|
USE PARENCHYMA (P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402P0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$169.54 |
| Rate for Payer: Anthem Medicaid |
$81.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| 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 |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.19
|
|
|
USE PARENCHYMA (T
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402T0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$472.32 |
| Rate for Payer: Aetna Commercial |
$378.84
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$408.36
|
| Rate for Payer: First Health Commercial |
$467.40
|
| Rate for Payer: Humana Commercial |
$418.20
|
| Rate for Payer: Humana KY Medicaid |
$169.20
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$170.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.96
|
| Rate for Payer: Ohio Health Group HMO |
$369.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.52
|
| Rate for Payer: PHCS Commercial |
$472.32
|
| Rate for Payer: United Healthcare All Payer |
$432.96
|
|
|
USE PARENCHYMA (T
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402T0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$472.32 |
| Rate for Payer: Aetna Commercial |
$378.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$408.36
|
| Rate for Payer: First Health Commercial |
$467.40
|
| Rate for Payer: Humana Commercial |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.96
|
| Rate for Payer: Ohio Health Group HMO |
$369.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.52
|
| Rate for Payer: PHCS Commercial |
$472.32
|
| Rate for Payer: United Healthcare All Payer |
$432.96
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$551.04 |
| Rate for Payer: Aetna Commercial |
$441.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$447.72
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$476.42
|
| Rate for Payer: First Health Commercial |
$545.30
|
| Rate for Payer: Humana Commercial |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$470.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$423.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$505.12
|
| Rate for Payer: Ohio Health Group HMO |
$430.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.94
|
| Rate for Payer: PHCS Commercial |
$551.04
|
| Rate for Payer: United Healthcare All Payer |
$505.12
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$551.04 |
| Rate for Payer: Aetna Commercial |
$441.98
|
| Rate for Payer: Anthem Medicaid |
$197.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$447.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$476.42
|
| Rate for Payer: First Health Commercial |
$545.30
|
| Rate for Payer: Humana Commercial |
$487.90
|
| Rate for Payer: Humana KY Medicaid |
$197.40
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$199.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$470.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$423.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$505.12
|
| Rate for Payer: Ohio Health Group HMO |
$430.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.94
|
| Rate for Payer: PHCS Commercial |
$551.04
|
| Rate for Payer: United Healthcare All Payer |
$505.12
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$574.00 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$70.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$574.00
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$161.63
|
| Rate for Payer: Healthspan PPO |
$143.32
|
| Rate for Payer: Humana Medicaid |
$70.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.09
|
| Rate for Payer: Molina Healthcare Passport |
$70.68
|
| Rate for Payer: Multiplan PHCS |
$344.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$401.80
|
| Rate for Payer: UHCCP Medicaid |
$200.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.39
|
|
|
US EXAM INFANT HIPS DYNAMIC(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402P0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$70.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$161.63
|
| Rate for Payer: Healthspan PPO |
$143.32
|
| Rate for Payer: Humana Medicaid |
$70.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.09
|
| Rate for Payer: Molina Healthcare Passport |
$70.68
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.39
|
|
|
US EXAM INFANT HIPS DYNAMIC(T
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402T0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Humana KY Medicaid |
$116.58
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$117.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
US EXAM INFANT HIPS DYNAMIC(T
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402T0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
US GUIDANCE FOR AMNIOCENTESIS
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
US GUIDANCE FOR AMNIOCENTESIS
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$142.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$142.37
|
| Rate for Payer: Kentucky WC Medicaid |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Professional
|
Both
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,197.00
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$718.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$837.90
|
| Rate for Payer: UHCCP Medicaid |
$418.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUID - INTRAOPERATIVE
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.16 |
| Max. Negotiated Rate |
$2,046.72 |
| Rate for Payer: Aetna Commercial |
$1,641.64
|
| Rate for Payer: Anthem Medicaid |
$733.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,662.96
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,769.56
|
| Rate for Payer: First Health Commercial |
$2,025.40
|
| Rate for Payer: Humana Commercial |
$1,812.20
|
| Rate for Payer: Humana KY Medicaid |
$733.19
|
| Rate for Payer: Kentucky WC Medicaid |
$740.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,748.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,573.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$747.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,876.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.92
|
| Rate for Payer: PHCS Commercial |
$2,046.72
|
| Rate for Payer: United Healthcare All Payer |
$1,876.16
|
|
|
US GUID - INTRAOPERATIVE
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$2,132.00 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,132.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$92.63
|
| Rate for Payer: Healthspan PPO |
$227.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.48
|
| Rate for Payer: Multiplan PHCS |
$1,279.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,492.40
|
| Rate for Payer: UHCCP Medicaid |
$746.20
|
|
|
US GUID - INTRAOPERATIVE
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.16 |
| Max. Negotiated Rate |
$2,046.72 |
| Rate for Payer: Aetna Commercial |
$1,641.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,662.96
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,769.56
|
| Rate for Payer: First Health Commercial |
$2,025.40
|
| Rate for Payer: Humana Commercial |
$1,812.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,748.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,573.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,876.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.92
|
| Rate for Payer: PHCS Commercial |
$2,046.72
|
| Rate for Payer: United Healthcare All Payer |
$1,876.16
|
|
|
US GUID - INTRAOPERATIVE(P
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402P0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$935.00
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$92.63
|
| Rate for Payer: Healthspan PPO |
$227.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.48
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.50
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
|
|
US GUID - INTRAOPERATIVE(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402T0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUID - INTRAOPERATIVE(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402T0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUID NEEDLE PLACEMENT
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,397.00
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$838.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.90
|
| Rate for Payer: UHCCP Medicaid |
$488.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
US GUID NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
