|
WET PREP - W/INTERPRETATION
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
WHEAT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHEAT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHEELCHAIR MNGMENT TRAINING
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
43000026
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.20 |
| 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 |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| 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 |
$19.20 |
| 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 |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
WHIRLPOOL
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$151.68 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.24
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.02
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
WHIRLPOOL
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$151.68 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem Medicaid |
$54.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.24
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Humana KY Medicaid |
$54.34
|
| Rate for Payer: Kentucky WC Medicaid |
$54.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.02
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
WHISKER SLOTTED 3.85MM*12.5MM
|
Facility
|
OP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem Medicaid |
$1,235.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Humana KY Medicaid |
$1,235.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
|
WHISKER SLOTTED 3.85MM*12.5MM
|
Facility
|
IP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
|
WHITE ASH TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHITE ASH TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHITE BLOOD CELL (WBC)
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
30000573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| 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 |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| 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 |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Payer |
$23.76
|
|
|
WHITE HICKORY TREES IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHITE HICKORY TREES IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHITE PINE TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHITE PINE TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
WHOLEY GUIDEWIRE FLOPPY ST TIP
|
Facility
|
OP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem Medicaid |
$515.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Humana KY Medicaid |
$515.92
|
| Rate for Payer: Kentucky WC Medicaid |
$521.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
|
WHOLEY GUIDEWIRE FLOPPY ST TIP
|
Facility
|
IP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
|
WHOLEY GUIDEWIRE STD ST TIP 14
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$811.20 |
| Rate for Payer: Aetna Commercial |
$650.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$659.10
|
| Rate for Payer: Cash Price |
$422.50
|
| Rate for Payer: Cigna Commercial |
$701.35
|
| Rate for Payer: First Health Commercial |
$802.75
|
| Rate for Payer: Humana Commercial |
$718.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$692.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$623.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$743.60
|
| Rate for Payer: Ohio Health Group HMO |
$633.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.05
|
| Rate for Payer: PHCS Commercial |
$811.20
|
| Rate for Payer: United Healthcare All Payer |
$743.60
|
|
|
WHOLEY GUIDEWIRE STD ST TIP 14
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$811.20 |
| Rate for Payer: Aetna Commercial |
$650.65
|
| Rate for Payer: Anthem Medicaid |
$290.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$659.10
|
| Rate for Payer: Cash Price |
$422.50
|
| Rate for Payer: Cigna Commercial |
$701.35
|
| Rate for Payer: First Health Commercial |
$802.75
|
| Rate for Payer: Humana Commercial |
$718.25
|
| Rate for Payer: Humana KY Medicaid |
$290.60
|
| Rate for Payer: Kentucky WC Medicaid |
$293.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$692.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$623.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$296.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$743.60
|
| Rate for Payer: Ohio Health Group HMO |
$633.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.05
|
| Rate for Payer: PHCS Commercial |
$811.20
|
| Rate for Payer: United Healthcare All Payer |
$743.60
|
|
|
WHOLEY GUIDEWRE STD STTIP 300C
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
WHOLEY GUIDEWRE STD STTIP 300C
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
WIGGLE WIRE 300CM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
WIGGLE WIRE 300CM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
