|
COMPLETE SKELETAL BONE SURVEY
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.30 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
COMPLETE SKELETAL BONE SURVEY
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
COMPLETE SKELETAL BONE SURVEY
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$450.60 |
| Rate for Payer: Aetna Commercial |
$151.21
|
| Rate for Payer: Ambetter Exchange |
$89.30
|
| Rate for Payer: Anthem Medicaid |
$62.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.16
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$131.65
|
| Rate for Payer: Healthspan PPO |
$141.69
|
| Rate for Payer: Humana Medicaid |
$62.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.99
|
| Rate for Payer: Molina Healthcare Passport |
$62.74
|
| Rate for Payer: Multiplan PHCS |
$450.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.09
|
| Rate for Payer: UHCCP Medicaid |
$262.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.30
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,674.24 |
| Rate for Payer: Aetna Commercial |
$1,342.88
|
| Rate for Payer: Anthem Medicaid |
$599.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,447.52
|
| Rate for Payer: First Health Commercial |
$1,656.80
|
| Rate for Payer: Humana Commercial |
$1,482.40
|
| Rate for Payer: Humana KY Medicaid |
$599.76
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$605.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.36
|
| Rate for Payer: PHCS Commercial |
$1,674.24
|
| Rate for Payer: United Healthcare All Payer |
$1,534.72
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$1,674.24 |
| Rate for Payer: Aetna Commercial |
$1,342.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.32
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,447.52
|
| Rate for Payer: First Health Commercial |
$1,656.80
|
| Rate for Payer: Humana Commercial |
$1,482.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.36
|
| Rate for Payer: PHCS Commercial |
$1,674.24
|
| Rate for Payer: United Healthcare All Payer |
$1,534.72
|
|
|
COMPLEX CYSTOMETROGRAM
|
Professional
|
Both
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$1,046.40 |
| Rate for Payer: Aetna Commercial |
$493.13
|
| Rate for Payer: Ambetter Exchange |
$250.80
|
| Rate for Payer: Anthem Medicaid |
$87.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$250.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$300.96
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$394.30
|
| Rate for Payer: Humana Medicaid |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.70
|
| Rate for Payer: Molina Healthcare Passport |
$87.94
|
| Rate for Payer: Multiplan PHCS |
$1,046.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$326.04
|
| Rate for Payer: UHCCP Medicaid |
$610.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$250.80
|
|
|
COMPLEX CYSTOMETROGRAM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320P0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$509.73 |
| Rate for Payer: Aetna Commercial |
$493.13
|
| Rate for Payer: Ambetter Exchange |
$250.80
|
| Rate for Payer: Anthem Medicaid |
$87.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$250.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$300.96
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$394.30
|
| Rate for Payer: Humana Medicaid |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$250.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.70
|
| Rate for Payer: Molina Healthcare Passport |
$87.94
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$326.04
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$250.80
|
|
|
COMPLEX CYSTOMETROGRAM(T
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320T0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,098.24 |
| Rate for Payer: Aetna Commercial |
$880.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.32
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$949.52
|
| Rate for Payer: First Health Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial |
$972.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,006.72
|
| Rate for Payer: Ohio Health Group HMO |
$858.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$789.36
|
| Rate for Payer: PHCS Commercial |
$1,098.24
|
| Rate for Payer: United Healthcare All Payer |
$1,006.72
|
|
|
COMPLEX CYSTOMETROGRAM(T
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320T0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,098.24 |
| Rate for Payer: Aetna Commercial |
$880.88
|
| Rate for Payer: Anthem Medicaid |
$393.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$949.52
|
| Rate for Payer: First Health Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial |
$972.40
|
| Rate for Payer: Humana KY Medicaid |
$393.42
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$397.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$401.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,006.72
|
| Rate for Payer: Ohio Health Group HMO |
$858.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$789.36
|
| Rate for Payer: PHCS Commercial |
$1,098.24
|
| Rate for Payer: United Healthcare All Payer |
$1,006.72
|
|
|
COMPLEX DRAINAGE - WOUND
|
Professional
|
Both
|
$4,217.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
76100016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$2,530.20 |
| Rate for Payer: Aetna Commercial |
$255.51
|
| Rate for Payer: Ambetter Exchange |
$168.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.02
|
| Rate for Payer: Anthem Medicaid |
$97.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.78
|
| Rate for Payer: Cash Price |
$2,108.50
|
| Rate for Payer: Cash Price |
$2,108.50
|
| Rate for Payer: Cigna Commercial |
$247.26
|
| Rate for Payer: Healthspan PPO |
$260.36
|
| Rate for Payer: Humana Medicaid |
$97.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$219.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.03
|
| Rate for Payer: Molina Healthcare Passport |
$97.09
|
| Rate for Payer: Multiplan PHCS |
$2,530.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.67
|
| Rate for Payer: UHCCP Medicaid |
$95.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.98
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
OP
|
$4,217.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
76100016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,450.23 |
| Max. Negotiated Rate |
$4,048.32 |
| Rate for Payer: Aetna Commercial |
$3,247.09
|
| Rate for Payer: Anthem Medicaid |
$1,450.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,289.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,108.50
|
| Rate for Payer: Cash Price |
$2,108.50
|
| Rate for Payer: Cigna Commercial |
$3,500.11
|
| Rate for Payer: First Health Commercial |
$4,006.15
|
| Rate for Payer: Humana Commercial |
$3,584.45
|
| Rate for Payer: Humana KY Medicaid |
$1,450.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,464.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,112.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,668.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.73
|
| Rate for Payer: PHCS Commercial |
$4,048.32
|
| Rate for Payer: United Healthcare All Payer |
$3,710.96
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,115.10 |
| Max. Negotiated Rate |
$3,568.32 |
| Rate for Payer: Aetna Commercial |
$2,862.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.26
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna Commercial |
$3,085.11
|
| Rate for Payer: First Health Commercial |
$3,531.15
|
| Rate for Payer: Humana Commercial |
$3,159.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.73
|
| Rate for Payer: PHCS Commercial |
$3,568.32
|
| Rate for Payer: United Healthcare All Payer |
$3,270.96
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,278.28 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,862.09
|
| Rate for Payer: Anthem Medicaid |
$1,278.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna Commercial |
$3,085.11
|
| Rate for Payer: First Health Commercial |
$3,531.15
|
| Rate for Payer: Humana Commercial |
$3,159.45
|
| Rate for Payer: Humana KY Medicaid |
$1,278.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,303.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.73
|
| Rate for Payer: PHCS Commercial |
$3,568.32
|
| Rate for Payer: United Healthcare All Payer |
$3,270.96
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
IP
|
$4,217.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
76100016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,265.10 |
| Max. Negotiated Rate |
$4,048.32 |
| Rate for Payer: Aetna Commercial |
$3,247.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,289.26
|
| Rate for Payer: Cash Price |
$2,108.50
|
| Rate for Payer: Cigna Commercial |
$3,500.11
|
| Rate for Payer: First Health Commercial |
$4,006.15
|
| Rate for Payer: Humana Commercial |
$3,584.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,112.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,668.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.73
|
| Rate for Payer: PHCS Commercial |
$4,048.32
|
| Rate for Payer: United Healthcare All Payer |
$3,710.96
|
|
|
COMPLEX DRAINAGE - WOUND(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
761P0016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.02 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$255.51
|
| Rate for Payer: Ambetter Exchange |
$168.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.02
|
| Rate for Payer: Anthem Medicaid |
$97.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.78
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$247.26
|
| Rate for Payer: Healthspan PPO |
$260.36
|
| Rate for Payer: Humana Medicaid |
$97.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$219.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.03
|
| Rate for Payer: Molina Healthcare Passport |
$97.09
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.67
|
| Rate for Payer: UHCCP Medicaid |
$95.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.98
|
|
|
COMPLEX DRAINAGE - WOUND(T
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
761T0016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,278.28 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,862.09
|
| Rate for Payer: Anthem Medicaid |
$1,278.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna Commercial |
$3,085.11
|
| Rate for Payer: First Health Commercial |
$3,531.15
|
| Rate for Payer: Humana Commercial |
$3,159.45
|
| Rate for Payer: Humana KY Medicaid |
$1,278.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,303.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.73
|
| Rate for Payer: PHCS Commercial |
$3,568.32
|
| Rate for Payer: United Healthcare All Payer |
$3,270.96
|
|
|
COMPLEX DRAINAGE - WOUND(T
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
761T0016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,115.10 |
| Max. Negotiated Rate |
$3,568.32 |
| Rate for Payer: Aetna Commercial |
$2,862.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.26
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna Commercial |
$3,085.11
|
| Rate for Payer: First Health Commercial |
$3,531.15
|
| Rate for Payer: Humana Commercial |
$3,159.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,047.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,270.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,787.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,973.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.73
|
| Rate for Payer: PHCS Commercial |
$3,568.32
|
| Rate for Payer: United Healthcare All Payer |
$3,270.96
|
|
|
COMPLEX E/M VISIT ADD ON
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
51000307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
COMPLEX E/M VISIT ADD ON
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
51000307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
51000307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Ambetter Exchange |
$15.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.20
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.17
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.72
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.17
|
|
|
COMPLEXION RENEW PADS 60CT GBL
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
22200143
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$17.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$17.54
|
| Rate for Payer: Kentucky WC Medicaid |
$17.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
COMPLEXION RENEW PADS 60CT GBL
|
Professional
|
Both
|
$51.00
|
|
| Hospital Charge Code |
22200143
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Multiplan PHCS |
$30.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.70
|
| Rate for Payer: UHCCP Medicaid |
$17.85
|
|
|
COMPLEXION RENEW PADS 60CT GBL
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
22200143
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
COMPLEX RPR TRUNK 1.1-2.5
|
Professional
|
Both
|
$2,494.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$1,496.40 |
| Rate for Payer: Aetna Commercial |
$334.67
|
| Rate for Payer: Ambetter Exchange |
$188.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.23
|
| Rate for Payer: Anthem Medicaid |
$123.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.79
|
| Rate for Payer: Cash Price |
$1,247.00
|
| Rate for Payer: Cash Price |
$1,247.00
|
| Rate for Payer: Cigna Commercial |
$410.07
|
| Rate for Payer: Healthspan PPO |
$348.04
|
| Rate for Payer: Humana Medicaid |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$292.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.30
|
| Rate for Payer: Molina Healthcare Passport |
$123.82
|
| Rate for Payer: Multiplan PHCS |
$1,496.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.61
|
| Rate for Payer: UHCCP Medicaid |
$106.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.16
|
|
|
COMPLEX RPR TRUNK 1.1-2.5
|
Facility
|
IP
|
$2,494.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$748.20 |
| Max. Negotiated Rate |
$2,394.24 |
| Rate for Payer: Aetna Commercial |
$1,920.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,945.32
|
| Rate for Payer: Cash Price |
$1,247.00
|
| Rate for Payer: Cigna Commercial |
$2,070.02
|
| Rate for Payer: First Health Commercial |
$2,369.30
|
| Rate for Payer: Humana Commercial |
$2,119.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,045.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,840.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,194.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,870.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,169.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,720.86
|
| Rate for Payer: PHCS Commercial |
$2,394.24
|
| Rate for Payer: United Healthcare All Payer |
$2,194.72
|
|
