|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$7,947.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
76101648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.11 |
| Max. Negotiated Rate |
$7,629.12 |
| Rate for Payer: Aetna Commercial |
$6,119.19
|
| Rate for Payer: Anthem Medicaid |
$2,732.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cigna Commercial |
$6,596.01
|
| Rate for Payer: First Health Commercial |
$7,549.65
|
| Rate for Payer: Humana Commercial |
$6,754.95
|
| Rate for Payer: Humana KY Medicaid |
$2,732.97
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,993.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,960.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.57
|
| Rate for Payer: PHCS Commercial |
$7,629.12
|
| Rate for Payer: United Healthcare All Payer |
$6,993.36
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$5,323.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
76101649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.11 |
| Max. Negotiated Rate |
$5,323.00 |
| Rate for Payer: Aetna Commercial |
$500.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$195.26
|
| Rate for Payer: Anthem Medicaid |
$150.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,323.00
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cigna Commercial |
$583.70
|
| Rate for Payer: Healthspan PPO |
$511.74
|
| Rate for Payer: Humana Medicaid |
$150.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.11
|
| Rate for Payer: Molina Healthcare Passport |
$150.11
|
| Rate for Payer: Multiplan PHCS |
$3,193.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,726.10
|
| Rate for Payer: UHCCP Medicaid |
$205.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.61
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$9,542.40 |
| Rate for Payer: Aetna Commercial |
$7,653.80
|
| Rate for Payer: Anthem Medicaid |
$3,418.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,753.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$8,250.20
|
| Rate for Payer: First Health Commercial |
$9,443.00
|
| Rate for Payer: Humana Commercial |
$8,449.00
|
| Rate for Payer: Humana KY Medicaid |
$3,418.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,453.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,150.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,335.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,486.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.40
|
| Rate for Payer: PHCS Commercial |
$9,542.40
|
| Rate for Payer: United Healthcare All Payer |
$8,747.20
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$5,323.00
|
|
|
Service Code
|
HCPCS 41017
|
| Hospital Charge Code |
76101649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.99 |
| Max. Negotiated Rate |
$5,110.08 |
| Rate for Payer: Aetna Commercial |
$4,098.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,151.94
|
| Rate for Payer: Cash Price |
$2,661.50
|
| Rate for Payer: Cigna Commercial |
$4,418.09
|
| Rate for Payer: First Health Commercial |
$5,056.85
|
| Rate for Payer: Humana Commercial |
$4,524.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,364.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,928.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,596.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,684.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,992.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.13
|
| Rate for Payer: PHCS Commercial |
$5,110.08
|
| Rate for Payer: United Healthcare All Payer |
$4,684.24
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$9,542.40 |
| Rate for Payer: Aetna Commercial |
$7,653.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,753.20
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$8,250.20
|
| Rate for Payer: First Health Commercial |
$9,443.00
|
| Rate for Payer: Humana Commercial |
$8,449.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,150.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,335.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,982.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,747.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,455.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,292.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,081.40
|
| Rate for Payer: PHCS Commercial |
$9,542.40
|
| Rate for Payer: United Healthcare All Payer |
$8,747.20
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$70,190.40
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$47,629.20 |
| Max. Negotiated Rate |
$70,190.40 |
| Rate for Payer: Anthem Medicaid |
$47,629.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$50,136.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$70,190.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$67,683.60
|
| Rate for Payer: Humana KY Medicaid |
$47,629.20
|
| Rate for Payer: Humana Medicare Advantage |
$50,136.00
|
| Rate for Payer: Kentucky WC Medicaid |
$48,105.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60,163.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$48,581.78
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
EXTREMITY ULTRASOUND LIMITED(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
EXTREMITY ULTRASOUND LIMITED(T
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
EXTREMITY ULTRASOUND LIMITED(T
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
EXTRNL COUNTERPULSE, PER TX
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS G0166
|
| Hospital Charge Code |
76102533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
EXTRNL COUNTERPULSE, PER TX
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS G0166
|
| Hospital Charge Code |
76102533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
EXTRNL COUNTERPULSE, PER TX
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS G0166
|
| Hospital Charge Code |
76102533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$196.77 |
| Rate for Payer: Aetna Commercial |
$112.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.77
|
| Rate for Payer: Multiplan PHCS |
$55.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.40
|
| Rate for Payer: UHCCP Medicaid |
$32.20
|
|
|
EYE EXAM & TREATMENT
|
Facility
|
IP
|
$368.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
76102447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$353.76 |
| Rate for Payer: Aetna Commercial |
$283.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.43
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cigna Commercial |
$305.86
|
| Rate for Payer: First Health Commercial |
$350.08
|
| Rate for Payer: Humana Commercial |
$313.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.28
|
| Rate for Payer: Ohio Health Group HMO |
$276.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.24
|
| Rate for Payer: PHCS Commercial |
$353.76
|
| Rate for Payer: United Healthcare All Payer |
$324.28
|
|
|
EYE EXAM & TREATMENT
|
Professional
|
Both
|
$368.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
76102447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$94.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$69.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$368.50
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cigna Commercial |
$145.86
|
| Rate for Payer: Healthspan PPO |
$130.59
|
| Rate for Payer: Humana Medicaid |
$69.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.20
|
| Rate for Payer: Molina Healthcare Passport |
$69.80
|
| Rate for Payer: Multiplan PHCS |
$221.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.95
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: United Healthcare Non-Options |
$69.26
|
| Rate for Payer: United Healthcare Options |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.50
|
|
|
EYE EXAM & TREATMENT
|
Facility
|
OP
|
$368.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
76102447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$353.76 |
| Rate for Payer: Aetna Commercial |
$283.74
|
| Rate for Payer: Anthem Medicaid |
$126.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cash Price |
$184.25
|
| Rate for Payer: Cigna Commercial |
$305.86
|
| Rate for Payer: First Health Commercial |
$350.08
|
| Rate for Payer: Humana Commercial |
$313.22
|
| Rate for Payer: Humana KY Medicaid |
$126.73
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$128.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$302.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$324.28
|
| Rate for Payer: Ohio Health Group HMO |
$276.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.24
|
| Rate for Payer: PHCS Commercial |
$353.76
|
| Rate for Payer: United Healthcare All Payer |
$324.28
|
|
|
EYE EXAM & TREATMENT(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
761P2447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$94.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.73
|
| Rate for Payer: Anthem Medicaid |
$69.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$145.86
|
| Rate for Payer: Healthspan PPO |
$130.59
|
| Rate for Payer: Humana Medicaid |
$69.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.20
|
| Rate for Payer: Molina Healthcare Passport |
$69.80
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$36.47
|
| Rate for Payer: United Healthcare Non-Options |
$69.26
|
| Rate for Payer: United Healthcare Options |
$56.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.50
|
|
|
EYE EXAM & TREATMENT(T
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
761T2447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$168.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.43
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cigna Commercial |
$181.36
|
| Rate for Payer: First Health Commercial |
$207.58
|
| Rate for Payer: Humana Commercial |
$185.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.28
|
| Rate for Payer: Ohio Health Group HMO |
$163.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.74
|
| Rate for Payer: PHCS Commercial |
$209.76
|
| Rate for Payer: United Healthcare All Payer |
$192.28
|
|
|
EYE EXAM & TREATMENT(T
|
Facility
|
OP
|
$218.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
761T2447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$168.24
|
| Rate for Payer: Anthem Medicaid |
$75.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cigna Commercial |
$181.36
|
| Rate for Payer: First Health Commercial |
$207.58
|
| Rate for Payer: Humana Commercial |
$185.72
|
| Rate for Payer: Humana KY Medicaid |
$75.14
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$75.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.28
|
| Rate for Payer: Ohio Health Group HMO |
$163.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.74
|
| Rate for Payer: PHCS Commercial |
$209.76
|
| Rate for Payer: United Healthcare All Payer |
$192.28
|
|
|
FACIAL BONES COMPLETE 3 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320P0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Aetna Commercial |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: Healthspan PPO |
$60.69
|
| Rate for Payer: Humana Medicaid |
$32.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.32
|
| Rate for Payer: Molina Healthcare Passport |
$32.67
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.00
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna Commercial |
$64.77
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$490.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: Healthspan PPO |
$60.69
|
| Rate for Payer: Humana Medicaid |
$32.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.32
|
| Rate for Payer: Molina Healthcare Passport |
$32.67
|
| Rate for Payer: Multiplan PHCS |
$294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$343.00
|
| Rate for Payer: UHCCP Medicaid |
$171.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.00
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem Medicaid |
$168.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Humana KY Medicaid |
$168.51
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$170.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.90
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Commercial |
$377.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.20
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna Commercial |
$406.70
|
| Rate for Payer: First Health Commercial |
$465.50
|
| Rate for Payer: Humana Commercial |
$416.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.20
|
| Rate for Payer: Ohio Health Group HMO |
$367.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.90
|
| Rate for Payer: PHCS Commercial |
$470.40
|
| Rate for Payer: United Healthcare All Payer |
$431.20
|
|
