|
ACUTE INTENSIVE HEMODIALYSIS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80000001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.32
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$410.02
|
| Rate for Payer: First Health Commercial |
$469.30
|
| Rate for Payer: Humana Commercial |
$419.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.72
|
| Rate for Payer: Ohio Health Group HMO |
$370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.86
|
| Rate for Payer: PHCS Commercial |
$474.24
|
| Rate for Payer: United Healthcare All Payer |
$434.72
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 1
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 1
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
76200021
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 2
|
Facility
|
IP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 2
|
Facility
|
OP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99235
|
| Hospital Charge Code |
76200022
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem Medicaid |
$1,112.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Humana KY Medicaid |
$1,112.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 3
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem Medicaid |
$1,257.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Humana KY Medicaid |
$1,257.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTE OBS ADM/DC SAMEDAY LVL 3
|
Facility
|
IP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99236
|
| Hospital Charge Code |
76200023
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTE OBS CARE <30M
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE OBS CARE <30M
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 1
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99231
|
| Hospital Charge Code |
76200018
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 1
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99231
|
| Hospital Charge Code |
76200018
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 2
|
Facility
|
IP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
76200019
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 2
|
Facility
|
OP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
76200019
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem Medicaid |
$1,112.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Humana KY Medicaid |
$1,112.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 3
|
Facility
|
IP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTE SUBSEQ OBS PER DAY LVL 3
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem Medicaid |
$1,257.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Humana KY Medicaid |
$1,257.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTRAK 2 GUIDEWIRE 9.25*.094
|
Facility
|
OP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem Medicaid |
$155.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Humana KY Medicaid |
$155.70
|
| Rate for Payer: Kentucky WC Medicaid |
$157.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
ACUTRAK 2 GUIDEWIRE 9.25*.094
|
Facility
|
IP
|
$452.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
ACUTRAK 4.0 CANN DRIVER TIP
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
ACUTRAK 4.0 CANN DRIVER TIP
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
ACUTRAK 4.0 SOLID DRIVER TIP
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
ACUTRAK 4.0 SOLID DRIVER TIP
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
ACUTRAK 6/7 X-RAY TEMPLATE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem Medicaid |
$11.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.74
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Humana KY Medicaid |
$11.35
|
| Rate for Payer: Kentucky WC Medicaid |
$11.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
ACUTRAK 6/7 X-RAY TEMPLATE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.74
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
ACUTRAK GUIDE WIRES .045 SHORT
|
Facility
|
OP
|
$547.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.18 |
| Max. Negotiated Rate |
$525.36 |
| Rate for Payer: Aetna Commercial |
$421.38
|
| Rate for Payer: Anthem Medicaid |
$188.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.86
|
| Rate for Payer: Cash Price |
$273.62
|
| Rate for Payer: Cigna Commercial |
$454.22
|
| Rate for Payer: First Health Commercial |
$519.89
|
| Rate for Payer: Humana Commercial |
$465.16
|
| Rate for Payer: Humana KY Medicaid |
$188.20
|
| Rate for Payer: Kentucky WC Medicaid |
$190.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.58
|
| Rate for Payer: Ohio Health Group HMO |
$410.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.60
|
| Rate for Payer: PHCS Commercial |
$525.36
|
| Rate for Payer: United Healthcare All Payer |
$481.58
|
|
|
ACUTRAK GUIDE WIRES .045 SHORT
|
Facility
|
IP
|
$547.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.18 |
| Max. Negotiated Rate |
$525.36 |
| Rate for Payer: Aetna Commercial |
$421.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.86
|
| Rate for Payer: Cash Price |
$273.62
|
| Rate for Payer: Cigna Commercial |
$454.22
|
| Rate for Payer: First Health Commercial |
$519.89
|
| Rate for Payer: Humana Commercial |
$465.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.58
|
| Rate for Payer: Ohio Health Group HMO |
$410.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.60
|
| Rate for Payer: PHCS Commercial |
$525.36
|
| Rate for Payer: United Healthcare All Payer |
$481.58
|
|
