|
COMPLEX RPR TRUNK 1.1-2.5
|
Facility
|
OP
|
$2,494.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,394.24 |
| Rate for Payer: Aetna Commercial |
$1,920.38
|
| Rate for Payer: Anthem Medicaid |
$857.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,945.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$1,247.00
|
| 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: Humana KY Medicaid |
$857.69
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$866.42
|
| 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 |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$874.90
|
| 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
|
|
|
COMPLEX RPR TRUNK 1.1-2.5(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
761P0149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$410.07 |
| 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 |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| 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 |
$270.00
|
| 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(T
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
761T0149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$1,962.24 |
| Rate for Payer: Aetna Commercial |
$1,573.88
|
| Rate for Payer: Anthem Medicaid |
$702.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,594.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$1,022.00
|
| Rate for Payer: Cash Price |
$1,022.00
|
| Rate for Payer: Cigna Commercial |
$1,696.52
|
| Rate for Payer: First Health Commercial |
$1,941.80
|
| Rate for Payer: Humana Commercial |
$1,737.40
|
| Rate for Payer: Humana KY Medicaid |
$702.93
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$710.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,676.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,508.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,798.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,533.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.36
|
| Rate for Payer: PHCS Commercial |
$1,962.24
|
| Rate for Payer: United Healthcare All Payer |
$1,798.72
|
|
|
COMPLEX RPR TRUNK 1.1-2.5(T
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
761T0149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$1,962.24 |
| Rate for Payer: Aetna Commercial |
$1,573.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,594.32
|
| Rate for Payer: Cash Price |
$1,022.00
|
| Rate for Payer: Cigna Commercial |
$1,696.52
|
| Rate for Payer: First Health Commercial |
$1,941.80
|
| Rate for Payer: Humana Commercial |
$1,737.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,676.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,508.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,798.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,533.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,778.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.36
|
| Rate for Payer: PHCS Commercial |
$1,962.24
|
| Rate for Payer: United Healthcare All Payer |
$1,798.72
|
|
|
COMPOSITE SKIN GRAFT
|
Professional
|
Both
|
$5,925.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.06 |
| Max. Negotiated Rate |
$3,555.28 |
| Rate for Payer: Aetna Commercial |
$1,006.84
|
| Rate for Payer: Ambetter Exchange |
$656.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$355.06
|
| Rate for Payer: Anthem Medicaid |
$465.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.38
|
| Rate for Payer: Cash Price |
$2,962.73
|
| Rate for Payer: Cash Price |
$2,962.73
|
| Rate for Payer: Cigna Commercial |
$959.98
|
| Rate for Payer: Healthspan PPO |
$939.44
|
| Rate for Payer: Humana Medicaid |
$465.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$890.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.78
|
| Rate for Payer: Molina Healthcare Passport |
$465.47
|
| Rate for Payer: Multiplan PHCS |
$3,555.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.00
|
| Rate for Payer: UHCCP Medicaid |
$372.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$470.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.15
|
|
|
COMPOSITE SKIN GRAFT
|
Facility
|
OP
|
$5,925.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$5,688.44 |
| Rate for Payer: Aetna Commercial |
$4,562.60
|
| Rate for Payer: Anthem Medicaid |
$2,037.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,621.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,962.73
|
| Rate for Payer: Cash Price |
$2,962.73
|
| Rate for Payer: Cigna Commercial |
$4,918.13
|
| Rate for Payer: First Health Commercial |
$5,629.19
|
| Rate for Payer: Humana Commercial |
$5,036.64
|
| Rate for Payer: Humana KY Medicaid |
$2,037.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,058.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,858.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,372.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,078.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,444.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,740.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,155.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,088.57
|
| Rate for Payer: PHCS Commercial |
$5,688.44
|
| Rate for Payer: United Healthcare All Payer |
$5,214.40
|
|
|
COMPOSITE SKIN GRAFT
|
Facility
|
IP
|
$5,925.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,777.64 |
| Max. Negotiated Rate |
$5,688.44 |
| Rate for Payer: Aetna Commercial |
$4,562.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,621.86
|
| Rate for Payer: Cash Price |
$2,962.73
|
| Rate for Payer: Cigna Commercial |
$4,918.13
|
| Rate for Payer: First Health Commercial |
$5,629.19
|
| Rate for Payer: Humana Commercial |
$5,036.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,858.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,372.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,777.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,444.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,740.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,155.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,088.57
|
| Rate for Payer: PHCS Commercial |
$5,688.44
|
| Rate for Payer: United Healthcare All Payer |
$5,214.40
|
|
|
COMPOSITE SKIN GRAFT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
761P0208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.06 |
| Max. Negotiated Rate |
$1,006.84 |
| Rate for Payer: Aetna Commercial |
$1,006.84
|
| Rate for Payer: Ambetter Exchange |
$656.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$355.06
|
| Rate for Payer: Anthem Medicaid |
$465.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.38
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$959.98
|
| Rate for Payer: Healthspan PPO |
$939.44
|
| Rate for Payer: Humana Medicaid |
$465.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$890.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.78
|
| Rate for Payer: Molina Healthcare Passport |
$465.47
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.00
|
| Rate for Payer: UHCCP Medicaid |
$372.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$470.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.15
|
|
|
COMPOSITE SKIN GRAFT(T
|
Facility
|
OP
|
$4,525.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
761T0208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.31 |
| Max. Negotiated Rate |
$4,344.44 |
| Rate for Payer: Aetna Commercial |
$3,484.60
|
| Rate for Payer: Anthem Medicaid |
$1,556.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,529.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,262.73
|
| Rate for Payer: Cash Price |
$2,262.73
|
| Rate for Payer: Cigna Commercial |
$3,756.13
|
| Rate for Payer: First Health Commercial |
$4,299.19
|
| Rate for Payer: Humana Commercial |
$3,846.64
|
| Rate for Payer: Humana KY Medicaid |
$1,556.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,572.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,710.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,339.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,982.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,620.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,937.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,122.57
|
| Rate for Payer: PHCS Commercial |
$4,344.44
|
| Rate for Payer: United Healthcare All Payer |
$3,982.40
|
|
|
COMPOSITE SKIN GRAFT(T
|
Facility
|
IP
|
$4,525.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
761T0208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,357.64 |
| Max. Negotiated Rate |
$4,344.44 |
| Rate for Payer: Aetna Commercial |
$3,484.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,529.86
|
| Rate for Payer: Cash Price |
$2,262.73
|
| Rate for Payer: Cigna Commercial |
$3,756.13
|
| Rate for Payer: First Health Commercial |
$4,299.19
|
| Rate for Payer: Humana Commercial |
$3,846.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,710.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,339.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,982.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,620.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,937.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,122.57
|
| Rate for Payer: PHCS Commercial |
$4,344.44
|
| Rate for Payer: United Healthcare All Payer |
$3,982.40
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$10.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$10.56
|
| Rate for Payer: Humana Medicare Advantage |
$10.56
|
| Rate for Payer: Kentucky WC Medicaid |
$10.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
COMPREHEN METABOLIC PANEL
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$54.60 |
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Ambetter Exchange |
$10.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.67
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: Healthspan PPO |
$11.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.56
|
| Rate for Payer: Multiplan PHCS |
$54.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$31.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.56
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$97.11
|
| Rate for Payer: Ambetter Exchange |
$31.13
|
| Rate for Payer: Anthem Medicaid |
$60.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.36
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$111.28
|
| Rate for Payer: Healthspan PPO |
$79.46
|
| Rate for Payer: Humana Medicaid |
$60.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.25
|
| Rate for Payer: Molina Healthcare Passport |
$60.05
|
| Rate for Payer: Multiplan PHCS |
$226.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.47
|
| Rate for Payer: UHCCP Medicaid |
$132.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.13
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.82
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
COMPREHENSIVE REV STEM 10MM
|
Facility
|
OP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem Medicaid |
$9,619.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Humana KY Medicaid |
$9,619.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,812.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 10MM
|
Facility
|
IP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 12MM
|
Facility
|
OP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem Medicaid |
$9,619.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Humana KY Medicaid |
$9,619.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,812.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 12MM
|
Facility
|
IP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 14MM
|
Facility
|
OP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem Medicaid |
$9,619.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Humana KY Medicaid |
$9,619.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,812.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 14MM
|
Facility
|
IP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 4MM
|
Facility
|
IP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 4MM
|
Facility
|
OP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem Medicaid |
$9,619.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Humana KY Medicaid |
$9,619.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,812.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 6MM
|
Facility
|
OP
|
$22,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.25 |
| Max. Negotiated Rate |
$21,309.60 |
| Rate for Payer: Aetna Commercial |
$17,092.08
|
| Rate for Payer: Anthem Medicaid |
$7,633.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,314.05
|
| Rate for Payer: Cash Price |
$11,098.75
|
| Rate for Payer: Cigna Commercial |
$18,423.92
|
| Rate for Payer: First Health Commercial |
$21,087.62
|
| Rate for Payer: Humana Commercial |
$18,867.88
|
| Rate for Payer: Humana KY Medicaid |
$7,633.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7,711.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,201.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,381.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,659.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,786.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,533.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,648.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,311.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,316.27
|
| Rate for Payer: PHCS Commercial |
$21,309.60
|
| Rate for Payer: United Healthcare All Payer |
$19,533.80
|
|
