|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$24,694.92
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$16,757.27 |
| Max. Negotiated Rate |
$24,694.92 |
| Rate for Payer: Anthem Medicaid |
$16,757.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,639.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,694.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,812.96
|
| Rate for Payer: Humana KY Medicaid |
$16,757.27
|
| Rate for Payer: Humana Medicare Advantage |
$17,639.23
|
| Rate for Payer: Kentucky WC Medicaid |
$16,924.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,167.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,092.41
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$10,407.91
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$7,062.51 |
| Max. Negotiated Rate |
$10,407.91 |
| Rate for Payer: Anthem Medicaid |
$7,062.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,434.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,407.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,036.20
|
| Rate for Payer: Humana KY Medicaid |
$7,062.51
|
| Rate for Payer: Humana Medicare Advantage |
$7,434.22
|
| Rate for Payer: Kentucky WC Medicaid |
$7,133.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,921.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,203.76
|
|
|
EAR WAX REMOVAL
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
76102413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EAR WAX REMOVAL
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
45000308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
EAR WAX REMOVAL
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
45000308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
EAR WAX REMOVAL
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
76102413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$48.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$21.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$206.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$70.74
|
| Rate for Payer: Healthspan PPO |
$62.41
|
| Rate for Payer: Humana Medicaid |
$21.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.90
|
| Rate for Payer: Molina Healthcare Passport |
$21.47
|
| Rate for Payer: Multiplan PHCS |
$123.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.20
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.68
|
|
|
EAR WAX REMOVAL
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
76102413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EAR WAX REMOVAL(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
761P2413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$48.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$21.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$70.74
|
| Rate for Payer: Healthspan PPO |
$62.41
|
| Rate for Payer: Humana Medicaid |
$21.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.90
|
| Rate for Payer: Molina Healthcare Passport |
$21.47
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.68
|
|
|
EAR WAX REMOVAL(T
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
761T2413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
EAR WAX REMOVAL(T
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
761T2413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.11
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
EA T/A/L 1ST 100SQCM OR <
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$3,085.44 |
| Rate for Payer: Aetna Commercial |
$2,474.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,506.92
|
| Rate for Payer: Cash Price |
$1,607.00
|
| Rate for Payer: Cigna Commercial |
$2,667.62
|
| Rate for Payer: First Health Commercial |
$3,053.30
|
| Rate for Payer: Humana Commercial |
$2,731.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,371.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.34
|
| Rate for Payer: PHCS Commercial |
$3,085.44
|
| Rate for Payer: United Healthcare All Payer |
$2,828.32
|
|
|
EA T/A/L 1ST 100SQCM OR <
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.82 |
| Max. Negotiated Rate |
$3,085.44 |
| Rate for Payer: Aetna Commercial |
$2,474.78
|
| Rate for Payer: Anthem Medicaid |
$1,105.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,506.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,607.00
|
| Rate for Payer: Cash Price |
$1,607.00
|
| Rate for Payer: Cigna Commercial |
$2,667.62
|
| Rate for Payer: First Health Commercial |
$3,053.30
|
| Rate for Payer: Humana Commercial |
$2,731.90
|
| Rate for Payer: Humana KY Medicaid |
$1,105.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,371.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.34
|
| Rate for Payer: PHCS Commercial |
$3,085.44
|
| Rate for Payer: United Healthcare All Payer |
$2,828.32
|
|
|
EA T/A/L 1ST 100SQCM OR <
|
Professional
|
Both
|
$3,214.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
76100177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.79 |
| Max. Negotiated Rate |
$3,214.00 |
| Rate for Payer: Aetna Commercial |
$1,064.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.79
|
| Rate for Payer: Anthem Medicaid |
$494.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,214.00
|
| Rate for Payer: Cash Price |
$1,607.00
|
| Rate for Payer: Cash Price |
$1,607.00
|
| Rate for Payer: Cigna Commercial |
$1,032.73
|
| Rate for Payer: Healthspan PPO |
$964.51
|
| Rate for Payer: Humana Medicaid |
$494.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$922.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$504.82
|
| Rate for Payer: Molina Healthcare Passport |
$494.92
|
| Rate for Payer: Multiplan PHCS |
$1,928.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,249.80
|
| Rate for Payer: UHCCP Medicaid |
$471.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$499.87
|
|
|
EA T/A/L 1ST 100SQCM OR <(P
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
761P0177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.79 |
| Max. Negotiated Rate |
$1,064.42 |
| Rate for Payer: Aetna Commercial |
$1,064.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.79
|
| Rate for Payer: Anthem Medicaid |
$494.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$1,032.73
|
| Rate for Payer: Healthspan PPO |
$964.51
|
| Rate for Payer: Humana Medicaid |
$494.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$922.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$504.82
|
| Rate for Payer: Molina Healthcare Passport |
$494.92
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.00
|
| Rate for Payer: UHCCP Medicaid |
$471.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$499.87
|
|
|
EA T/A/L 1ST 100SQCM OR <(T
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
761T0177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
EA T/A/L 1ST 100SQCM OR <(T
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
761T0177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
EA T/A/L EA ADTL 100SQCM
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15111
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
EA T/A/L EA ADTL 100SQCM
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15111
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
EBU GUIDE CATH 3.0 LA6EBU30
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
EBU GUIDE CATH 3.0 LA6EBU30
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
EBU GUIDE CATH 3.0 LA7EBU30
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
EBU GUIDE CATH 3.0 LA7EBU30
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
EBU GUIDE CATH 3.5 8FR
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
EBU GUIDE CATH 3.5 8FR
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
EBU GUIDE CATH 3.5 LA6EBU35
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
