|
US GUID NEEDLE PLACEMENT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
US GUID NEEDLE PLACEMENT(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0080
|
|
Hospital Revenue Code
|
402
|
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
US GUID NEEDLE PLACEMENT(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0080
|
|
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 NEEDLE PLACEMENT(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0080
|
|
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 IUD TV
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US IUD TV
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
|
|
US IUD TV
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US IUD TV(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| 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 |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| 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 |
$45.41
|
|
|
US IUD TV(T
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US IUD TV(T
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US LIMITED OR FOLLICLE
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US LIMITED OR FOLLICLE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
|
|
US LIMITED OR FOLLICLE
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US LIMITED OR FOLLICLE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| 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 |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| 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 |
$45.41
|
|
|
US LIMITED OR FOLLICLE(T
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US LIMITED OR FOLLICLE(T
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200064
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US PED HIPS W/O MAN BIL
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna Commercial |
$143.00
|
| Rate for Payer: Anthem Medicaid |
$62.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$136.35
|
| Rate for Payer: Healthspan PPO |
$134.00
|
| Rate for Payer: Humana Medicaid |
$62.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.12
|
| Rate for Payer: Molina Healthcare Passport |
$62.86
|
| Rate for Payer: Multiplan PHCS |
$326.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$380.80
|
| Rate for Payer: UHCCP Medicaid |
$190.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.49
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.64
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem Medicaid |
$187.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Humana KY Medicaid |
$187.08
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$188.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.64
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200064
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US PED HIPS W/O MAN BIL(P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402P0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$143.00
|
| Rate for Payer: Anthem Medicaid |
$62.86
|
| 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 |
$136.35
|
| Rate for Payer: Healthspan PPO |
$134.00
|
| Rate for Payer: Humana Medicaid |
$62.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.12
|
| Rate for Payer: Molina Healthcare Passport |
$62.86
|
| 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 |
$63.49
|
|
|
US PED HIPS W/O MAN BIL(T
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402T0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US PED HIPS W/O MAN BIL(T
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402T0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
