|
ULTRASONIC GUIDANCE
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
HCPCS 76932
|
| Hospital Charge Code |
40200065
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,032.96 |
| Rate for Payer: Aetna Commercial |
$828.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.28
|
| Rate for Payer: Cash Price |
$538.00
|
| Rate for Payer: Cigna Commercial |
$893.08
|
| Rate for Payer: First Health Commercial |
$1,022.20
|
| Rate for Payer: Humana Commercial |
$914.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$882.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.88
|
| Rate for Payer: Ohio Health Group HMO |
$807.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.44
|
| Rate for Payer: PHCS Commercial |
$1,032.96
|
| Rate for Payer: United Healthcare All Payer |
$946.88
|
|
|
ULTRASONIC GUIDANCE(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 76932
|
| Hospital Charge Code |
402P0065
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$235.16 |
| Rate for Payer: Aetna Commercial |
$150.88
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$143.10
|
| Rate for Payer: Healthspan PPO |
$235.16
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
ULTRASONIC GUIDANCE(T
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
HCPCS 76932
|
| Hospital Charge Code |
402T0065
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.30 |
| Max. Negotiated Rate |
$768.96 |
| Rate for Payer: Aetna Commercial |
$616.77
|
| Rate for Payer: Anthem Medicaid |
$275.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.78
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$664.83
|
| Rate for Payer: First Health Commercial |
$760.95
|
| Rate for Payer: Humana Commercial |
$680.85
|
| Rate for Payer: Humana KY Medicaid |
$275.46
|
| Rate for Payer: Kentucky WC Medicaid |
$278.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.88
|
| Rate for Payer: Ohio Health Group HMO |
$600.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.69
|
| Rate for Payer: PHCS Commercial |
$768.96
|
| Rate for Payer: United Healthcare All Payer |
$704.88
|
|
|
ULTRASONIC GUIDANCE(T
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
HCPCS 76932
|
| Hospital Charge Code |
402T0065
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.30 |
| Max. Negotiated Rate |
$768.96 |
| Rate for Payer: Aetna Commercial |
$616.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.78
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$664.83
|
| Rate for Payer: First Health Commercial |
$760.95
|
| Rate for Payer: Humana Commercial |
$680.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.88
|
| Rate for Payer: Ohio Health Group HMO |
$600.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.69
|
| Rate for Payer: PHCS Commercial |
$768.96
|
| Rate for Payer: United Healthcare All Payer |
$704.88
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$522.60 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$522.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$304.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| 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 |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem Medicaid |
$299.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Humana KY Medicaid |
$299.54
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
ULTRASOUND PELVIC ONLY LIMITED
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
ULTRASOUND PYLORIS LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
ULTRASOUND PYLORIS LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
ULTRASOUND PYLORIS LTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
ULTRASOUND PYLORIS LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| 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 |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
ULTRASOUND PYLORIS LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
ULTRASOUND PYLORIS LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
ULTRASOUND THERAPY 15 MIN
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
43000011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
ULTRASOUND THERAPY 15 MIN
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 97035
|
| Hospital Charge Code |
43000011
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$48.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$48.83
|
| Rate for Payer: Kentucky WC Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
ULTRASOUND TRANSRECTAL
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem Medicaid |
$397.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Humana KY Medicaid |
$397.89
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$401.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,006.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.33
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
ULTRASOUND TRANSRECTAL
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.39 |
| Max. Negotiated Rate |
$694.20 |
| Rate for Payer: Aetna Commercial |
$273.72
|
| Rate for Payer: Ambetter Exchange |
$159.15
|
| Rate for Payer: Anthem Medicaid |
$110.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.98
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$251.18
|
| Rate for Payer: Healthspan PPO |
$256.49
|
| Rate for Payer: Humana Medicaid |
$110.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.58
|
| Rate for Payer: Molina Healthcare Passport |
$110.37
|
| Rate for Payer: Multiplan PHCS |
$694.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.90
|
| Rate for Payer: UHCCP Medicaid |
$404.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.15
|
|
|
ULTRASOUND TRANSRECTAL
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$347.10 |
| Max. Negotiated Rate |
$1,110.72 |
| Rate for Payer: Aetna Commercial |
$890.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.46
|
| Rate for Payer: Cash Price |
$578.50
|
| Rate for Payer: Cigna Commercial |
$960.31
|
| Rate for Payer: First Health Commercial |
$1,099.15
|
| Rate for Payer: Humana Commercial |
$983.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.16
|
| Rate for Payer: Ohio Health Group HMO |
$867.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,006.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.33
|
| Rate for Payer: PHCS Commercial |
$1,110.72
|
| Rate for Payer: United Healthcare All Payer |
$1,018.16
|
|
|
ULTRASOUND TRANSRECTAL(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
402P0054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$273.72 |
| Rate for Payer: Aetna Commercial |
$273.72
|
| Rate for Payer: Ambetter Exchange |
$159.15
|
| Rate for Payer: Anthem Medicaid |
$110.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.98
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$251.18
|
| Rate for Payer: Healthspan PPO |
$256.49
|
| Rate for Payer: Humana Medicaid |
$110.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$159.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.58
|
| Rate for Payer: Molina Healthcare Passport |
$110.37
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.90
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.15
|
|
|
ULTRASOUND TRANSRECTAL(T
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
402T0054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$287.10 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
ULTRASOUND TRANSRECTAL(T
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
HCPCS 76873
|
| Hospital Charge Code |
402T0054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem Medicaid |
$329.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Humana KY Medicaid |
$329.11
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$332.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
ULTRASOUNDVASCULAR ACCESS
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
32000218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.90
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
