|
US IUD TV
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$269.10 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
US IUD TV
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem Medicaid |
$308.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Humana KY Medicaid |
$308.48
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$311.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$314.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
US IUD TV
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$538.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$313.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US IUD TV(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US IUD TV(T
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem Medicaid |
$265.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Humana KY Medicaid |
$265.49
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$268.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US IUD TV(T
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0049
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US LIMITED OR FOLLICLE
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$538.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$313.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US LIMITED OR FOLLICLE
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem Medicaid |
$308.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Humana KY Medicaid |
$308.48
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$311.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$314.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
US LIMITED OR FOLLICLE
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$269.10 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
US LIMITED OR FOLLICLE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US LIMITED OR FOLLICLE(T
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem Medicaid |
$265.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Humana KY Medicaid |
$265.49
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$268.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US LIMITED OR FOLLICLE(T
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem Medicaid |
$190.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Humana KY Medicaid |
$190.18
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$192.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200064
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US PED HIPS W/O MAN BIL
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$331.80 |
| Rate for Payer: Aetna Commercial |
$143.00
|
| Rate for Payer: Ambetter Exchange |
$89.46
|
| Rate for Payer: Anthem Medicaid |
$62.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.35
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$136.35
|
| Rate for Payer: Healthspan PPO |
$134.00
|
| Rate for Payer: Humana Medicaid |
$62.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.12
|
| Rate for Payer: Molina Healthcare Passport |
$62.86
|
| Rate for Payer: Multiplan PHCS |
$331.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.30
|
| Rate for Payer: UHCCP Medicaid |
$193.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.46
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.90 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
US PED HIPS W/O MAN BIL
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
40200064
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
US PED HIPS W/O MAN BIL(P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402P0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Commercial |
$143.00
|
| Rate for Payer: Ambetter Exchange |
$89.46
|
| Rate for Payer: Anthem Medicaid |
$62.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.35
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$136.35
|
| Rate for Payer: Healthspan PPO |
$134.00
|
| Rate for Payer: Humana Medicaid |
$62.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.12
|
| Rate for Payer: Molina Healthcare Passport |
$62.86
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.30
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.46
|
|
|
US PED HIPS W/O MAN BIL(T
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402T0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.87
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
US PED HIPS W/O MAN BIL(T
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
402T0106
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$310.08 |
| Rate for Payer: Aetna Commercial |
$248.71
|
| Rate for Payer: Anthem Medicaid |
$111.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cigna Commercial |
$268.09
|
| Rate for Payer: First Health Commercial |
$306.85
|
| Rate for Payer: Humana Commercial |
$274.55
|
| Rate for Payer: Humana KY Medicaid |
$111.08
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$112.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.24
|
| Rate for Payer: Ohio Health Group HMO |
$242.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.87
|
| Rate for Payer: PHCS Commercial |
$310.08
|
| Rate for Payer: United Healthcare All Payer |
$284.24
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
US POPLITEAL UNILTERAL LIMITED
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0060
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
