|
CHOCOLATE OTW 5*40*120
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOCOLATE OTW 5*40*120
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOCOLATE OTW 6*120*120
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOCOLATE OTW 6*120*120
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOCOLATE OTW 6*40*120
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOCOLATE OTW 6*40*120
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CHOICE EXTRA SUPPORT 180CM
|
Facility
|
OP
|
$1,816.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.04 |
| Max. Negotiated Rate |
$1,744.13 |
| Rate for Payer: Aetna Commercial |
$1,398.94
|
| Rate for Payer: Anthem Medicaid |
$624.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.10
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,507.94
|
| Rate for Payer: First Health Commercial |
$1,725.96
|
| Rate for Payer: Humana Commercial |
$1,544.28
|
| Rate for Payer: Humana KY Medicaid |
$624.80
|
| Rate for Payer: Kentucky WC Medicaid |
$631.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.59
|
| Rate for Payer: PHCS Commercial |
$1,744.13
|
| Rate for Payer: United Healthcare All Payer |
$1,598.78
|
|
|
CHOICE EXTRA SUPPORT 180CM
|
Facility
|
IP
|
$1,816.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.04 |
| Max. Negotiated Rate |
$1,744.13 |
| Rate for Payer: Aetna Commercial |
$1,398.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,417.10
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,507.94
|
| Rate for Payer: First Health Commercial |
$1,725.96
|
| Rate for Payer: Humana Commercial |
$1,544.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.59
|
| Rate for Payer: PHCS Commercial |
$1,744.13
|
| Rate for Payer: United Healthcare All Payer |
$1,598.78
|
|
|
CHOICE FLOPPY WIRE
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
CHOICE FLOPPY WIRE
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
CHOICE PT WIRE 182CM
|
Facility
|
OP
|
$3,122.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.81 |
| Max. Negotiated Rate |
$2,997.80 |
| Rate for Payer: Aetna Commercial |
$2,404.49
|
| Rate for Payer: Anthem Medicaid |
$1,073.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.71
|
| Rate for Payer: Cash Price |
$1,561.36
|
| Rate for Payer: Cigna Commercial |
$2,591.85
|
| Rate for Payer: First Health Commercial |
$2,966.57
|
| Rate for Payer: Humana Commercial |
$2,654.30
|
| Rate for Payer: Humana KY Medicaid |
$1,073.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.67
|
| Rate for Payer: PHCS Commercial |
$2,997.80
|
| Rate for Payer: United Healthcare All Payer |
$2,747.98
|
|
|
CHOICE PT WIRE 182CM
|
Facility
|
IP
|
$3,122.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.81 |
| Max. Negotiated Rate |
$2,997.80 |
| Rate for Payer: Aetna Commercial |
$2,404.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.71
|
| Rate for Payer: Cash Price |
$1,561.36
|
| Rate for Payer: Cigna Commercial |
$2,591.85
|
| Rate for Payer: First Health Commercial |
$2,966.57
|
| Rate for Payer: Humana Commercial |
$2,654.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.67
|
| Rate for Payer: PHCS Commercial |
$2,997.80
|
| Rate for Payer: United Healthcare All Payer |
$2,747.98
|
|
|
CHOICE PT WIRE 300CM
|
Facility
|
OP
|
$3,122.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.81 |
| Max. Negotiated Rate |
$2,997.80 |
| Rate for Payer: Aetna Commercial |
$2,404.49
|
| Rate for Payer: Anthem Medicaid |
$1,073.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.71
|
| Rate for Payer: Cash Price |
$1,561.36
|
| Rate for Payer: Cigna Commercial |
$2,591.85
|
| Rate for Payer: First Health Commercial |
$2,966.57
|
| Rate for Payer: Humana Commercial |
$2,654.30
|
| Rate for Payer: Humana KY Medicaid |
$1,073.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.67
|
| Rate for Payer: PHCS Commercial |
$2,997.80
|
| Rate for Payer: United Healthcare All Payer |
$2,747.98
|
|
|
CHOICE PT WIRE 300CM
|
Facility
|
IP
|
$3,122.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.81 |
| Max. Negotiated Rate |
$2,997.80 |
| Rate for Payer: Aetna Commercial |
$2,404.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.71
|
| Rate for Payer: Cash Price |
$1,561.36
|
| Rate for Payer: Cigna Commercial |
$2,591.85
|
| Rate for Payer: First Health Commercial |
$2,966.57
|
| Rate for Payer: Humana Commercial |
$2,654.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,498.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,154.67
|
| Rate for Payer: PHCS Commercial |
$2,997.80
|
| Rate for Payer: United Healthcare All Payer |
$2,747.98
|
|
|
CHOLANGIOGRAM - OR
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
CHOLANGIOGRAM - OR
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
CHOLANGIOGRAM - OR
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
32000139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Anthem Medicaid |
$39.94
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| 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 |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$217.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.34
|
|
|
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: 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
|
$545.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
320T0139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.50 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem Medicaid |
$187.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Humana KY Medicaid |
$187.43
|
| Rate for Payer: Kentucky WC Medicaid |
$189.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
CHOLANGIOGRAM - OR(T
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
320T0139
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.50 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
CHOLANGIOGRAM T-TUBE
|
Professional
|
Both
|
$5,183.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$3,109.80 |
| Rate for Payer: Ambetter Exchange |
$65.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$279.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.66
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.25
|
| Rate for Payer: Molina Healthcare Passport |
$279.66
|
| Rate for Payer: Multiplan PHCS |
$3,109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.22
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.55
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
IP
|
$5,053.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,515.90 |
| Max. Negotiated Rate |
$4,850.88 |
| Rate for Payer: Aetna Commercial |
$3,890.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,941.34
|
| Rate for Payer: Cash Price |
$2,526.50
|
| Rate for Payer: Cigna Commercial |
$4,193.99
|
| Rate for Payer: First Health Commercial |
$4,800.35
|
| Rate for Payer: Humana Commercial |
$4,295.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,143.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,729.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,446.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,042.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,396.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,486.57
|
| Rate for Payer: PHCS Commercial |
$4,850.88
|
| Rate for Payer: United Healthcare All Payer |
$4,446.64
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
OP
|
$5,053.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,737.73 |
| Max. Negotiated Rate |
$4,850.88 |
| Rate for Payer: Aetna Commercial |
$3,890.81
|
| Rate for Payer: Anthem Medicaid |
$1,737.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,941.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$2,526.50
|
| Rate for Payer: Cash Price |
$2,526.50
|
| Rate for Payer: Cigna Commercial |
$4,193.99
|
| Rate for Payer: First Health Commercial |
$4,800.35
|
| Rate for Payer: Humana Commercial |
$4,295.05
|
| Rate for Payer: Humana KY Medicaid |
$1,737.73
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,755.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,143.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,729.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,772.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,446.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,042.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,396.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,486.57
|
| Rate for Payer: PHCS Commercial |
$4,850.88
|
| Rate for Payer: United Healthcare All Payer |
$4,446.64
|
|
|
CHOLANGIOGRAM T-TUBE
|
Facility
|
OP
|
$5,183.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
76101956
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,782.43 |
| Max. Negotiated Rate |
$4,975.68 |
| Rate for Payer: Aetna Commercial |
$3,990.91
|
| Rate for Payer: Anthem Medicaid |
$1,782.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,042.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cash Price |
$2,591.50
|
| Rate for Payer: Cigna Commercial |
$4,301.89
|
| Rate for Payer: First Health Commercial |
$4,923.85
|
| Rate for Payer: Humana Commercial |
$4,405.55
|
| Rate for Payer: Humana KY Medicaid |
$1,782.43
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,800.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,250.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,825.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,818.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,561.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,509.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,576.27
|
| Rate for Payer: PHCS Commercial |
$4,975.68
|
| Rate for Payer: United Healthcare All Payer |
$4,561.04
|
|
|
CHOLANGIOGRAM T-TUBE
|
Professional
|
Both
|
$5,053.00
|
|
|
Service Code
|
HCPCS 47531
|
| Hospital Charge Code |
32000372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$3,031.80 |
| Rate for Payer: Ambetter Exchange |
$65.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.25
|
| Rate for Payer: Anthem Medicaid |
$279.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.66
|
| Rate for Payer: Cash Price |
$2,526.50
|
| Rate for Payer: Cash Price |
$2,526.50
|
| Rate for Payer: Cigna Commercial |
$160.14
|
| Rate for Payer: Humana Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$134.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.25
|
| Rate for Payer: Molina Healthcare Passport |
$279.66
|
| Rate for Payer: Multiplan PHCS |
$3,031.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.22
|
| Rate for Payer: UHCCP Medicaid |
$73.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.55
|
|
