|
RT BREAST LUMP US (P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402P0112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$141.32 |
| Rate for Payer: Ambetter Exchange |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.40
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$141.32
|
| Rate for Payer: Humana Medicaid |
$67.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
RT BREAST LUMP US(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402P0011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$141.32 |
| Rate for Payer: Ambetter Exchange |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$67.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.40
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$141.32
|
| Rate for Payer: Humana Medicaid |
$67.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Passport |
$67.64
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.00
|
|
|
RT BREAST LUMP US (T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.10 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$589.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.53
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
RT BREAST LUMP US (T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$589.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.53
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
RT BREAST LUMP US(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
RT BREAST LUMP US(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
402T0011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
RT BREAST US
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
40200008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
RT BREAST US
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
40200008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
RT BREAST US
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
40200008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Ambetter Exchange |
$92.47
|
| Rate for Payer: Anthem Medicaid |
$81.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.96
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$171.21
|
| Rate for Payer: Humana Medicaid |
$81.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.44
|
| Rate for Payer: Molina Healthcare Passport |
$81.80
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.21
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.47
|
|
|
RT BREAST US(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
402P0008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$171.21 |
| Rate for Payer: Ambetter Exchange |
$92.47
|
| Rate for Payer: Anthem Medicaid |
$81.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$110.96
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$171.21
|
| Rate for Payer: Humana Medicaid |
$81.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.44
|
| Rate for Payer: Molina Healthcare Passport |
$81.80
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.21
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.47
|
|
|
RT BREAST US(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
402T0008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
RT BREAST US(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 76641
|
| Hospital Charge Code |
402T0008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
RUBELLA SCREEN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
30001210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
RUBELLA SCREEN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
30001210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
RUNTHROUGH .014 GUIDEWIRE 180
|
Facility
|
OP
|
$1,771.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.36 |
| Max. Negotiated Rate |
$1,700.35 |
| Rate for Payer: Aetna Commercial |
$1,363.82
|
| Rate for Payer: Anthem Medicaid |
$609.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,470.10
|
| Rate for Payer: First Health Commercial |
$1,682.64
|
| Rate for Payer: Humana Commercial |
$1,505.52
|
| Rate for Payer: Humana KY Medicaid |
$609.12
|
| Rate for Payer: Kentucky WC Medicaid |
$615.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.13
|
| Rate for Payer: PHCS Commercial |
$1,700.35
|
| Rate for Payer: United Healthcare All Payer |
$1,558.66
|
|
|
RUNTHROUGH .014 GUIDEWIRE 180
|
Facility
|
IP
|
$1,771.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.36 |
| Max. Negotiated Rate |
$1,700.35 |
| Rate for Payer: Aetna Commercial |
$1,363.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,470.10
|
| Rate for Payer: First Health Commercial |
$1,682.64
|
| Rate for Payer: Humana Commercial |
$1,505.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.13
|
| Rate for Payer: PHCS Commercial |
$1,700.35
|
| Rate for Payer: United Healthcare All Payer |
$1,558.66
|
|
|
RUNTHROUGH .014 GUIDEWIRE 300
|
Facility
|
OP
|
$1,771.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.36 |
| Max. Negotiated Rate |
$1,700.35 |
| Rate for Payer: Aetna Commercial |
$1,363.82
|
| Rate for Payer: Anthem Medicaid |
$609.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,470.10
|
| Rate for Payer: First Health Commercial |
$1,682.64
|
| Rate for Payer: Humana Commercial |
$1,505.52
|
| Rate for Payer: Humana KY Medicaid |
$609.12
|
| Rate for Payer: Kentucky WC Medicaid |
$615.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.13
|
| Rate for Payer: PHCS Commercial |
$1,700.35
|
| Rate for Payer: United Healthcare All Payer |
$1,558.66
|
|
|
RUNTHROUGH .014 GUIDEWIRE 300
|
Facility
|
IP
|
$1,771.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$531.36 |
| Max. Negotiated Rate |
$1,700.35 |
| Rate for Payer: Aetna Commercial |
$1,363.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.54
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,470.10
|
| Rate for Payer: First Health Commercial |
$1,682.64
|
| Rate for Payer: Humana Commercial |
$1,505.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.13
|
| Rate for Payer: PHCS Commercial |
$1,700.35
|
| Rate for Payer: United Healthcare All Payer |
$1,558.66
|
|
|
RUPTURE FETAL MEMBRANE
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 84112
|
| Hospital Charge Code |
30000478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$98.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.11
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$98.11
|
| Rate for Payer: Humana Medicare Advantage |
$98.11
|
| Rate for Payer: Kentucky WC Medicaid |
$99.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
RUPTURE FETAL MEMBRANE
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 84112
|
| Hospital Charge Code |
30000478
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.98
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
RUQ BILTREE GB LIV PANC CBDLTD
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
RUQ BILTREE GB LIV PANC CBDLTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
RUQ BILTREE GB LIV PANC CBDLTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
RUQ BILTREE GB LIV PANC CBDLTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
RUQ BILTREE GB LIV PANC CBDLTD
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
