana Medicaid |
$126.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.68
|
| Rate for Payer: Molina Healthcare Passport |
$126.16
|
| Rate for Payer: Multiplan PHCS |
$510.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.70
|
| Rate for Payer: UHCCP Medicaid |
$297.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.42
|
|
|
BILAT MAT VIEW W/CAD
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.63 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem Medicaid |
$292.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Humana KY Medicaid |
$292.66
|
| Rate for Payer: Kentucky WC Medicaid |
$295.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.81
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
BILAT MAT VIEW W/CAD(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
401P0011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$266.31 |
| Rate for Payer: Anthem Medicaid |
$126.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$266.31
|
| Rate for Payer: Humana Medicaid |
$126.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.68
|
| Rate for Payer: Molina Healthcare Passport |
$126.16
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.42
|
|
|
BILAT MAT VIEW W/CAD(T
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
401T0011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$78.13 |
| Max. Negotiated Rate |
$576.96 |
| Rate for Payer: Aetna Commercial |
$462.77
|
| Rate for Payer: Anthem Medicaid |
$206.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.78
|
| Rate for Payer: Cash Price |
$300.50
|
| Rate for Payer: Cigna Commercial |
$498.83
|
| Rate for Payer: First Health Commercial |
$570.95
|
| Rate for Payer: Humana Commercial |
$510.85
|
| Rate for Payer: Humana KY Medicaid |
$206.68
|
| Rate for Payer: Kentucky WC Medicaid |
$208.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$443.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.88
|
| Rate for Payer: Ohio Health Group HMO |
$450.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.31
|
| Rate for Payer: PHCS Commercial |
$576.96
|
| Rate for Payer: United Healthcare All Payer |
$528.88
|
|
