|
BICORTICAL TF SHAFT 3.5MM
|
Facility
|
OP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem Medicaid |
$1,061.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Humana KY Medicaid |
$1,061.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
|
BIER BLOCK
|
Professional
|
Both
|
$2,871.57
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,712.80 |
| Rate for Payer: Anthem Medicaid |
$3,640.00
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$3,640.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,712.80
|
| Rate for Payer: Molina Healthcare Passport |
$3,640.00
|
| Rate for Payer: Multiplan PHCS |
$1,722.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,010.10
|
| Rate for Payer: UHCCP Medicaid |
$1,005.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,676.40
|
|
|
BIER BLOCK
|
Facility
|
IP
|
$2,871.57
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.47 |
| Max. Negotiated Rate |
$2,756.71 |
| Rate for Payer: Aetna Commercial |
$2,211.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,239.82
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,727.99
|
| Rate for Payer: Humana Commercial |
$2,440.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,354.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,119.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$861.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,526.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,153.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,498.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,981.38
|
| Rate for Payer: PHCS Commercial |
$2,756.71
|
| Rate for Payer: United Healthcare All Payer |
$2,526.98
|
|
|
BIER BLOCK
|
Facility
|
OP
|
$2,871.57
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$2,756.71 |
| Rate for Payer: Aetna Commercial |
$2,211.11
|
| Rate for Payer: Anthem Medicaid |
$987.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,239.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,727.99
|
| Rate for Payer: Humana Commercial |
$2,440.83
|
| Rate for Payer: Humana KY Medicaid |
$987.53
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$997.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,354.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,119.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,007.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,526.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,153.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,498.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,981.38
|
| Rate for Payer: PHCS Commercial |
$2,756.71
|
| Rate for Payer: United Healthcare All Payer |
$2,526.98
|
|
|
BIER BLOCK(T
|
Facility
|
OP
|
$2,871.57
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
761T2380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$2,756.71 |
| Rate for Payer: Aetna Commercial |
$2,211.11
|
| Rate for Payer: Anthem Medicaid |
$987.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,239.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,727.99
|
| Rate for Payer: Humana Commercial |
$2,440.83
|
| Rate for Payer: Humana KY Medicaid |
$987.53
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$997.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,354.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,119.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,007.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,526.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,153.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,498.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,981.38
|
| Rate for Payer: PHCS Commercial |
$2,756.71
|
| Rate for Payer: United Healthcare All Payer |
$2,526.98
|
|
|
BIER BLOCK(T
|
Facility
|
IP
|
$2,871.57
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
761T2380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$861.47 |
| Max. Negotiated Rate |
$2,756.71 |
| Rate for Payer: Aetna Commercial |
$2,211.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,239.82
|
| Rate for Payer: Cash Price |
$1,435.79
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,727.99
|
| Rate for Payer: Humana Commercial |
$2,440.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,354.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,119.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$861.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,526.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,153.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,498.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,981.38
|
| Rate for Payer: PHCS Commercial |
$2,756.71
|
| Rate for Payer: United Healthcare All Payer |
$2,526.98
|
|
|
Bikini Extended Lsr Hair Remvl
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
22200186
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
Bikini Extended Lsr Hair Remvl
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200186
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
Bikini Extended Lsr Hair Remvl
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
22200186
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
Bikini Ext LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$319.00
|
|
| Hospital Charge Code |
22200350
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$223.30 |
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Multiplan PHCS |
$191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.30
|
| Rate for Payer: UHCCP Medicaid |
$111.65
|
|
|
Bikini Full Laser Hair Removal
|
Professional
|
Both
|
$375.00
|
|
| Hospital Charge Code |
22200187
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$262.50 |
| 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
|
|
|
Bikini Full Laser Hair Removal
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
22200187
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem Medicaid |
$128.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Humana KY Medicaid |
$128.96
|
| Rate for Payer: Kentucky WC Medicaid |
$130.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
Bikini Full Laser Hair Removal
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
22200187
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$288.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$292.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$311.25
|
| Rate for Payer: First Health Commercial |
$356.25
|
| Rate for Payer: Humana Commercial |
$318.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$307.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$330.00
|
| Rate for Payer: Ohio Health Group HMO |
$281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$326.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.75
|
| Rate for Payer: PHCS Commercial |
$360.00
|
| Rate for Payer: United Healthcare All Payer |
$330.00
|
|
|
Bikini FulLsr HairRem-PP#1 50%
|
Professional
|
Both
|
$478.00
|
|
| Hospital Charge Code |
22200351
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$334.60 |
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Multiplan PHCS |
$286.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$334.60
|
| Rate for Payer: UHCCP Medicaid |
$167.30
|
|
|
Bikini Line Only LsrHair Rem
|
Professional
|
Both
|
$200.00
|
|
| Hospital Charge Code |
22200222
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
BikniExt LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200466
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
Bikni FulLsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$239.00
|
|
| Hospital Charge Code |
22200467
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$83.65 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Multiplan PHCS |
$143.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.30
|
| Rate for Payer: UHCCP Medicaid |
$83.65
|
|
|
BikniLine LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$256.00
|
|
| Hospital Charge Code |
22200223
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Multiplan PHCS |
$153.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.20
|
| Rate for Payer: UHCCP Medicaid |
$89.60
|
|
|
BikniLne LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$127.00
|
|
| Hospital Charge Code |
22200477
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$44.45 |
| Max. Negotiated Rate |
$88.90 |
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Multiplan PHCS |
$76.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.90
|
| Rate for Payer: UHCCP Medicaid |
$44.45
|
|
|
BI LAPAROSCOP OVARIAN DRILLING
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
|
|
BI LAPAROSCOP OVARIAN DRILLING
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
BI LAPAROSCOP OVARIAN DRILLING
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 58679
|
| Hospital Charge Code |
76102937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
BILAT DIAGNOSITIC W/CAD
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100010
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$255.30 |
| 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 |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.19
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
BILAT DIAGNOSITIC W/CAD
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100010
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$255.30 |
| 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 |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.19
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
BILAT DIAGNOSITIC W/CAD
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100010
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$510.60 |
| Rate for Payer: Ambetter Exchange |
$143.09
|
| Rate for Payer: Anthem Medicaid |
$127.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$143.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$143.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$171.71
|
| 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 |
$127.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$143.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.55
|
| Rate for Payer: Molina Healthcare Passport |
$127.99
|
| Rate for Payer: Multiplan PHCS |
$510.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.02
|
| Rate for Payer: UHCCP Medicaid |
$297.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$143.09
|
|
