|
COSM MAMMO W/O LIP 120 M
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
22200082
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
COSM MAMMO W/O LIP 120 M
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
22200082
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
COSM MAMMO W/O LIPO 120M -80
|
Professional
|
Both
|
$875.00
|
|
| Hospital Charge Code |
22200383
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$612.50 |
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
|
|
COSM MAMMO W/O LIPO 120M -80
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
22200383
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
COSM MAMMO W/O LIPO 120M -80
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
22200383
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
COSM SCALP COOLING SP
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
22200728
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
COSM SCALP COOLING SP
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
22200728
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
COSM SCLEROTHERAPY MULT VEINS
|
Professional
|
Both
|
$950.00
|
|
| Hospital Charge Code |
22200196
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
|
|
COSM SCLEROTHERAPY SINGLE VEIN
|
Professional
|
Both
|
$475.00
|
|
| Hospital Charge Code |
22200195
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
|
|
COSM SCLEROTHERAPY SPOT VEIN
|
Professional
|
Both
|
$275.00
|
|
| Hospital Charge Code |
22200194
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
COSOPT PLUS 10 ML
|
Facility
|
IP
|
$27.10
|
|
|
Service Code
|
NDC 61314003002
|
| Hospital Charge Code |
25000483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$26.02 |
| Rate for Payer: Aetna Commercial |
$20.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.14
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cigna Commercial |
$22.49
|
| Rate for Payer: First Health Commercial |
$25.75
|
| Rate for Payer: Humana Commercial |
$23.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.85
|
| Rate for Payer: Ohio Health Group HMO |
$20.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$26.02
|
| Rate for Payer: United Healthcare All Payer |
$23.85
|
|
|
COSOPT PLUS 10 ML
|
Facility
|
OP
|
$27.10
|
|
|
Service Code
|
NDC 61314003002
|
| Hospital Charge Code |
25000483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$26.02 |
| Rate for Payer: Aetna Commercial |
$20.87
|
| Rate for Payer: Anthem Medicaid |
$9.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.14
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cigna Commercial |
$22.49
|
| Rate for Payer: First Health Commercial |
$25.75
|
| Rate for Payer: Humana Commercial |
$23.04
|
| Rate for Payer: Humana KY Medicaid |
$9.32
|
| Rate for Payer: Kentucky WC Medicaid |
$9.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.85
|
| Rate for Payer: Ohio Health Group HMO |
$20.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.70
|
| Rate for Payer: PHCS Commercial |
$26.02
|
| Rate for Payer: United Healthcare All Payer |
$23.85
|
|
|
COSYNTROPIN 0.25MG SDV
|
Professional
|
Both
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
63600216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$320.75 |
| Rate for Payer: Aetna Commercial |
$48.74
|
| Rate for Payer: Ambetter Exchange |
$28.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.62
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.02
|
| Rate for Payer: Multiplan PHCS |
$320.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.43
|
| Rate for Payer: UHCCP Medicaid |
$187.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.02
|
|
|
COSYNTROPIN 0.25MG SDV
|
Facility
|
OP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
63600216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem Medicaid |
$183.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Humana KY Medicaid |
$183.84
|
| Rate for Payer: Kentucky WC Medicaid |
$185.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
COSYNTROPIN 0.25MG SDV
|
Facility
|
IP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
636T0216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
COSYNTROPIN 0.25MG SDV
|
Facility
|
IP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
63600216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
COSYNTROPIN 0.25MG SDV
|
Facility
|
OP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
636T0216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem Medicaid |
$183.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Humana KY Medicaid |
$183.84
|
| Rate for Payer: Kentucky WC Medicaid |
$185.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
COUNSEL NEED LUNG CA SCREEN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS G0296
|
| Hospital Charge Code |
51000138
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
COUNSEL NEED LUNG CA SCREEN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS G0296
|
| Hospital Charge Code |
51000138
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$119.66 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
COUNSEL NEED LUNG CA SCREEN
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS G0296
|
| Hospital Charge Code |
51000138
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Ambetter Exchange |
$23.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.06
|
| Rate for Payer: Anthem Medicaid |
$42.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.46
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Humana Medicaid |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.71
|
| Rate for Payer: Molina Healthcare Passport |
$42.85
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.84
|
| Rate for Payer: UHCCP Medicaid |
$22.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.72
|
|
|
COUNTERSINK HEADLESS 4.0
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
COUNTERSINK HEADLESS 4.0
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
COUPLER MINI MALE TO MALE 2MM
|
Facility
|
OP
|
$8,610.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.29 |
| Max. Negotiated Rate |
$8,266.52 |
| Rate for Payer: Aetna Commercial |
$6,630.44
|
| Rate for Payer: Anthem Medicaid |
$2,961.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.55
|
| Rate for Payer: Cash Price |
$4,305.48
|
| Rate for Payer: Cigna Commercial |
$7,147.10
|
| Rate for Payer: First Health Commercial |
$8,180.41
|
| Rate for Payer: Humana Commercial |
$7,319.32
|
| Rate for Payer: Humana KY Medicaid |
$2,961.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,060.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,888.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,491.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,941.56
|
| Rate for Payer: PHCS Commercial |
$8,266.52
|
| Rate for Payer: United Healthcare All Payer |
$7,577.64
|
|
|
COUPLER MINI MALE TO MALE 2MM
|
Facility
|
IP
|
$8,610.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.29 |
| Max. Negotiated Rate |
$8,266.52 |
| Rate for Payer: Aetna Commercial |
$6,630.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.55
|
| Rate for Payer: Cash Price |
$4,305.48
|
| Rate for Payer: Cigna Commercial |
$7,147.10
|
| Rate for Payer: First Health Commercial |
$8,180.41
|
| Rate for Payer: Humana Commercial |
$7,319.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,060.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,888.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,491.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,941.56
|
| Rate for Payer: PHCS Commercial |
$8,266.52
|
| Rate for Payer: United Healthcare All Payer |
$7,577.64
|
|
|
COUPLER MINI MALE TO MALE 4MM
|
Facility
|
OP
|
$8,610.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.29 |
| Max. Negotiated Rate |
$8,266.52 |
| Rate for Payer: Aetna Commercial |
$6,630.44
|
| Rate for Payer: Anthem Medicaid |
$2,961.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.55
|
| Rate for Payer: Cash Price |
$4,305.48
|
| Rate for Payer: Cigna Commercial |
$7,147.10
|
| Rate for Payer: First Health Commercial |
$8,180.41
|
| Rate for Payer: Humana Commercial |
$7,319.32
|
| Rate for Payer: Humana KY Medicaid |
$2,961.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,060.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,888.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,491.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,941.56
|
| Rate for Payer: PHCS Commercial |
$8,266.52
|
| Rate for Payer: United Healthcare All Payer |
$7,577.64
|
|
