|
WET PREP - W/INTERPRETATION
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
WET PREP - W/INTERPRETATION
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$6.12
|
| Rate for Payer: Healthspan PPO |
$4.47
|
| Rate for Payer: Multiplan PHCS |
$40.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.60
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.49
|
|
|
WET PREP - W/INTERPRETATION
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$5.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$5.82
|
| Rate for Payer: Humana Medicare Advantage |
$5.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
WHEAT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHEAT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHEELCHAIR MNGMENT TRAINING
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
43000026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$22.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$22.01
|
| Rate for Payer: Kentucky WC Medicaid |
$22.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
WHEELCHAIR MNGMENT TRAINING
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
43000026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
WHIRLPOOL
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
WHIRLPOOL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$51.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$51.24
|
| Rate for Payer: Kentucky WC Medicaid |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
WHISKER SLOTTED 3.85MM*12.5MM
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
WHISKER SLOTTED 3.85MM*12.5MM
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
WHITE ASH TREE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHITE ASH TREE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHITE BLOOD CELL (WBC)
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
30000573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.68
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: First Health Commercial |
$25.65
|
| Rate for Payer: Humana Commercial |
$22.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.76
|
| Rate for Payer: Ohio Health Group HMO |
$20.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.37
|
| Rate for Payer: PHCS Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Payer |
$23.76
|
|
|
WHITE BLOOD CELL (WBC)
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
30000573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Anthem Medicaid |
$2.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.54
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: First Health Commercial |
$25.65
|
| Rate for Payer: Humana Commercial |
$22.95
|
| Rate for Payer: Humana KY Medicaid |
$2.54
|
| Rate for Payer: Humana Medicare Advantage |
$2.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.76
|
| Rate for Payer: Ohio Health Group HMO |
$20.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.37
|
| Rate for Payer: PHCS Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Payer |
$23.76
|
|
|
WHITE HICKORY TREES IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHITE HICKORY TREES IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHITE PINE TREE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHITE PINE TREE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
WHOLEY GUIDEWIRE FLOPPY ST TIP
|
Facility
|
OP
|
$1,526.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.44 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,175.40
|
| Rate for Payer: Anthem Medicaid |
$524.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.67
|
| Rate for Payer: Cash Price |
$763.25
|
| Rate for Payer: Cigna Commercial |
$1,267.00
|
| Rate for Payer: First Health Commercial |
$1,450.18
|
| Rate for Payer: Humana Commercial |
$1,297.52
|
| Rate for Payer: Humana KY Medicaid |
$524.96
|
| Rate for Payer: Kentucky WC Medicaid |
$530.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$535.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.22
|
| Rate for Payer: PHCS Commercial |
$1,465.44
|
| Rate for Payer: United Healthcare All Payer |
$1,343.32
|
|
|
WHOLEY GUIDEWIRE FLOPPY ST TIP
|
Facility
|
IP
|
$1,526.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.44 |
| Max. Negotiated Rate |
$1,465.44 |
| Rate for Payer: Aetna Commercial |
$1,175.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.67
|
| Rate for Payer: Cash Price |
$763.25
|
| Rate for Payer: Cigna Commercial |
$1,267.00
|
| Rate for Payer: First Health Commercial |
$1,450.18
|
| Rate for Payer: Humana Commercial |
$1,297.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.22
|
| Rate for Payer: PHCS Commercial |
$1,465.44
|
| Rate for Payer: United Healthcare All Payer |
$1,343.32
|
|
|
WHOLEY GUIDEWIRE STD ST TIP 14
|
Facility
|
OP
|
$820.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.66 |
| Max. Negotiated Rate |
$787.68 |
| Rate for Payer: Aetna Commercial |
$631.78
|
| Rate for Payer: Anthem Medicaid |
$282.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.99
|
| Rate for Payer: Cash Price |
$410.25
|
| Rate for Payer: Cigna Commercial |
$681.02
|
| Rate for Payer: First Health Commercial |
$779.48
|
| Rate for Payer: Humana Commercial |
$697.42
|
| Rate for Payer: Humana KY Medicaid |
$282.17
|
| Rate for Payer: Kentucky WC Medicaid |
$285.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$722.04
|
| Rate for Payer: Ohio Health Group HMO |
$615.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.36
|
| Rate for Payer: PHCS Commercial |
$787.68
|
| Rate for Payer: United Healthcare All Payer |
$722.04
|
|
|
WHOLEY GUIDEWIRE STD ST TIP 14
|
Facility
|
IP
|
$820.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.66 |
| Max. Negotiated Rate |
$787.68 |
| Rate for Payer: Aetna Commercial |
$631.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.99
|
| Rate for Payer: Cash Price |
$410.25
|
| Rate for Payer: Cigna Commercial |
$681.02
|
| Rate for Payer: First Health Commercial |
$779.48
|
| Rate for Payer: Humana Commercial |
$697.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$722.04
|
| Rate for Payer: Ohio Health Group HMO |
$615.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.36
|
| Rate for Payer: PHCS Commercial |
$787.68
|
| Rate for Payer: United Healthcare All Payer |
$722.04
|
|
|
WHOLEY GUIDEWRE STD STTIP 300C
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.74
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
|
WHOLEY GUIDEWRE STD STTIP 300C
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.02 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: Anthem Medicaid |
$637.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.12
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna Commercial |
$1,538.82
|
| Rate for Payer: First Health Commercial |
$1,761.30
|
| Rate for Payer: Humana Commercial |
$1,575.90
|
| Rate for Payer: Humana KY Medicaid |
$637.59
|
| Rate for Payer: Kentucky WC Medicaid |
$644.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.74
|
| Rate for Payer: PHCS Commercial |
$1,779.84
|
| Rate for Payer: United Healthcare All Payer |
$1,631.52
|
|
