|
US EXAM INFANT HIPS DYNAMIC
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$458.92
|
| Rate for Payer: Anthem Medicaid |
$204.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$298.00
|
| 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: Humana KY Medicaid |
$204.96
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$207.05
|
| 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 |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$209.08
|
| 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
|
|
|
US EXAM INFANT HIPS DYNAMIC
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$357.60 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Ambetter Exchange |
$121.12
|
| Rate for Payer: Anthem Medicaid |
$70.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.34
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cigna Commercial |
$161.63
|
| Rate for Payer: Healthspan PPO |
$143.32
|
| Rate for Payer: Humana Medicaid |
$70.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.09
|
| Rate for Payer: Molina Healthcare Passport |
$70.68
|
| Rate for Payer: Multiplan PHCS |
$357.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.46
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.12
|
|
|
US EXAM INFANT HIPS DYNAMIC(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402P0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$161.63 |
| Rate for Payer: Aetna Commercial |
$152.96
|
| Rate for Payer: Ambetter Exchange |
$121.12
|
| Rate for Payer: Anthem Medicaid |
$70.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.34
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$161.63
|
| Rate for Payer: Healthspan PPO |
$143.32
|
| Rate for Payer: Humana Medicaid |
$70.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.09
|
| Rate for Payer: Molina Healthcare Passport |
$70.68
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.46
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.12
|
|
|
US EXAM INFANT HIPS DYNAMIC(T
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402T0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.09
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
US EXAM INFANT HIPS DYNAMIC(T
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
402T0063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem Medicaid |
$124.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Humana KY Medicaid |
$124.15
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$125.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.09
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
US GUIDANCE FOR AMNIOCENTESIS
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$142.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$142.37
|
| Rate for Payer: Kentucky WC Medicaid |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
US GUIDANCE FOR AMNIOCENTESIS
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$360.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.66
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Professional
|
Both
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$718.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$418.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
US GUIDANCE NEEDLE PLCMT,I&S
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
76102443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUIDE NEEDLE PLACEMENT S&I
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
32000389
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
US GUID - INTRAOPERATIVE
|
Facility
|
OP
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,046.72 |
| Rate for Payer: Aetna Commercial |
$1,641.64
|
| Rate for Payer: Anthem Medicaid |
$733.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,662.96
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,769.56
|
| Rate for Payer: First Health Commercial |
$2,025.40
|
| Rate for Payer: Humana Commercial |
$1,812.20
|
| Rate for Payer: Humana KY Medicaid |
$733.19
|
| Rate for Payer: Kentucky WC Medicaid |
$740.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,748.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,573.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$747.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,876.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,854.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.08
|
| Rate for Payer: PHCS Commercial |
$2,046.72
|
| Rate for Payer: United Healthcare All Payer |
$1,876.16
|
|
|
US GUID - INTRAOPERATIVE
|
Facility
|
IP
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,046.72 |
| Rate for Payer: Aetna Commercial |
$1,641.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,662.96
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$1,769.56
|
| Rate for Payer: First Health Commercial |
$2,025.40
|
| Rate for Payer: Humana Commercial |
$1,812.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,748.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,573.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,876.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,854.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.08
|
| Rate for Payer: PHCS Commercial |
$2,046.72
|
| Rate for Payer: United Healthcare All Payer |
$1,876.16
|
|
|
US GUID - INTRAOPERATIVE
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
40200084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$1,492.40 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cigna Commercial |
$92.63
|
| Rate for Payer: Healthspan PPO |
$227.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.48
|
| Rate for Payer: Multiplan PHCS |
$1,279.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,492.40
|
| Rate for Payer: UHCCP Medicaid |
$746.20
|
|
|
US GUID - INTRAOPERATIVE(P
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402P0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$654.50 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$92.63
|
| Rate for Payer: Healthspan PPO |
$227.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.48
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.50
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
|
|
US GUID - INTRAOPERATIVE(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402T0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUID - INTRAOPERATIVE(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
402T0084
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
US GUID NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
US GUID NEEDLE PLACEMENT
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
US GUID NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
US GUID NEEDLE PLACEMENT(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
US GUID NEEDLE PLACEMENT(T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
US GUID NEEDLE PLACEMENT(T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
