|
US ABDL AORTA SCREEN AAA
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Anthem Medicaid |
$71.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$148.48
|
| Rate for Payer: Humana Medicaid |
$71.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.50
|
| Rate for Payer: Molina Healthcare Passport |
$71.08
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.79
|
|
|
US ABDL AORTA SCREEN AAA(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402P0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$148.48 |
| Rate for Payer: Anthem Medicaid |
$71.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$148.48
|
| Rate for Payer: Humana Medicaid |
$71.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.50
|
| Rate for Payer: Molina Healthcare Passport |
$71.08
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.79
|
|
|
US ABDL AORTA SCREEN AAA(T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402T0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
US ABDL AORTA SCREEN AAA(T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 76706
|
| Hospital Charge Code |
402T0025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
US ABDOMEN LTD
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,104.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| 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: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$662.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.80
|
| Rate for Payer: UHCCP Medicaid |
$386.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
US ABDOMEN LTD
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
US ABDOMEN LTD
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem Medicaid |
$379.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Humana KY Medicaid |
$379.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
US ABDOMEN LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| 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: 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 |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
US ABDOMEN LTD(T
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.27 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
US ABDOMEN LTD(T
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem Medicaid |
$336.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Humana KY Medicaid |
$336.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$340.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$654.72 |
| Rate for Payer: Aetna Commercial |
$525.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.96
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna Commercial |
$566.06
|
| Rate for Payer: First Health Commercial |
$647.90
|
| Rate for Payer: Humana Commercial |
$579.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$559.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$503.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$600.16
|
| Rate for Payer: Ohio Health Group HMO |
$511.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.42
|
| Rate for Payer: PHCS Commercial |
$654.72
|
| Rate for Payer: United Healthcare All Payer |
$600.16
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$682.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.04
|
| Rate for Payer: Anthem Medicaid |
$49.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna Commercial |
$168.99
|
| Rate for Payer: Humana Medicaid |
$49.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.84
|
| Rate for Payer: Molina Healthcare Passport |
$49.84
|
| Rate for Payer: Multiplan PHCS |
$409.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.40
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.34
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$654.72 |
| Rate for Payer: Aetna Commercial |
$525.14
|
| Rate for Payer: Anthem Medicaid |
$234.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna Commercial |
$566.06
|
| Rate for Payer: First Health Commercial |
$647.90
|
| Rate for Payer: Humana Commercial |
$579.70
|
| Rate for Payer: Humana KY Medicaid |
$234.54
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$236.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$559.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$503.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$600.16
|
| Rate for Payer: Ohio Health Group HMO |
$511.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.42
|
| Rate for Payer: PHCS Commercial |
$654.72
|
| Rate for Payer: United Healthcare All Payer |
$600.16
|
|
|
US ASPIRATION MAJOR JNT BURS(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761P0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.04
|
| Rate for Payer: Anthem Medicaid |
$49.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$168.99
|
| Rate for Payer: Humana Medicaid |
$49.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.84
|
| Rate for Payer: Molina Healthcare Passport |
$49.84
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.34
|
|
|
US ASPIRATION MAJOR JNT BURS(T
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761T0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
US ASPIRATION MAJOR JNT BURS(T
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761T0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem Medicaid |
$174.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Humana KY Medicaid |
$174.36
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$176.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem Medicaid |
$273.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Humana KY Medicaid |
$273.06
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$275.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.14
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
US COMPL JOINT R-T W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna Commercial |
$179.18
|
| Rate for Payer: Anthem Medicaid |
$100.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$794.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$189.32
|
| Rate for Payer: Healthspan PPO |
$126.39
|
| Rate for Payer: Humana Medicaid |
$100.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.59
|
| Rate for Payer: Molina Healthcare Passport |
$100.58
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.80
|
| Rate for Payer: UHCCP Medicaid |
$277.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.59
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.14
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
US COMPL JOINT R-T W/IMG(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402P0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Aetna Commercial |
$179.18
|
| Rate for Payer: Anthem Medicaid |
$100.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$189.32
|
| Rate for Payer: Healthspan PPO |
$126.39
|
| Rate for Payer: Humana Medicaid |
$100.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.59
|
| Rate for Payer: Molina Healthcare Passport |
$100.58
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.59
|
|
|
US COMPL JOINT R-T W/IMG(T
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402T0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.14
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
US COMPL JOINT R-T W/IMG(T
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402T0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem Medicaid |
$238.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Humana KY Medicaid |
$238.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$241.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.14
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
USE PARENCHYMA
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
USE PARENCHYMA
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem Medicaid |
$201.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Humana KY Medicaid |
$201.18
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$203.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
USE PARENCHYMA
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Anthem Medicaid |
$81.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$585.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$169.54
|
| Rate for Payer: Humana Medicaid |
$81.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.01
|
| Rate for Payer: Molina Healthcare Passport |
$81.38
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.50
|
| Rate for Payer: UHCCP Medicaid |
$204.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.19
|
|
