|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$7,947.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
76101648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$4,768.20 |
| Rate for Payer: Aetna Commercial |
$498.72
|
| Rate for Payer: Ambetter Exchange |
$322.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.71
|
| Rate for Payer: Anthem Medicaid |
$217.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$387.02
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cash Price |
$3,973.50
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$508.14
|
| Rate for Payer: Humana Medicaid |
$217.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$322.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.71
|
| Rate for Payer: Molina Healthcare Passport |
$217.36
|
| Rate for Payer: Multiplan PHCS |
$4,768.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.28
|
| Rate for Payer: UHCCP Medicaid |
$240.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.52
|
|
|
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 |
$2,982.00 |
| 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 |
$7,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,647.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,858.60
|
| 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
|
OP
|
$3,033.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
76101650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,043.05 |
| Max. Negotiated Rate |
$2,911.68 |
| Rate for Payer: Aetna Commercial |
$2,335.41
|
| Rate for Payer: Anthem Medicaid |
$1,043.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,365.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna Commercial |
$2,517.39
|
| Rate for Payer: First Health Commercial |
$2,881.35
|
| Rate for Payer: Humana Commercial |
$2,578.05
|
| Rate for Payer: Humana KY Medicaid |
$1,043.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,274.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,638.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,092.77
|
| Rate for Payer: PHCS Commercial |
$2,911.68
|
| Rate for Payer: United Healthcare All Payer |
$2,669.04
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$7,947.00
|
|
|
Service Code
|
HCPCS 41016
|
| Hospital Charge Code |
76101648
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,384.10 |
| Max. Negotiated Rate |
$7,629.12 |
| Rate for Payer: Aetna Commercial |
$6,119.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.66
|
| 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: 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 |
$2,384.10
|
| 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 |
$6,357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,913.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,483.43
|
| 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 |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$500.85
|
| Rate for Payer: Ambetter Exchange |
$320.13
|
| 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 Individual/Medicaid |
$320.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$320.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$384.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$320.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.13
|
| 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 |
$416.17
|
| Rate for Payer: UHCCP Medicaid |
$205.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$320.13
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$3,033.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
76101650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.90 |
| Max. Negotiated Rate |
$2,911.68 |
| Rate for Payer: Aetna Commercial |
$2,335.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,365.74
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna Commercial |
$2,517.39
|
| Rate for Payer: First Health Commercial |
$2,881.35
|
| Rate for Payer: Humana Commercial |
$2,578.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,274.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,638.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,092.77
|
| Rate for Payer: PHCS Commercial |
$2,911.68
|
| Rate for Payer: United Healthcare All Payer |
$2,669.04
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$3,033.00
|
|
|
Service Code
|
HCPCS 41018
|
| Hospital Charge Code |
76101650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.30 |
| Max. Negotiated Rate |
$1,819.80 |
| Rate for Payer: Aetna Commercial |
$589.20
|
| Rate for Payer: Ambetter Exchange |
$375.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.30
|
| Rate for Payer: Anthem Medicaid |
$254.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$450.86
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna Commercial |
$672.49
|
| Rate for Payer: Healthspan PPO |
$589.86
|
| Rate for Payer: Humana Medicaid |
$254.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$375.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.11
|
| Rate for Payer: Molina Healthcare Passport |
$254.03
|
| Rate for Payer: Multiplan PHCS |
$1,819.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.44
|
| Rate for Payer: UHCCP Medicaid |
$265.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.72
|
|
|
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 |
$2,996.53 |
| 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 |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,753.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$7,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,647.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,858.60
|
| Rate for Payer: PHCS Commercial |
$9,542.40
|
| Rate for Payer: United Healthcare All Payer |
$8,747.20
|
|
|
EXTRAORAL I/D ABSC CYST/HEMAT
|
Professional
|
Both
|
$9,940.00
|
|
|
Service Code
|
HCPCS 41114
|
| Hospital Charge Code |
76101657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.36 |
| Max. Negotiated Rate |
$5,964.00 |
| Rate for Payer: Aetna Commercial |
$919.45
|
| Rate for Payer: Ambetter Exchange |
$582.96
|
| Rate for Payer: Anthem Medicaid |
$420.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$582.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$582.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$699.55
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cash Price |
$4,970.00
|
| Rate for Payer: Cigna Commercial |
$913.02
|
| Rate for Payer: Healthspan PPO |
$775.39
|
| Rate for Payer: Humana Medicaid |
$420.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$815.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$582.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$428.77
|
| Rate for Payer: Molina Healthcare Passport |
$420.36
|
| Rate for Payer: Multiplan PHCS |
$5,964.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$757.85
|
| Rate for Payer: UHCCP Medicaid |
$3,479.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$424.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$582.96
|
|
|
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 |
$2,732.97 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$6,119.19
|
| Rate for Payer: Anthem Medicaid |
$2,732.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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 |
$6,357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,913.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,483.43
|
| Rate for Payer: PHCS Commercial |
$7,629.12
|
| Rate for Payer: United Healthcare All Payer |
$6,993.36
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
EXTREMITY ULTRASOUND LIMITED
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
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 |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| 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 |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
EXTREMITY ULTRASOUND LIMITED(T
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
EXTREMITY ULTRASOUND LIMITED(T
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
EXTRNL COUNTERPULSE, PER TX
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS G0166
|
| Hospital Charge Code |
76102533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| 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 |
$119.10
|
| 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 |
$142.92
|
| 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 |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| 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: Ambetter Exchange |
$88.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.27
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.56
|
| Rate for Payer: Multiplan PHCS |
$55.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.13
|
| Rate for Payer: UHCCP Medicaid |
$32.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.56
|
|
|
EXTRNL COUNTERPULSE, PER TX
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS G0166
|
| Hospital Charge Code |
76102533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.60 |
| 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 |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
EYE EXAM & TREATMENT
|
Facility
|
IP
|
$368.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
76102447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$353.76 |
| Rate for Payer: Aetna Commercial |
$283.75
|
| 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 |
$350.07
|
| Rate for Payer: Humana Commercial |
$313.23
|
| 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 |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.26
|
| Rate for Payer: PHCS Commercial |
$353.76
|
| Rate for Payer: United Healthcare All Payer |
$324.28
|
|
|
EYE EXAM & TREATMENT
|
Facility
|
OP
|
$368.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
76102447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$353.76 |
| Rate for Payer: Aetna Commercial |
$283.75
|
| Rate for Payer: Anthem Medicaid |
$126.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| 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 |
$350.07
|
| Rate for Payer: Humana Commercial |
$313.23
|
| Rate for Payer: Humana KY Medicaid |
$126.73
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| 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 |
$142.88
|
| 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 |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.26
|
| 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 |
$221.10 |
| Rate for Payer: Aetna Commercial |
$94.24
|
| Rate for Payer: Ambetter Exchange |
$69.96
|
| 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 Individual/Medicaid |
$69.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$69.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.96
|
| 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 |
$90.95
|
| 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
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.96
|
|
|
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 |
$145.86 |
| Rate for Payer: Aetna Commercial |
$94.24
|
| Rate for Payer: Ambetter Exchange |
$69.96
|
| 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 Individual/Medicaid |
$69.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.95
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$69.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.96
|
| 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 |
$90.95
|
| 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
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.96
|
|
|
EYE EXAM & TREATMENT(T
|
Facility
|
IP
|
$218.50
|
|
|
Service Code
|
HCPCS 92014
|
| Hospital Charge Code |
761T2447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$168.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.43
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cigna Commercial |
$181.35
|
| Rate for Payer: First Health Commercial |
$207.57
|
| 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 |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.76
|
| 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 |
$75.14 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$168.25
|
| Rate for Payer: Anthem Medicaid |
$75.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cash Price |
$109.25
|
| Rate for Payer: Cigna Commercial |
$181.35
|
| Rate for Payer: First Health Commercial |
$207.57
|
| Rate for Payer: Humana Commercial |
$185.72
|
| Rate for Payer: Humana KY Medicaid |
$75.14
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| 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 |
$142.88
|
| 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 |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.76
|
| Rate for Payer: PHCS Commercial |
$209.76
|
| Rate for Payer: United Healthcare All Payer |
$192.28
|
|
