|
CHOCOLATE OTW 2.5*120*150
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CHOCOLATE OTW 2.5*120*150
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CHOCOLATE OTW 4*80*135
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
CHOCOLATE OTW 4*80*135
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
CHOCOLATE OTW 5*40*120
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOCOLATE OTW 5*40*120
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOCOLATE OTW 6*120*120
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOCOLATE OTW 6*120*120
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOCOLATE OTW 6*40*120
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOCOLATE OTW 6*40*120
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
CHOICE EXTRA SUPPORT 180CM
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$1,752.96 |
| Rate for Payer: Aetna Commercial |
$1,406.02
|
| Rate for Payer: Anthem Medicaid |
$627.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.28
|
| Rate for Payer: Cash Price |
$913.00
|
| Rate for Payer: Cigna Commercial |
$1,515.58
|
| Rate for Payer: First Health Commercial |
$1,734.70
|
| Rate for Payer: Humana Commercial |
$1,552.10
|
| Rate for Payer: Humana KY Medicaid |
$627.96
|
| Rate for Payer: Kentucky WC Medicaid |
$634.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.06
|
| Rate for Payer: PHCS Commercial |
$1,752.96
|
| Rate for Payer: United Healthcare All Payer |
$1,606.88
|
|
|
CHOICE EXTRA SUPPORT 180CM
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$1,752.96 |
| Rate for Payer: Aetna Commercial |
$1,406.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.28
|
| Rate for Payer: Cash Price |
$913.00
|
| Rate for Payer: Cigna Commercial |
$1,515.58
|
| Rate for Payer: First Health Commercial |
$1,734.70
|
| Rate for Payer: Humana Commercial |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.06
|
| Rate for Payer: PHCS Commercial |
$1,752.96
|
| Rate for Payer: United Healthcare All Payer |
$1,606.88
|
|
|
CHOICE FLOPPY WIRE
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
CHOICE FLOPPY WIRE
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
CHOLANGIOGRAM - OR
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem Medicaid |
$201.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Humana KY Medicaid |
$201.87
|
| Rate for Payer: Kentucky WC Medicaid |
$203.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.97
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
CHOLANGIOGRAM - OR
|
Professional
|
Both
|
$587.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$587.00 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Anthem Medicaid |
$39.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$587.00
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$78.00
|
| Rate for Payer: Healthspan PPO |
$174.48
|
| Rate for Payer: Humana Medicaid |
$39.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.74
|
| Rate for Payer: Molina Healthcare Passport |
$39.94
|
| Rate for Payer: Multiplan PHCS |
$352.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.90
|
| Rate for Payer: UHCCP Medicaid |
$205.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.34
|
|
|
CHOLANGIOGRAM - OR
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.97
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
CHOLANGIOGRAM - OR(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
320P0139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$174.48 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Anthem Medicaid |
$39.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$78.00
|
| Rate for Payer: Healthspan PPO |
$174.48
|
| Rate for Payer: Humana Medicaid |
$39.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.74
|
| Rate for Payer: Molina Healthcare Passport |
$39.94
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.34
|
|
|
CHOLANGIOGRAM - OR(T
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
320T0139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Anthem Medicaid |
$176.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.36
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cigna Commercial |
$424.96
|
| Rate for Payer: First Health Commercial |
$486.40
|
| Rate for Payer: Humana Commercial |
$435.20
|
| Rate for Payer: Humana KY Medicaid |
$176.08
|
| Rate for Payer: Kentucky WC Medicaid |
$177.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.56
|
| Rate for Payer: Ohio Health Group HMO |
$384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.72
|
| Rate for Payer: PHCS Commercial |
$491.52
|
| Rate for Payer: United Healthcare All Payer |
$450.56
|
|
|
CHOLANGIOGRAM - OR(T
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
320T0139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.36
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cigna Commercial |
$424.96
|
| Rate for Payer: First Health Commercial |
$486.40
|
| Rate for Payer: Humana Commercial |
$435.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.56
|
| Rate for Payer: Ohio Health Group HMO |
$384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.72
|
| Rate for Payer: PHCS Commercial |
$491.52
|
| Rate for Payer: United Healthcare All Payer |
$450.56
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.13 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem Medicaid |
$1,685.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Humana KY Medicaid |
$1,685.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.31
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.13 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.31
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
CHOLANGIOGRAM T-TUBE
|
Professional
|
Both
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$4,901.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$78.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,901.00
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$78.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.94
|
| Rate for Payer: Molina Healthcare Passport |
$78.37
|
| Rate for Payer: Multiplan PHCS |
$2,940.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,430.70
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.15
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.13 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.31
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
CHOLANGIOGRAM T-TUBE
|
Professional
|
Both
|
$4,901.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$4,901.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$78.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,901.00
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$78.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.94
|
| Rate for Payer: Molina Healthcare Passport |
$78.37
|
| Rate for Payer: Multiplan PHCS |
$2,940.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,430.70
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.15
|
|
