|
CERVIDIL 10MG INSERT
|
Facility
|
IP
|
$693.98
|
|
|
Service Code
|
NDC 55566280001
|
| Hospital Charge Code |
25002935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$666.22 |
| Rate for Payer: Aetna Commercial |
$534.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.30
|
| Rate for Payer: Cash Price |
$346.99
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: First Health Commercial |
$659.28
|
| Rate for Payer: Humana Commercial |
$589.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.70
|
| Rate for Payer: Ohio Health Group HMO |
$520.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.13
|
| Rate for Payer: PHCS Commercial |
$666.22
|
| Rate for Payer: United Healthcare All Payer |
$610.70
|
|
|
CERVIX ULTRASOUND
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem Medicaid |
$301.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Humana KY Medicaid |
$301.60
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$304.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
CERVIX ULTRASOUND
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$877.00 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.00
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$145.01
|
| Rate for Payer: Healthspan PPO |
$142.86
|
| Rate for Payer: Humana Medicaid |
$71.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$526.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$613.90
|
| Rate for Payer: UHCCP Medicaid |
$306.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
|
|
CERVIX ULTRASOUND
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$114.01 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
CERVIX ULTRASOUND(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402P0040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$145.01
|
| Rate for Payer: Healthspan PPO |
$142.86
|
| Rate for Payer: Humana Medicaid |
$71.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
|
|
CERVIX ULTRASOUND(T
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
CERVIX ULTRASOUND(T
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$267.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Humana KY Medicaid |
$267.21
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$269.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
CESAREAN DELIVERY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
72000024
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
CESAREAN DELIVERY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
72000024
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
CESAREAN DELIVERY
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
72000024
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,799.82
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,655.32
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,596.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
CESAREAN DELIVERY(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
720P0024
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,799.82
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,655.32
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,596.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$12,295.99
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$7,620.00 |
| Max. Negotiated Rate |
$12,295.99 |
| Rate for Payer: Anthem Medicaid |
$8,343.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,782.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,295.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,856.85
|
| Rate for Payer: Humana KY Medicaid |
$8,343.71
|
| Rate for Payer: Humana Medicare Advantage |
$8,782.85
|
| Rate for Payer: Kentucky WC Medicaid |
$8,427.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,510.58
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$20,466.04
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$7,620.00 |
| Max. Negotiated Rate |
$20,466.04 |
| Rate for Payer: Anthem Medicaid |
$13,887.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,618.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,466.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,735.11
|
| Rate for Payer: Humana KY Medicaid |
$13,887.67
|
| Rate for Payer: Humana Medicare Advantage |
$14,618.60
|
| Rate for Payer: Kentucky WC Medicaid |
$14,026.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,165.42
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$10,001.96
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$6,787.05 |
| Max. Negotiated Rate |
$10,001.96 |
| Rate for Payer: Anthem Medicaid |
$6,787.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,144.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,001.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,644.75
|
| Rate for Payer: Humana KY Medicaid |
$6,787.05
|
| Rate for Payer: Humana Medicare Advantage |
$7,144.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,854.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,922.79
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$11,980.14
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$7,620.00 |
| Max. Negotiated Rate |
$11,980.14 |
| Rate for Payer: Anthem Medicaid |
$8,129.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,557.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,980.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,552.27
|
| Rate for Payer: Humana KY Medicaid |
$8,129.38
|
| Rate for Payer: Humana Medicare Advantage |
$8,557.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,210.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,291.97
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$20,726.89
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$7,620.00 |
| Max. Negotiated Rate |
$20,726.89 |
| Rate for Payer: Anthem Medicaid |
$14,064.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,804.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,726.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,986.64
|
| Rate for Payer: Humana KY Medicaid |
$14,064.67
|
| Rate for Payer: Humana Medicare Advantage |
$14,804.92
|
| Rate for Payer: Kentucky WC Medicaid |
$14,205.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,345.97
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$10,134.17
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$6,876.76 |
| Max. Negotiated Rate |
$10,134.17 |
| Rate for Payer: Anthem Medicaid |
$6,876.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,238.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,134.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,772.23
|
| Rate for Payer: Humana KY Medicaid |
$6,876.76
|
| Rate for Payer: Humana Medicare Advantage |
$7,238.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,945.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,014.29
|
|
|
CESARN DLV/POSTPART ATTMPT VBA
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 59622
|
| Hospital Charge Code |
72000026
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna Commercial |
$1,951.85
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,215.00
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$1,795.75
|
| Rate for Payer: Healthspan PPO |
$1,416.69
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,978.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,929.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,250.50
|
| Rate for Payer: UHCCP Medicaid |
$1,125.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
CESARN DLV/POSTPART ATTMPT VBA
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS 59622
|
| Hospital Charge Code |
72000026
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem Medicaid |
$1,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana KY Medicaid |
$1,105.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
CESARN DLV/POSTPART ATTMPT VBA
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
HCPCS 59622
|
| Hospital Charge Code |
720P0026
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna Commercial |
$1,951.85
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,215.00
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$1,795.75
|
| Rate for Payer: Healthspan PPO |
$1,416.69
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,978.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,929.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,250.50
|
| Rate for Payer: UHCCP Medicaid |
$1,125.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
CESARN DLV/POSTPART ATTMPT VBA
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS 59622
|
| Hospital Charge Code |
72000026
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
[C]ESGIC (COMBINATION) T 1TAB
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 527169501
|
| Hospital Charge Code |
25000070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
[C]ESGIC (COMBINATION) T 1TAB
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 527169501
|
| Hospital Charge Code |
25000070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
CESSJ THERAPY CATH REMOVAL
|
Professional
|
Both
|
$5,443.00
|
|
|
Service Code
|
HCPCS 37214
|
| Hospital Charge Code |
76101539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.33 |
| Max. Negotiated Rate |
$5,443.00 |
| Rate for Payer: Anthem Medicaid |
$118.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,443.00
|
| Rate for Payer: Cash Price |
$2,721.50
|
| Rate for Payer: Cash Price |
$2,721.50
|
| Rate for Payer: Cigna Commercial |
$273.65
|
| Rate for Payer: Healthspan PPO |
$139.48
|
| Rate for Payer: Humana Medicaid |
$118.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$185.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.70
|
| Rate for Payer: Molina Healthcare Passport |
$118.33
|
| Rate for Payer: Multiplan PHCS |
$3,265.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,810.10
|
| Rate for Payer: UHCCP Medicaid |
$1,905.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.51
|
|
|
CESSJ THERAPY CATH REMOVAL
|
Facility
|
OP
|
$5,443.00
|
|
|
Service Code
|
HCPCS 37214
|
| Hospital Charge Code |
76101539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$707.59 |
| Max. Negotiated Rate |
$5,225.28 |
| Rate for Payer: Aetna Commercial |
$4,191.11
|
| Rate for Payer: Anthem Medicaid |
$1,871.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,245.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,721.50
|
| Rate for Payer: Cash Price |
$2,721.50
|
| Rate for Payer: Cigna Commercial |
$4,517.69
|
| Rate for Payer: First Health Commercial |
$5,170.85
|
| Rate for Payer: Humana Commercial |
$4,626.55
|
| Rate for Payer: Humana KY Medicaid |
$1,871.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,463.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,016.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,909.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,789.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,082.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,687.33
|
| Rate for Payer: PHCS Commercial |
$5,225.28
|
| Rate for Payer: United Healthcare All Payer |
$4,789.84
|
|
