|
ULTRAVERSE BALLOON 150*5*100
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ULTRAVERSE BALLOON 150*5*100
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ULTRAVERSE BALLOON 150*5*120
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
ULTRAVERSE BALLOON 150*5*120
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
ULTRAVERSE BALLOON 150*5*40
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
ULTRAVERSE BALLOON 150*5*40
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
ULTRAVERSE BALLOON 150*5*80
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ULTRAVERSE BALLOON 150*5*80
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ULTRAVIOLET LIGHT THERAPY
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 96900
|
| Hospital Charge Code |
76102703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$29.25
|
| Rate for Payer: Ambetter Exchange |
$22.14
|
| Rate for Payer: Anthem Medicaid |
$10.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.57
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$27.06
|
| Rate for Payer: Humana Medicaid |
$10.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.14
|
| Rate for Payer: Molina Healthcare Passport |
$10.92
|
| Rate for Payer: Multiplan PHCS |
$52.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.78
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.14
|
|
|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,565.09
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,260.78 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
|
|
UMBILICAL ARTERY ECHO
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
UMBILICAL ARTERY ECHO
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.92
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
UMBILICAL ARTERY ECHO
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Ambetter Exchange |
$40.42
|
| Rate for Payer: Anthem Medicaid |
$64.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.50
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$117.24
|
| Rate for Payer: Healthspan PPO |
$80.69
|
| Rate for Payer: Humana Medicaid |
$64.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.94
|
| Rate for Payer: Molina Healthcare Passport |
$64.65
|
| Rate for Payer: Multiplan PHCS |
$460.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.55
|
| Rate for Payer: UHCCP Medicaid |
$268.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.42
|
|
|
UMBILICAL ARTERY ECHO(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
402P0043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Ambetter Exchange |
$40.42
|
| Rate for Payer: Anthem Medicaid |
$64.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$117.24
|
| Rate for Payer: Healthspan PPO |
$80.69
|
| Rate for Payer: Humana Medicaid |
$64.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.94
|
| Rate for Payer: Molina Healthcare Passport |
$64.65
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.55
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.42
|
|
|
UMBILICAL ARTERY ECHO(T
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
402T0043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.90 |
| Max. Negotiated Rate |
$502.08 |
| Rate for Payer: Aetna Commercial |
$402.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.94
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$434.09
|
| Rate for Payer: First Health Commercial |
$496.85
|
| Rate for Payer: Humana Commercial |
$444.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$460.24
|
| Rate for Payer: Ohio Health Group HMO |
$392.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.87
|
| Rate for Payer: PHCS Commercial |
$502.08
|
| Rate for Payer: United Healthcare All Payer |
$460.24
|
|
|
UMBILICAL ARTERY ECHO(T
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
402T0043
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$502.08 |
| Rate for Payer: Aetna Commercial |
$402.71
|
| Rate for Payer: Anthem Medicaid |
$179.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$407.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cash Price |
$261.50
|
| Rate for Payer: Cigna Commercial |
$434.09
|
| Rate for Payer: First Health Commercial |
$496.85
|
| Rate for Payer: Humana Commercial |
$444.55
|
| Rate for Payer: Humana KY Medicaid |
$179.86
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$181.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$428.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$385.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$460.24
|
| Rate for Payer: Ohio Health Group HMO |
$392.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$360.87
|
| Rate for Payer: PHCS Commercial |
$502.08
|
| Rate for Payer: United Healthcare All Payer |
$460.24
|
|
|
UMBILICUS EXCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$830.04 |
| Rate for Payer: Aetna Commercial |
$830.04
|
| Rate for Payer: Ambetter Exchange |
$567.98
|
| Rate for Payer: Anthem Medicaid |
$362.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$567.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$567.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.58
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$770.76
|
| Rate for Payer: Healthspan PPO |
$699.99
|
| Rate for Payer: Humana Medicaid |
$362.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$567.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.54
|
| Rate for Payer: Molina Healthcare Passport |
$362.29
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.37
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$567.98
|
|
|
UMBILICUS EXCISION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
UMBILICUS EXCISION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
76101985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
UMBILICUS EXCISION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49250
|
| Hospital Charge Code |
761P1985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$830.04 |
| Rate for Payer: Aetna Commercial |
$830.04
|
| Rate for Payer: Ambetter Exchange |
$567.98
|
| Rate for Payer: Anthem Medicaid |
$362.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$567.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$567.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.58
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$770.76
|
| Rate for Payer: Healthspan PPO |
$699.99
|
| Rate for Payer: Humana Medicaid |
$362.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$738.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$567.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.54
|
| Rate for Payer: Molina Healthcare Passport |
$362.29
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.37
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$567.98
|
|
|
UNASYN 1.5gm (1.5gm PreMix)ANE
|
Facility
|
OP
|
$168.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$161.95 |
| Rate for Payer: Aetna Commercial |
$129.90
|
| Rate for Payer: Anthem Medicaid |
$58.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.59
|
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: Cigna Commercial |
$140.02
|
| Rate for Payer: First Health Commercial |
$160.26
|
| Rate for Payer: Humana Commercial |
$143.40
|
| Rate for Payer: Humana KY Medicaid |
$58.02
|
| Rate for Payer: Kentucky WC Medicaid |
$58.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.46
|
| Rate for Payer: Ohio Health Group HMO |
$126.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.40
|
| Rate for Payer: PHCS Commercial |
$161.95
|
| Rate for Payer: United Healthcare All Payer |
$148.46
|
|
|
UNASYN 1.5gm (1.5gm PreMix)ANE
|
Facility
|
IP
|
$168.70
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.61 |
| Max. Negotiated Rate |
$161.95 |
| Rate for Payer: Aetna Commercial |
$129.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.59
|
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: Cigna Commercial |
$140.02
|
| Rate for Payer: First Health Commercial |
$160.26
|
| Rate for Payer: Humana Commercial |
$143.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.46
|
| Rate for Payer: Ohio Health Group HMO |
$126.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.40
|
| Rate for Payer: PHCS Commercial |
$161.95
|
| Rate for Payer: United Healthcare All Payer |
$148.46
|
|
|
UNASYN 1.5gm (3gm PreMix) ANE
|
Facility
|
OP
|
$115.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$110.78 |
| Rate for Payer: Aetna Commercial |
$88.86
|
| Rate for Payer: Anthem Medicaid |
$39.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.01
|
| Rate for Payer: Cash Price |
$57.70
|
| Rate for Payer: Cigna Commercial |
$95.78
|
| Rate for Payer: First Health Commercial |
$109.63
|
| Rate for Payer: Humana Commercial |
$98.09
|
| Rate for Payer: Humana KY Medicaid |
$39.69
|
| Rate for Payer: Kentucky WC Medicaid |
$40.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.55
|
| Rate for Payer: Ohio Health Group HMO |
$86.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.63
|
| Rate for Payer: PHCS Commercial |
$110.78
|
| Rate for Payer: United Healthcare All Payer |
$101.55
|
|
|
UNASYN 1.5gm (3gm PreMix) ANE
|
Facility
|
IP
|
$115.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25004144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$110.78 |
| Rate for Payer: Aetna Commercial |
$88.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.01
|
| Rate for Payer: Cash Price |
$57.70
|
| Rate for Payer: Cigna Commercial |
$95.78
|
| Rate for Payer: First Health Commercial |
$109.63
|
| Rate for Payer: Humana Commercial |
$98.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.55
|
| Rate for Payer: Ohio Health Group HMO |
$86.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.63
|
| Rate for Payer: PHCS Commercial |
$110.78
|
| Rate for Payer: United Healthcare All Payer |
$101.55
|
|
|
UNASYN 1.5GM (3 GM VIAL)
|
Facility
|
OP
|
$112.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna Commercial |
$86.52
|
| Rate for Payer: Anthem Medicaid |
$38.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.64
|
| Rate for Payer: Cash Price |
$56.18
|
| Rate for Payer: Cigna Commercial |
$93.26
|
| Rate for Payer: First Health Commercial |
$106.74
|
| Rate for Payer: Humana Commercial |
$95.51
|
| Rate for Payer: Humana KY Medicaid |
$38.64
|
| Rate for Payer: Kentucky WC Medicaid |
$39.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.88
|
| Rate for Payer: Ohio Health Group HMO |
$84.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.53
|
| Rate for Payer: PHCS Commercial |
$107.87
|
| Rate for Payer: United Healthcare All Payer |
$98.88
|
|
