|
SP KNOX BILAT CATARACT SX (S)
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
36001281
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$3,927.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,978.00
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$4,233.00
|
| Rate for Payer: First Health Commercial |
$4,845.00
|
| Rate for Payer: Humana Commercial |
$4,335.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,763.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,437.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,519.00
|
| Rate for Payer: PHCS Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Payer |
$4,488.00
|
|
|
SP KNOX BILAT CATARACT SX (S)
|
Facility
|
OP
|
$5,100.00
|
|
| Hospital Charge Code |
36001281
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$3,927.00
|
| Rate for Payer: Anthem Medicaid |
$1,753.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,978.00
|
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$4,233.00
|
| Rate for Payer: First Health Commercial |
$4,845.00
|
| Rate for Payer: Humana Commercial |
$4,335.00
|
| Rate for Payer: Humana KY Medicaid |
$1,753.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,771.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,182.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,763.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,789.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,488.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,437.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,519.00
|
| Rate for Payer: PHCS Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Payer |
$4,488.00
|
|
|
SP KNOX BILAT CATARACT SX (S)
|
Professional
|
Both
|
$5,100.00
|
|
| Hospital Charge Code |
36001281
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,785.00 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Cash Price |
$2,550.00
|
| Rate for Payer: Multiplan PHCS |
$3,060.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,570.00
|
| Rate for Payer: UHCCP Medicaid |
$1,785.00
|
|
|
SP KNOX BILAT CATARACT SX (T)
|
Professional
|
Both
|
$5,700.00
|
|
| Hospital Charge Code |
36001280
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Multiplan PHCS |
$3,420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,990.00
|
| Rate for Payer: UHCCP Medicaid |
$1,995.00
|
|
|
SP KNOX BILAT CATARACT SX (T)
|
Facility
|
OP
|
$5,700.00
|
|
| Hospital Charge Code |
36001280
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem Medicaid |
$1,960.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Humana KY Medicaid |
$1,960.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,980.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,999.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
SP KNOX BILAT CATARACT SX (T)
|
Facility
|
IP
|
$5,700.00
|
|
| Hospital Charge Code |
36001280
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
SP KNOX UNILAT CATARACT SX (P)
|
Facility
|
IP
|
$4,800.00
|
|
| Hospital Charge Code |
36001282
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,440.00 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$3,696.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,984.00
|
| Rate for Payer: First Health Commercial |
$4,560.00
|
| Rate for Payer: Humana Commercial |
$4,080.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,176.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,312.00
|
| Rate for Payer: PHCS Commercial |
$4,608.00
|
| Rate for Payer: United Healthcare All Payer |
$4,224.00
|
|
|
SP KNOX UNILAT CATARACT SX (P)
|
Professional
|
Both
|
$4,800.00
|
|
| Hospital Charge Code |
36001282
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Multiplan PHCS |
$2,880.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,360.00
|
| Rate for Payer: UHCCP Medicaid |
$1,680.00
|
|
|
SP KNOX UNILAT CATARACT SX (P)
|
Facility
|
OP
|
$4,800.00
|
|
| Hospital Charge Code |
36001282
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,440.00 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$3,696.00
|
| Rate for Payer: Anthem Medicaid |
$1,650.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cigna Commercial |
$3,984.00
|
| Rate for Payer: First Health Commercial |
$4,560.00
|
| Rate for Payer: Humana Commercial |
$4,080.00
|
| Rate for Payer: Humana KY Medicaid |
$1,650.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,683.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,176.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,312.00
|
| Rate for Payer: PHCS Commercial |
$4,608.00
|
| Rate for Payer: United Healthcare All Payer |
$4,224.00
|
|
|
SP KNOX UNILAT CATARACT SX (S)
|
Professional
|
Both
|
$4,000.00
|
|
| Hospital Charge Code |
36001284
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
|
|
SP KNOX UNILAT CATARACT SX (S)
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
36001284
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
SP KNOX UNILAT CATARACT SX (S)
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
36001284
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
SP KNOX UNILAT CATARACT SX (T)
|
Facility
|
OP
|
$4,300.00
|
|
| Hospital Charge Code |
36001283
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
SP KNOX UNILAT CATARACT SX (T)
|
Professional
|
Both
|
$4,300.00
|
|
| Hospital Charge Code |
36001283
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,010.00 |
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,010.00
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
|
|
SP KNOX UNILAT CATARACT SX (T)
|
Facility
|
IP
|
$4,300.00
|
|
| Hospital Charge Code |
36001283
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
SPLEEN ULTRASOUND ONLY LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200021
|
|
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
|
|
|
SPLEEN ULTRASOUND ONLY LTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200021
|
|
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
|
|
|
SPLEEN ULTRASOUND ONLY LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200021
|
|
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
|
|
|
SPLEEN ULTRASOUND ONLY LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0021
|
|
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
|
|
|
SPLEEN ULTRASOUND ONLY LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| 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: 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 |
$312.60
|
| 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
|
|
|
SPLEEN ULTRASOUND ONLY LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0021
|
|
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
|
|
|
SPLENECTOMY; TOTAL (SEPARATE P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
76101585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.14 |
| Max. Negotiated Rate |
$1,631.60 |
| Rate for Payer: Aetna Commercial |
$1,631.60
|
| Rate for Payer: Ambetter Exchange |
$1,095.43
|
| Rate for Payer: Anthem Medicaid |
$625.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,095.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,095.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,314.52
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,492.74
|
| Rate for Payer: Healthspan PPO |
$1,304.61
|
| Rate for Payer: Humana Medicaid |
$625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,466.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,095.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.64
|
| Rate for Payer: Molina Healthcare Passport |
$625.14
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,424.06
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,095.43
|
|
|
SPLENECTOMY; TOTAL (SEPARATE P
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
76101585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
SPLENECTOMY; TOTAL (SEPARATE P
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
76101585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
SPLENECTOMY; TOTAL (SEPARATE P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
761P1585
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.14 |
| Max. Negotiated Rate |
$1,631.60 |
| Rate for Payer: Aetna Commercial |
$1,631.60
|
| Rate for Payer: Ambetter Exchange |
$1,095.43
|
| Rate for Payer: Anthem Medicaid |
$625.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,095.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,095.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,314.52
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,492.74
|
| Rate for Payer: Healthspan PPO |
$1,304.61
|
| Rate for Payer: Humana Medicaid |
$625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,466.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,095.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.64
|
| Rate for Payer: Molina Healthcare Passport |
$625.14
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,424.06
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$631.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,095.43
|
|
