|
EAR WAX REMOVAL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
45000308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
EAR WAX REMOVAL
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
76102413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$202.56 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Anthem Medicaid |
$72.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$175.13
|
| Rate for Payer: First Health Commercial |
$200.45
|
| Rate for Payer: Humana Commercial |
$179.35
|
| Rate for Payer: Humana KY Medicaid |
$72.56
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$73.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$74.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$185.68
|
| Rate for Payer: Ohio Health Group HMO |
$158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.59
|
| Rate for Payer: PHCS Commercial |
$202.56
|
| Rate for Payer: United Healthcare All Payer |
$185.68
|
|
|
EAR WAX REMOVAL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
45000308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
EAR WAX REMOVAL
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
76102413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$202.56 |
| Rate for Payer: Humana Commercial |
$179.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$155.72
|
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.58
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$175.13
|
| Rate for Payer: First Health Commercial |
$200.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$185.68
|
| Rate for Payer: Ohio Health Group HMO |
$158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.59
|
| Rate for Payer: PHCS Commercial |
$202.56
|
| Rate for Payer: United Healthcare All Payer |
$185.68
|
|
|
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 |
$75.00 |
| Rate for Payer: Aetna Commercial |
$48.94
|
| Rate for Payer: Ambetter Exchange |
$30.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$24.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.38
|
| 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 |
$24.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.04
|
| Rate for Payer: Molina Healthcare Passport |
$24.55
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.42
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.32
|
|
|
EAR WAX REMOVAL(T
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
761T2413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
EAR WAX REMOVAL(T
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
761T2413
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
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 |
$964.20 |
| 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 |
$2,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,796.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,217.66
|
| 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 |
$1,105.29 |
| 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 |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,506.92
|
| 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 |
$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 |
$1,690.17
|
| 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 |
$2,028.20
|
| 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 |
$2,571.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,796.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,217.66
|
| 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 |
$1,928.40 |
| Rate for Payer: Aetna Commercial |
$1,064.42
|
| Rate for Payer: Ambetter Exchange |
$675.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.79
|
| Rate for Payer: Anthem Medicaid |
$588.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.08
|
| 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 |
$588.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$922.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.60
|
| Rate for Payer: Molina Healthcare Passport |
$588.82
|
| Rate for Payer: Multiplan PHCS |
$1,928.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$878.67
|
| Rate for Payer: UHCCP Medicaid |
$471.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.90
|
|
|
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: Ambetter Exchange |
$675.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.79
|
| Rate for Payer: Anthem Medicaid |
$588.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.08
|
| 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 |
$588.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$922.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.60
|
| Rate for Payer: Molina Healthcare Passport |
$588.82
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$878.67
|
| Rate for Payer: UHCCP Medicaid |
$471.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$594.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.90
|
|
|
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 |
$799.22 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| 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 |
$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 |
$1,690.17
|
| 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 |
$2,028.20
|
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| 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
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
761T0177
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.20 |
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| 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 |
$697.20 |
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| 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 |
$697.20 |
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| 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
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.0 LA6EBU30
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.0 LA7EBU30
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.0 LA7EBU30
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.5 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EBU GUIDE CATH 3.5 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EBU GUIDE CATH 3.5 LA6EBU35
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.5 LA6EBU35
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.5 LA7EBU35
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
EBU GUIDE CATH 3.5 LA7EBU35
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
