|
US ABDOMEN LTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
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
|
|
|
US ABDOMEN LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
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
|
|
|
US ABDOMEN LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200014
|
|
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
|
|
|
US ABDOMEN LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0014
|
|
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
|
|
|
US ABDOMEN LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0014
|
|
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
|
|
|
US ABDOMEN LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0014
|
|
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
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Ambetter Exchange |
$55.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.04
|
| Rate for Payer: Anthem Medicaid |
$71.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$67.15
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$168.99
|
| Rate for Payer: Humana Medicaid |
$71.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.00
|
| Rate for Payer: Molina Healthcare Passport |
$71.57
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.75
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.96
|
|
|
US ASPIRATION MAJOR JNT BURSA
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
76100346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
US ASPIRATION MAJOR JNT BURS(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761P0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$168.99 |
| Rate for Payer: Ambetter Exchange |
$55.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.04
|
| Rate for Payer: Anthem Medicaid |
$71.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$67.15
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$168.99
|
| Rate for Payer: Humana Medicaid |
$71.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$80.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.00
|
| Rate for Payer: Molina Healthcare Passport |
$71.57
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.75
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.96
|
|
|
US ASPIRATION MAJOR JNT BURS(T
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761T0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Anthem Medicaid |
$185.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$448.20
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Humana Commercial |
$459.00
|
| Rate for Payer: Humana KY Medicaid |
$185.71
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$187.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.20
|
| Rate for Payer: Ohio Health Group HMO |
$405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.60
|
| Rate for Payer: PHCS Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Payer |
$475.20
|
|
|
US ASPIRATION MAJOR JNT BURS(T
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
761T0346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$448.20
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Humana Commercial |
$459.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.20
|
| Rate for Payer: Ohio Health Group HMO |
$405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.60
|
| Rate for Payer: PHCS Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Payer |
$475.20
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.86
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
US COMPL JOINT R-T W/IMG
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$476.40 |
| Rate for Payer: Aetna Commercial |
$179.18
|
| Rate for Payer: Ambetter Exchange |
$49.94
|
| Rate for Payer: Anthem Medicaid |
$100.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.93
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$189.32
|
| Rate for Payer: Healthspan PPO |
$126.39
|
| Rate for Payer: Humana Medicaid |
$100.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.59
|
| Rate for Payer: Molina Healthcare Passport |
$100.58
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.92
|
| Rate for Payer: UHCCP Medicaid |
$277.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.94
|
|
|
US COMPL JOINT R-T W/IMG
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
40200055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$762.24 |
| Rate for Payer: Aetna Commercial |
$611.38
|
| Rate for Payer: Anthem Medicaid |
$273.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$659.02
|
| Rate for Payer: First Health Commercial |
$754.30
|
| Rate for Payer: Humana Commercial |
$674.90
|
| Rate for Payer: Humana KY Medicaid |
$273.06
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$275.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.72
|
| Rate for Payer: Ohio Health Group HMO |
$595.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.86
|
| Rate for Payer: PHCS Commercial |
$762.24
|
| Rate for Payer: United Healthcare All Payer |
$698.72
|
|
|
US COMPL JOINT R-T W/IMG(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402P0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Aetna Commercial |
$179.18
|
| Rate for Payer: Ambetter Exchange |
$49.94
|
| Rate for Payer: Anthem Medicaid |
$100.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.93
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$189.32
|
| Rate for Payer: Healthspan PPO |
$126.39
|
| Rate for Payer: Humana Medicaid |
$100.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.59
|
| Rate for Payer: Molina Healthcare Passport |
$100.58
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.92
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.94
|
|
|
US COMPL JOINT R-T W/IMG(T
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402T0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.20 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.86
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
US COMPL JOINT R-T W/IMG(T
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
402T0055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem Medicaid |
$238.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Humana KY Medicaid |
$238.67
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$241.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.86
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
USE PARENCHYMA
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.58
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.09
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
USE PARENCHYMA
|
Professional
|
Both
|
$561.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Ambetter Exchange |
$95.31
|
| Rate for Payer: Anthem Medicaid |
$81.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.37
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$169.54
|
| Rate for Payer: Humana Medicaid |
$81.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.01
|
| Rate for Payer: Molina Healthcare Passport |
$81.38
|
| Rate for Payer: Multiplan PHCS |
$336.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.90
|
| Rate for Payer: UHCCP Medicaid |
$196.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.31
|
|
|
USE PARENCHYMA
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
40200110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Anthem Medicaid |
$192.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cigna Commercial |
$465.63
|
| Rate for Payer: First Health Commercial |
$532.95
|
| Rate for Payer: Humana Commercial |
$476.85
|
| Rate for Payer: Humana KY Medicaid |
$192.93
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$194.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.68
|
| Rate for Payer: Ohio Health Group HMO |
$420.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.09
|
| Rate for Payer: PHCS Commercial |
$538.56
|
| Rate for Payer: United Healthcare All Payer |
$493.68
|
|
|
USE PARENCHYMA (P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402P0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$169.54 |
| Rate for Payer: Ambetter Exchange |
$95.31
|
| Rate for Payer: Anthem Medicaid |
$81.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.37
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$169.54
|
| Rate for Payer: Humana Medicaid |
$81.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.01
|
| Rate for Payer: Molina Healthcare Passport |
$81.38
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.90
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.31
|
|
|
USE PARENCHYMA (T
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402T0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Humana KY Medicaid |
$174.01
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$175.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.14
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
USE PARENCHYMA (T
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
402T0110
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.14
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$494.68
|
| Rate for Payer: First Health Commercial |
$566.20
|
| Rate for Payer: Humana Commercial |
$506.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$488.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$524.48
|
| Rate for Payer: Ohio Health Group HMO |
$447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$411.24
|
| Rate for Payer: PHCS Commercial |
$572.16
|
| Rate for Payer: United Healthcare All Payer |
$524.48
|
|
