|
CERVICAL SPINE 2-3V(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
320T0047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$616.32 |
| Rate for Payer: Aetna Commercial |
$494.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$500.76
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$532.86
|
| Rate for Payer: First Health Commercial |
$609.90
|
| Rate for Payer: Humana Commercial |
$545.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$526.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$473.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$564.96
|
| Rate for Payer: Ohio Health Group HMO |
$481.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.98
|
| Rate for Payer: PHCS Commercial |
$616.32
|
| Rate for Payer: United Healthcare All Payer |
$564.96
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Aetna Commercial |
$79.08
|
| Rate for Payer: Ambetter Exchange |
$48.59
|
| Rate for Payer: Anthem Medicaid |
$37.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.31
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: Healthspan PPO |
$74.10
|
| Rate for Payer: Humana Medicaid |
$37.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.34
|
| Rate for Payer: Molina Healthcare Passport |
$37.59
|
| Rate for Payer: Multiplan PHCS |
$385.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.17
|
| Rate for Payer: UHCCP Medicaid |
$224.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.59
|
|
|
CERVICAL SPINE ROUTINE 4-5V
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
32000048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$616.32 |
| Rate for Payer: Aetna Commercial |
$494.34
|
| Rate for Payer: Anthem Medicaid |
$220.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$500.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$532.86
|
| Rate for Payer: First Health Commercial |
$609.90
|
| Rate for Payer: Humana Commercial |
$545.70
|
| Rate for Payer: Humana KY Medicaid |
$220.78
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$223.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$526.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$473.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$225.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$564.96
|
| Rate for Payer: Ohio Health Group HMO |
$481.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.98
|
| Rate for Payer: PHCS Commercial |
$616.32
|
| Rate for Payer: United Healthcare All Payer |
$564.96
|
|
|
CERVICAL SPINE ROUTINE 4-5V(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320P0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$79.08 |
| Rate for Payer: Aetna Commercial |
$79.08
|
| Rate for Payer: Ambetter Exchange |
$48.59
|
| Rate for Payer: Anthem Medicaid |
$37.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.31
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: Healthspan PPO |
$74.10
|
| Rate for Payer: Humana Medicaid |
$37.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.34
|
| Rate for Payer: Molina Healthcare Passport |
$37.59
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.17
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.59
|
|
|
CERVICAL SPINE ROUTINE 4-5V(T
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320T0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem Medicaid |
$200.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Humana KY Medicaid |
$200.15
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$202.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
CERVICAL SPINE ROUTINE 4-5V(T
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
320T0048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.60 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.96
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$483.06
|
| Rate for Payer: First Health Commercial |
$552.90
|
| Rate for Payer: Humana Commercial |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$477.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$429.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$512.16
|
| Rate for Payer: Ohio Health Group HMO |
$436.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.58
|
| Rate for Payer: PHCS Commercial |
$558.72
|
| Rate for Payer: United Healthcare All Payer |
$512.16
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$348.60 |
| Rate for Payer: Aetna Commercial |
$98.72
|
| Rate for Payer: Ambetter Exchange |
$55.79
|
| Rate for Payer: Anthem Medicaid |
$46.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.95
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$93.46
|
| Rate for Payer: Healthspan PPO |
$92.50
|
| Rate for Payer: Humana Medicaid |
$46.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Molina Healthcare Passport |
$46.28
|
| Rate for Payer: Multiplan PHCS |
$348.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.53
|
| Rate for Payer: UHCCP Medicaid |
$203.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.79
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$557.76 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.18
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$482.23
|
| Rate for Payer: First Health Commercial |
$551.95
|
| Rate for Payer: Humana Commercial |
$493.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$476.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$511.28
|
| Rate for Payer: Ohio Health Group HMO |
$435.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.89
|
| Rate for Payer: PHCS Commercial |
$557.76
|
| Rate for Payer: United Healthcare All Payer |
$511.28
|
|
|
CERVICAL SPINE W/FLEX => 6V
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
32000049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$557.76 |
| Rate for Payer: Aetna Commercial |
$447.37
|
| Rate for Payer: Anthem Medicaid |
$199.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$453.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cigna Commercial |
$482.23
|
| Rate for Payer: First Health Commercial |
$551.95
|
| Rate for Payer: Humana Commercial |
$493.85
|
| Rate for Payer: Humana KY Medicaid |
$199.81
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$201.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$476.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$428.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$511.28
|
| Rate for Payer: Ohio Health Group HMO |
$435.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.89
|
| Rate for Payer: PHCS Commercial |
$557.76
|
| Rate for Payer: United Healthcare All Payer |
$511.28
|
|
|
CERVICAL SPINE W/FLEX => 6V(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320P0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$98.72 |
| Rate for Payer: Aetna Commercial |
$98.72
|
| Rate for Payer: Ambetter Exchange |
$55.79
|
| Rate for Payer: Anthem Medicaid |
$46.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.95
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$93.46
|
| Rate for Payer: Healthspan PPO |
$92.50
|
| Rate for Payer: Humana Medicaid |
$46.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$55.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Molina Healthcare Passport |
$46.28
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.53
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.79
|
|
|
CERVICAL SPINE W/FLEX => 6V(T
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320T0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Humana KY Medicaid |
$174.01
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$175.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.14
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
CERVICAL SPINE W/FLEX => 6V(T
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
320T0049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.14
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
CERVIDIL 10MG INSERT
|
Facility
|
OP
|
$720.18
|
|
|
Service Code
|
NDC 55566280001
|
| Hospital Charge Code |
25002935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$216.05 |
| Max. Negotiated Rate |
$691.37 |
| Rate for Payer: Aetna Commercial |
$554.54
|
| Rate for Payer: Anthem Medicaid |
$247.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.74
|
| Rate for Payer: Cash Price |
$360.09
|
| Rate for Payer: Cigna Commercial |
$597.75
|
| Rate for Payer: First Health Commercial |
$684.17
|
| Rate for Payer: Humana Commercial |
$612.15
|
| Rate for Payer: Humana KY Medicaid |
$247.67
|
| Rate for Payer: Kentucky WC Medicaid |
$250.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.76
|
| Rate for Payer: Ohio Health Group HMO |
$540.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.92
|
| Rate for Payer: PHCS Commercial |
$691.37
|
| Rate for Payer: United Healthcare All Payer |
$633.76
|
|
|
CERVIDIL 10MG INSERT
|
Facility
|
IP
|
$720.18
|
|
|
Service Code
|
NDC 55566280001
|
| Hospital Charge Code |
25002935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$216.05 |
| Max. Negotiated Rate |
$691.37 |
| Rate for Payer: Aetna Commercial |
$554.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.74
|
| Rate for Payer: Cash Price |
$360.09
|
| Rate for Payer: Cigna Commercial |
$597.75
|
| Rate for Payer: First Health Commercial |
$684.17
|
| Rate for Payer: Humana Commercial |
$612.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.76
|
| Rate for Payer: Ohio Health Group HMO |
$540.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.92
|
| Rate for Payer: PHCS Commercial |
$691.37
|
| Rate for Payer: United Healthcare All Payer |
$633.76
|
|
|
CERVIX ULTRASOUND
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
CERVIX ULTRASOUND
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Ambetter Exchange |
$83.35
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.02
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.34
|
| Rate for Payer: Molina Healthcare Passport |
$71.90
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.36
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.35
|
|
|
CERVIX ULTRASOUND
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
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: Ambetter Exchange |
$83.35
|
| Rate for Payer: Anthem Medicaid |
$71.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$83.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.35
|
| 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 |
$108.36
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.35
|
|
|
CERVIX ULTRASOUND(T
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
CERVIX ULTRASOUND(T
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
402T0040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem Medicaid |
$284.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Humana KY Medicaid |
$284.41
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
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 |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,799.82
|
| Rate for Payer: Ambetter Exchange |
$1,280.15
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,280.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,536.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,280.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.15
|
| 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 |
$1,664.19
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,280.15
|
|
|
CESAREAN DELIVERY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
72000024
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| 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 |
$900.00 |
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
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 |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,799.82
|
| Rate for Payer: Ambetter Exchange |
$1,280.15
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,280.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,536.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,280.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.15
|
| 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 |
$1,664.19
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,280.15
|
|
