|
UMBILICAL ARTERY ECHO(T
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
402T0043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.21
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
UMBILICUS EXCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$830.04
|
| Rate for Payer: Anthem Medicaid |
$362.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$770.76
|
| Rate for Payer: Healthspan PPO |
$699.99
|
| Rate for Payer: Humana Medicaid |
$362.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.54
|
| Rate for Payer: Molina Healthcare Passport |
$362.29
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.91
|
|
|
UMBILICUS EXCISION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
UMBILICUS EXCISION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
UMBILICUS EXCISION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
761P1985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$830.04
|
| Rate for Payer: Anthem Medicaid |
$362.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$770.76
|
| Rate for Payer: Healthspan PPO |
$699.99
|
| Rate for Payer: Humana Medicaid |
$362.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.54
|
| Rate for Payer: Molina Healthcare Passport |
$362.29
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.91
|
|
|
UNASYN 1.5gm (1.5gm PreMix)ANE
|
Facility
|
IP
|
$137.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$132.22 |
| Rate for Payer: Aetna Commercial |
$106.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.43
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cigna Commercial |
$114.32
|
| Rate for Payer: First Health Commercial |
$130.84
|
| Rate for Payer: Humana Commercial |
$117.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.20
|
| Rate for Payer: Ohio Health Group HMO |
$103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.70
|
| Rate for Payer: PHCS Commercial |
$132.22
|
| Rate for Payer: United Healthcare All Payer |
$121.20
|
|
|
UNASYN 1.5gm (1.5gm PreMix)ANE
|
Facility
|
OP
|
$137.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$132.22 |
| Rate for Payer: Aetna Commercial |
$106.05
|
| Rate for Payer: Anthem Medicaid |
$47.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.43
|
| Rate for Payer: Cash Price |
$68.86
|
| Rate for Payer: Cigna Commercial |
$114.32
|
| Rate for Payer: First Health Commercial |
$130.84
|
| Rate for Payer: Humana Commercial |
$117.07
|
| Rate for Payer: Humana KY Medicaid |
$47.37
|
| Rate for Payer: Kentucky WC Medicaid |
$47.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.20
|
| Rate for Payer: Ohio Health Group HMO |
$103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.70
|
| Rate for Payer: PHCS Commercial |
$132.22
|
| Rate for Payer: United Healthcare All Payer |
$121.20
|
|
|
UNASYN 1.5gm (3gm PreMix) ANE
|
Facility
|
OP
|
$121.56
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.70 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Anthem Medicaid |
$41.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.82
|
| Rate for Payer: Cash Price |
$60.78
|
| Rate for Payer: Cigna Commercial |
$100.89
|
| Rate for Payer: First Health Commercial |
$115.48
|
| Rate for Payer: Humana Commercial |
$103.33
|
| Rate for Payer: Humana KY Medicaid |
$41.80
|
| Rate for Payer: Kentucky WC Medicaid |
$42.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.97
|
| Rate for Payer: Ohio Health Group HMO |
$91.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$116.70
|
| Rate for Payer: United Healthcare All Payer |
$106.97
|
|
|
UNASYN 1.5gm (3gm PreMix) ANE
|
Facility
|
IP
|
$121.56
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.70 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.82
|
| Rate for Payer: Cash Price |
$60.78
|
| Rate for Payer: Cigna Commercial |
$100.89
|
| Rate for Payer: First Health Commercial |
$115.48
|
| Rate for Payer: Humana Commercial |
$103.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.97
|
| Rate for Payer: Ohio Health Group HMO |
$91.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$116.70
|
| Rate for Payer: United Healthcare All Payer |
$106.97
|
|
|
UNASYN 1.5GM (3 GM VIAL)
|
Facility
|
IP
|
$112.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna Commercial |
$86.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.64
|
| Rate for Payer: Cash Price |
$56.18
|
| Rate for Payer: Cigna Commercial |
$93.26
|
| Rate for Payer: First Health Commercial |
$106.74
|
| Rate for Payer: Humana Commercial |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.88
|
| Rate for Payer: Ohio Health Group HMO |
$84.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.83
|
| Rate for Payer: PHCS Commercial |
$107.87
|
| Rate for Payer: United Healthcare All Payer |
$98.88
|
|
|
UNASYN 1.5GM (3 GM VIAL)
|
Facility
|
OP
|
$112.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna Commercial |
$86.52
|
| Rate for Payer: Anthem Medicaid |
$38.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.64
|
| Rate for Payer: Cash Price |
$56.18
|
| Rate for Payer: Cigna Commercial |
$93.26
|
| Rate for Payer: First Health Commercial |
$106.74
|
| Rate for Payer: Humana Commercial |
$95.51
|
| Rate for Payer: Humana KY Medicaid |
$38.64
|
| Rate for Payer: Kentucky WC Medicaid |
$39.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.88
|
| Rate for Payer: Ohio Health Group HMO |
$84.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.83
|
| Rate for Payer: PHCS Commercial |
$107.87
|
| Rate for Payer: United Healthcare All Payer |
$98.88
|
|
|
UNASYN 1.5 GM VIAL
|
Facility
|
IP
|
$78.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$60.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.41
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: First Health Commercial |
$74.79
|
| Rate for Payer: Humana Commercial |
$66.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.41
|
| Rate for Payer: PHCS Commercial |
$75.58
|
| Rate for Payer: United Healthcare All Payer |
$69.28
|
|
|
UNASYN 1.5 GM VIAL
|
Facility
|
OP
|
$78.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$60.62
|
| Rate for Payer: Anthem Medicaid |
$27.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.41
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: First Health Commercial |
$74.79
|
| Rate for Payer: Humana Commercial |
$66.92
|
| Rate for Payer: Humana KY Medicaid |
$27.08
|
| Rate for Payer: Kentucky WC Medicaid |
$27.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.41
|
| Rate for Payer: PHCS Commercial |
$75.58
|
| Rate for Payer: United Healthcare All Payer |
$69.28
|
|
|
UNASYN IM 1.5GRAM VIAL
|
Facility
|
IP
|
$66.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
UNASYN IM 1.5GRAM VIAL
|
Facility
|
OP
|
$66.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem Medicaid |
$22.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Humana KY Medicaid |
$22.95
|
| Rate for Payer: Kentucky WC Medicaid |
$23.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$16,356.42
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,099.00 |
| Max. Negotiated Rate |
$16,356.42 |
| Rate for Payer: Anthem Medicaid |
$11,099.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,683.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,356.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,772.27
|
| Rate for Payer: Humana KY Medicaid |
$11,099.00
|
| Rate for Payer: Humana Medicare Advantage |
$11,683.16
|
| Rate for Payer: Kentucky WC Medicaid |
$11,209.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,019.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,320.98
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$10,244.12
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$6,951.37 |
| Max. Negotiated Rate |
$10,244.12 |
| Rate for Payer: Anthem Medicaid |
$6,951.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,317.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,244.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,878.26
|
| Rate for Payer: Humana KY Medicaid |
$6,951.37
|
| Rate for Payer: Humana Medicare Advantage |
$7,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,020.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,780.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,090.40
|
|
|
Underarm LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$95.00
|
|
| Hospital Charge Code |
22200465
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
Underarms Laser Hair Removal
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200185
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| 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
|
|
|
Underarms LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$192.00
|
|
| Hospital Charge Code |
22200349
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
UNI 14/16 TPR SLV +0
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
UNI 14/16 TPR SLV +0
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
UNI 14/16 TPR SLV +12
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
UNI 14/16 TPR SLV +12
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
UNI 14/16 TPR SLV +8
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
