|
COMP 35M ART 8.0*9.0 HUM HEDCE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 8.5*8.5 HUM HEDCE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 8.5*8.5 HUM HEDCE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.0*10. HUM HEDCE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.0*10. HUM HEDCE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.0*9.0 HUM HEDCE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.0*9.0 HUM HEDCE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.5*9.5 HUM HEDCE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 35M ART 9.5*9.5 HUM HEDCE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMPART SYNDROME MEASURING
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$135.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.33
|
| Rate for Payer: Anthem Medicaid |
$70.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,344.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna Commercial |
$148.09
|
| Rate for Payer: Healthspan PPO |
$305.66
|
| Rate for Payer: Humana Medicaid |
$70.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.75
|
| Rate for Payer: Molina Healthcare Passport |
$70.34
|
| Rate for Payer: Multiplan PHCS |
$806.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$940.80
|
| Rate for Payer: UHCCP Medicaid |
$49.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.04
|
|
|
COMPART SYNDROME MEASURING
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$1,290.24 |
| Rate for Payer: Aetna Commercial |
$1,034.88
|
| Rate for Payer: Anthem Medicaid |
$462.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,048.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna Commercial |
$1,115.52
|
| Rate for Payer: First Health Commercial |
$1,276.80
|
| Rate for Payer: Humana Commercial |
$1,142.40
|
| Rate for Payer: Humana KY Medicaid |
$462.20
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$466.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,102.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$471.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,182.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.64
|
| Rate for Payer: PHCS Commercial |
$1,290.24
|
| Rate for Payer: United Healthcare All Payer |
$1,182.72
|
|
|
COMPART SYNDROME MEASURING
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$1,290.24 |
| Rate for Payer: Aetna Commercial |
$1,034.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,048.32
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cigna Commercial |
$1,115.52
|
| Rate for Payer: First Health Commercial |
$1,276.80
|
| Rate for Payer: Humana Commercial |
$1,142.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,102.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$991.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,182.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$416.64
|
| Rate for Payer: PHCS Commercial |
$1,290.24
|
| Rate for Payer: United Healthcare All Payer |
$1,182.72
|
|
|
COMPART SYNDROME MEASURING(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
761P0358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$135.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.33
|
| Rate for Payer: Anthem Medicaid |
$70.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$148.09
|
| Rate for Payer: Healthspan PPO |
$305.66
|
| Rate for Payer: Humana Medicaid |
$70.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.75
|
| Rate for Payer: Molina Healthcare Passport |
$70.34
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$49.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.04
|
|
|
COMPART SYNDROME MEASURING(T
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
761T0358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$308.14
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
COMPART SYNDROME MEASURING(T
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
761T0358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.22 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem Medicaid |
$341.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Humana KY Medicaid |
$341.84
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$345.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$308.14
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
COMPATIBILITY TEST AGT EA
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
30001238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem Medicaid |
$31.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Humana KY Medicaid |
$31.00
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$31.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.23
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
|
COMPATIBILITY TEST AGT EA
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
30001238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.10
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.23
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
|
COMPATIBILITY TEST IMMED. SPIN
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
30001236
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$78.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$78.07
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$78.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
COMPATIBILITY TEST IMMED. SPIN
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
30001236
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
COMPATIBIL TEST INCUB EA UNIT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
30001237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$21.50
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$21.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
COMPATIBIL TEST INCUB EA UNIT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
30001237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Professional
|
Both
|
$4.62
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna Commercial |
$6.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Healthspan PPO |
$1.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.18
|
| Rate for Payer: Multiplan PHCS |
$2.77
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.23
|
| Rate for Payer: UHCCP Medicaid |
$1.62
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
636T0194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
25001969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$39.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$39.89
|
| Rate for Payer: Kentucky WC Medicaid |
$40.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
25001969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
