|
BILAT MAT VIEW W/CAD(T
|
Facility
|
IP
|
$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 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
|
|
|
BIL BEAST AUGMENTATION -80
|
Professional
|
Both
|
$375.00
|
|
| Hospital Charge Code |
22200370
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
|
|
BIL BREAST AUGMENTATION
|
Professional
|
Both
|
$750.00
|
|
| Hospital Charge Code |
22200034
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
|
|
BILIARY BALLOON DILATOR 10MM*4
|
Facility
|
IP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY BALLOON DILATOR 10MM*4
|
Facility
|
OP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem Medicaid |
$1,137.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Humana KY Medicaid |
$1,137.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY BALLOON DILATOR 4MM*4C
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.48 |
| Max. Negotiated Rate |
$2,972.16 |
| Rate for Payer: Aetna Commercial |
$2,383.92
|
| Rate for Payer: Anthem Medicaid |
$1,064.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.88
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,569.68
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial |
$2,631.60
|
| Rate for Payer: Humana KY Medicaid |
$1,064.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,075.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,538.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,086.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,724.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.76
|
| Rate for Payer: PHCS Commercial |
$2,972.16
|
| Rate for Payer: United Healthcare All Payer |
$2,724.48
|
|
|
BILIARY BALLOON DILATOR 4MM*4C
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.48 |
| Max. Negotiated Rate |
$2,972.16 |
| Rate for Payer: Aetna Commercial |
$2,383.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.88
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,569.68
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial |
$2,631.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,538.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,724.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.76
|
| Rate for Payer: PHCS Commercial |
$2,972.16
|
| Rate for Payer: United Healthcare All Payer |
$2,724.48
|
|
|
BILIARY BALLOON DILATOR 6MM*4C
|
Facility
|
OP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem Medicaid |
$1,137.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Humana KY Medicaid |
$1,137.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY BALLOON DILATOR 6MM*4C
|
Facility
|
IP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY BALLOON DILATOR 8MM*4C
|
Facility
|
IP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY BALLOON DILATOR 8MM*4C
|
Facility
|
OP
|
$3,306.70
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.87 |
| Max. Negotiated Rate |
$3,174.43 |
| Rate for Payer: Aetna Commercial |
$2,546.16
|
| Rate for Payer: Anthem Medicaid |
$1,137.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,579.23
|
| Rate for Payer: Cash Price |
$1,653.35
|
| Rate for Payer: Cigna Commercial |
$2,744.56
|
| Rate for Payer: First Health Commercial |
$3,141.36
|
| Rate for Payer: Humana Commercial |
$2,810.70
|
| Rate for Payer: Humana KY Medicaid |
$1,137.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,711.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,440.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,909.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.08
|
| Rate for Payer: PHCS Commercial |
$3,174.43
|
| Rate for Payer: United Healthcare All Payer |
$2,909.90
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$22,896.89
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$15,537.17 |
| Max. Negotiated Rate |
$22,896.89 |
| Rate for Payer: Anthem Medicaid |
$15,537.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,354.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,896.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,079.14
|
| Rate for Payer: Humana KY Medicaid |
$15,537.17
|
| Rate for Payer: Humana Medicare Advantage |
$16,354.92
|
| Rate for Payer: Kentucky WC Medicaid |
$15,692.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,625.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,847.92
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$43,543.05
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$29,547.07 |
| Max. Negotiated Rate |
$43,543.05 |
| Rate for Payer: Anthem Medicaid |
$29,547.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31,102.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43,543.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$41,987.94
|
| Rate for Payer: Humana KY Medicaid |
$29,547.07
|
| Rate for Payer: Humana Medicare Advantage |
$31,102.18
|
| Rate for Payer: Kentucky WC Medicaid |
$29,842.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37,322.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,138.01
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$18,310.04
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$12,424.67 |
| Max. Negotiated Rate |
$18,310.04 |
| Rate for Payer: Anthem Medicaid |
$12,424.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,078.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,310.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,656.11
|
| Rate for Payer: Humana KY Medicaid |
$12,424.67
|
| Rate for Payer: Humana Medicare Advantage |
$13,078.60
|
| Rate for Payer: Kentucky WC Medicaid |
$12,548.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,694.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,673.16
|
|
|
BILILARY TREE BIOPSY
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 47543
|
| Hospital Charge Code |
76102684
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.48 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.47
|
| Rate for Payer: Anthem Medicaid |
$136.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$281.41
|
| Rate for Payer: Humana Medicaid |
$136.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.21
|
| Rate for Payer: Molina Healthcare Passport |
$136.48
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$144.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.84
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.04
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
BILIRUBIN DIRECT
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$8.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$7.28
|
| Rate for Payer: Healthspan PPO |
$4.22
|
| Rate for Payer: Multiplan PHCS |
$48.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.70
|
| Rate for Payer: UHCCP Medicaid |
$28.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.01
|
|
|
BILIRUBIN (TOTAL)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.02
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
BILIRUBIN (TOTAL)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$8.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$19.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.40
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.01
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
