|
ACHILLESTENDONALLOGRAFT
|
Professional
|
Both
|
$4,620.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,234.00 |
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,772.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,234.00
|
| Rate for Payer: UHCCP Medicaid |
$1,617.00
|
|
|
ACHILLESTENDONALLOGRAFT(T
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
761T0361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ACHILLESTENDONALLOGRAFT(T
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
761T0361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ACHILLES TENDON W/BONE
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
ACHILLES TENDON W/BONE
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
ACHILLES TENDON W/O BONE
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
ACHILLES TENDON W/O BONE
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
ACID FAST CONCENTRATION
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
30001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
ACID FAST CONCENTRATION
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
30001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.68
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$6.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
ACID FAST SMEAR
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
30001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.39
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
ACID FAST SMEAR
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
30001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
ACINETOBACTER RPSA GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
ACINETOBACTER RPSA GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
ACL TIGHTROPE RT
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
ACL TIGHTROPE RT
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
ACNE PRE TX PROGRAM KIT US
|
Professional
|
Both
|
$140.00
|
|
| Hospital Charge Code |
22200154
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.00
|
| Rate for Payer: UHCCP Medicaid |
$49.00
|
|
|
ACNE PRE TX PROGRAM KIT US
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
22200154
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$48.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$48.15
|
| Rate for Payer: Kentucky WC Medicaid |
$48.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ACNE PRE TX PROGRAM KIT US
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
22200154
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$123.10
|
| Rate for Payer: Ambetter Exchange |
$48.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.33
|
| Rate for Payer: Anthem Medicaid |
$48.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.78
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$126.11
|
| Rate for Payer: Healthspan PPO |
$111.71
|
| Rate for Payer: Humana Medicaid |
$48.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.60
|
| Rate for Payer: Molina Healthcare Passport |
$48.63
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.67
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.98
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
ACNE SURGERY (EG - MARSUPIAL(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761P0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$126.11 |
| Rate for Payer: Aetna Commercial |
$123.10
|
| Rate for Payer: Ambetter Exchange |
$48.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.33
|
| Rate for Payer: Anthem Medicaid |
$48.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.78
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$126.11
|
| Rate for Payer: Healthspan PPO |
$111.71
|
| Rate for Payer: Humana Medicaid |
$48.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.60
|
| Rate for Payer: Molina Healthcare Passport |
$48.63
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.67
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.98
|
|
|
ACNE SURGERY (EG - MARSUPIAL(T
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761T0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
ACNE SURGERY (EG - MARSUPIAL(T
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761T0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
ACOUSTIC REFLEX TESTING
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 92568
|
| Hospital Charge Code |
47000014
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$30.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.96
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Humana KY Medicaid |
$30.61
|
| Rate for Payer: Humana Medicare Advantage |
$36.27
|
| Rate for Payer: Kentucky WC Medicaid |
$30.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.41
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
