|
TUMOR IMAGING WHOLE BODY
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
34000037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,309.00
|
| Rate for Payer: UHCCP Medicaid |
$654.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
|
|
TUMOR IMAGING WHOLE BODY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340P0037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$833.66 |
| Rate for Payer: Aetna Commercial |
$833.66
|
| Rate for Payer: Anthem Medicaid |
$492.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$742.07
|
| Rate for Payer: Healthspan PPO |
$833.23
|
| Rate for Payer: Humana Medicaid |
$492.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.47
|
| Rate for Payer: Molina Healthcare Passport |
$492.62
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.55
|
|
|
TUMOR IMAGING WHOLE BODY(T
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340T0037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,719.09 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem Medicaid |
$591.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Humana KY Medicaid |
$591.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$597.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
TUMOR IMAGING WHOLE BODY(T
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
340T0037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001532
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$182.13
|
| Rate for Payer: Anthem Medicaid |
$78.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$408.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: Healthspan PPO |
$172.93
|
| Rate for Payer: Humana Medicaid |
$78.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.43
|
| Rate for Payer: Molina Healthcare Passport |
$78.85
|
| Rate for Payer: Multiplan PHCS |
$244.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.60
|
| Rate for Payer: UHCCP Medicaid |
$142.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.64
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001532
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem Medicaid |
$140.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Humana KY Medicaid |
$140.31
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$141.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.48
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
30001532
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.62
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.48
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
TUMS (CALCIUM CARBONA TAB/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 904641292
|
| Hospital Charge Code |
25001609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
TUMS (CALCIUM CARBONA TAB/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 904641292
|
| Hospital Charge Code |
25001609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
TUNNELER SHEATH ON-Q 12
|
Facility
|
OP
|
$541.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$519.50 |
| Rate for Payer: Aetna Commercial |
$416.69
|
| Rate for Payer: Anthem Medicaid |
$186.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.10
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cigna Commercial |
$449.15
|
| Rate for Payer: First Health Commercial |
$514.09
|
| Rate for Payer: Humana Commercial |
$459.98
|
| Rate for Payer: Humana KY Medicaid |
$186.10
|
| Rate for Payer: Kentucky WC Medicaid |
$188.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.21
|
| Rate for Payer: Ohio Health Group HMO |
$405.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.76
|
| Rate for Payer: PHCS Commercial |
$519.50
|
| Rate for Payer: United Healthcare All Payer |
$476.21
|
|
|
TUNNELER SHEATH ON-Q 12
|
Facility
|
IP
|
$541.15
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$519.50 |
| Rate for Payer: Aetna Commercial |
$416.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.10
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cigna Commercial |
$449.15
|
| Rate for Payer: First Health Commercial |
$514.09
|
| Rate for Payer: Humana Commercial |
$459.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.21
|
| Rate for Payer: Ohio Health Group HMO |
$405.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.76
|
| Rate for Payer: PHCS Commercial |
$519.50
|
| Rate for Payer: United Healthcare All Payer |
$476.21
|
|
|
TUNNELER SHEATH ON-Q 8
|
Facility
|
IP
|
$552.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$530.74 |
| Rate for Payer: Aetna Commercial |
$425.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.22
|
| Rate for Payer: Cash Price |
$276.42
|
| Rate for Payer: Cigna Commercial |
$458.87
|
| Rate for Payer: First Health Commercial |
$525.21
|
| Rate for Payer: Humana Commercial |
$469.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.51
|
| Rate for Payer: Ohio Health Group HMO |
$414.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.38
|
| Rate for Payer: PHCS Commercial |
$530.74
|
| Rate for Payer: United Healthcare All Payer |
$486.51
|
|
|
TUNNELER SHEATH ON-Q 8
|
Facility
|
OP
|
$552.85
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$530.74 |
| Rate for Payer: Aetna Commercial |
$425.69
|
| Rate for Payer: Anthem Medicaid |
$190.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.22
|
| Rate for Payer: Cash Price |
$276.42
|
| Rate for Payer: Cigna Commercial |
$458.87
|
| Rate for Payer: First Health Commercial |
$525.21
|
| Rate for Payer: Humana Commercial |
$469.92
|
| Rate for Payer: Humana KY Medicaid |
$190.13
|
| Rate for Payer: Kentucky WC Medicaid |
$192.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.51
|
| Rate for Payer: Ohio Health Group HMO |
$414.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.38
|
| Rate for Payer: PHCS Commercial |
$530.74
|
| Rate for Payer: United Healthcare All Payer |
$486.51
|
|
|
TUNNLER/SHEATH 5 DISP
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
TUNNLER/SHEATH 5 DISP
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
TUTOPLAST PROCESS PERICARD 6*6
|
Facility
|
OP
|
$12,238.85
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.05 |
| Max. Negotiated Rate |
$11,749.30 |
| Rate for Payer: Aetna Commercial |
$9,423.91
|
| Rate for Payer: Anthem Medicaid |
$4,208.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,546.30
|
| Rate for Payer: Cash Price |
$6,119.42
|
| Rate for Payer: Cigna Commercial |
$10,158.25
|
| Rate for Payer: First Health Commercial |
$11,626.91
|
| Rate for Payer: Humana Commercial |
$10,403.02
|
| Rate for Payer: Humana KY Medicaid |
$4,208.94
|
| Rate for Payer: Kentucky WC Medicaid |
$4,251.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,035.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,032.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,671.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,293.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,770.19
|
| Rate for Payer: Ohio Health Group HMO |
$9,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,447.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,794.04
|
| Rate for Payer: PHCS Commercial |
$11,749.30
|
| Rate for Payer: United Healthcare All Payer |
$10,770.19
|
|
|
TUTOPLAST PROCESS PERICARD 6*6
|
Facility
|
IP
|
$12,238.85
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.05 |
| Max. Negotiated Rate |
$11,749.30 |
| Rate for Payer: Aetna Commercial |
$9,423.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,546.30
|
| Rate for Payer: Cash Price |
$6,119.42
|
| Rate for Payer: Cigna Commercial |
$10,158.25
|
| Rate for Payer: First Health Commercial |
$11,626.91
|
| Rate for Payer: Humana Commercial |
$10,403.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,035.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,032.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,671.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,770.19
|
| Rate for Payer: Ohio Health Group HMO |
$9,179.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,447.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,794.04
|
| Rate for Payer: PHCS Commercial |
$11,749.30
|
| Rate for Payer: United Healthcare All Payer |
$10,770.19
|
|
|
TV CONNECTOR (HEARING AID ACC)
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200665
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| 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
|
|
|
TWIN SITE SET 1EA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TWIN SITE SET 1EA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TX ATRIAL FIB PULM VEIN ISOL
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 93656
|
| Hospital Charge Code |
48000099
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$467.25 |
| Max. Negotiated Rate |
$1,949.65 |
| Rate for Payer: Anthem Medicaid |
$877.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,335.00
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$1,949.65
|
| Rate for Payer: Healthspan PPO |
$1,290.97
|
| Rate for Payer: Humana Medicaid |
$877.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,573.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$894.98
|
| Rate for Payer: Molina Healthcare Passport |
$877.43
|
| Rate for Payer: Multiplan PHCS |
$801.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.50
|
| Rate for Payer: UHCCP Medicaid |
$467.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$886.20
|
|
|
TX CLSDELBOWDISLOCATWITHANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
45000123
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TX CLSDELBOWDISLOCATWITHANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
45000123
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TX CONTOUR DEFECTS >10.0 CC
|
Facility
|
IP
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.87 |
| Max. Negotiated Rate |
$4,614.41 |
| Rate for Payer: Aetna Commercial |
$3,701.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.21
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$3,989.54
|
| Rate for Payer: First Health Commercial |
$4,566.35
|
| Rate for Payer: Humana Commercial |
$4,085.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,229.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.07
|
| Rate for Payer: PHCS Commercial |
$4,614.41
|
| Rate for Payer: United Healthcare All Payer |
$4,229.88
|
|
|
TX CONTOUR DEFECTS >10.0 CC
|
Facility
|
OP
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.11 |
| Max. Negotiated Rate |
$4,614.41 |
| Rate for Payer: Aetna Commercial |
$3,701.14
|
| Rate for Payer: Anthem Medicaid |
$1,653.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$3,989.54
|
| Rate for Payer: First Health Commercial |
$4,566.35
|
| Rate for Payer: Humana Commercial |
$4,085.68
|
| Rate for Payer: Humana KY Medicaid |
$1,653.02
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,229.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.07
|
| Rate for Payer: PHCS Commercial |
$4,614.41
|
| Rate for Payer: United Healthcare All Payer |
$4,229.88
|
|
