|
3DRC CATH 5F
|
Facility
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem Medicaid |
$56.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Humana KY Medicaid |
$56.42
|
| Rate for Payer: Kentucky WC Medicaid |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
3DRC CATH 5F
|
Facility
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
|
|
3DRC CATH 6F 100CM
|
Facility
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
|
|
3DRC CATH 6F 100CM
|
Facility
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
3D RENDER W/INTRP POSTPROCES
|
Professional
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
|
3D RENDER W/INTRP POSTPROCES
|
Facility
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
3D RENDER W/INTRP POSTPROCES
|
Facility
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
|
|
3D RENDER W/INTRP POSTPROCES(P
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
350P0095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$178.97 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
|
3D RENDER W/INTRP POSTPROCES(T
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
350T0095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
|
|
3D RENDER W/INTRP POSTPROCES(T
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
350T0095
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
3D REND W/INTERP REP OF CT
|
Facility
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
|
|
3D REND W/INTERP REP OF CT
|
Facility
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
|
|
3D REND W/INTERP REP OF CT
|
Facility
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
3D REND W/INTERP REP OF CT
|
Facility
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
3D REND W/INTERP REP OF CT
|
Professional
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,109.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.32
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$665.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.60
|
| Rate for Payer: UHCCP Medicaid |
$388.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.77
|
|
|
3D REND W/INTERP REP OF CT
|
Professional
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,109.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.32
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$665.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.60
|
| Rate for Payer: UHCCP Medicaid |
$388.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.77
|
|
|
3D REND W/INTERP REP OF CT(P
|
Professional
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.32
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.60
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.77
|
|
|
3D REND W/INTERP REP OF CT(P
|
Professional
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.32
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.60
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.77
|
|
|
3D REND W/INTERP REP OF CT(T
|
Facility
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
|
|
3D REND W/INTERP REP OF CT(T
|
Facility
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
|
|
3D REND W/INTERP REP OF CT(T
|
Facility
OP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0005
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem Medicaid |
$321.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Humana KY Medicaid |
$321.20
|
| Rate for Payer: Kentucky WC Medicaid |
$324.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
3D REND W/INTERP REP OF CT(T
|
Facility
OP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0004
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem Medicaid |
$321.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Humana KY Medicaid |
$321.20
|
| Rate for Payer: Kentucky WC Medicaid |
$324.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
402T0004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Professional
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
