|
ANES COSM UNLIST 120 MIN PX
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
37000253
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
ANES COSM UNLIST 120 MIN PX
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
37000253
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
ANES DX SHOULDER ARTHROSCOPY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01622
|
| Hospital Charge Code |
37000132
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES DX SHOULDER ARTHROSCOPY
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 01622
|
| Hospital Charge Code |
37000132
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES DX SHOULDER ARTHROSCOPY
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1622
|
| Hospital Charge Code |
37000132
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESH COSMET ABDOMINOPL - MINI
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
37000205
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANESH COSMET ABDOMINOPL - MINI
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
37000205
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANESH COSMET ABDOMINOPL - MINI
|
Professional
|
Both
|
$315.00
|
|
| Hospital Charge Code |
37000205
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
|
|
ANESH COSM TOTAL LOW BOD LIFT
|
Facility
|
IP
|
$1,280.00
|
|
| Hospital Charge Code |
37000197
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
ANESH COSM TOTAL LOW BOD LIFT
|
Facility
|
OP
|
$1,280.00
|
|
| Hospital Charge Code |
37000197
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
ANESH COSM TOTAL LOW BOD LIFT
|
Professional
|
Both
|
$1,280.00
|
|
| Hospital Charge Code |
37000197
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
|
|
ANES HRNA RPR UPR ABD LMB/VENT
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 752
|
| Hospital Charge Code |
37000053
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES HRNA RPR UPR ABD LMB/VENT
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00752
|
| Hospital Charge Code |
37000053
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES HRNA RPR UPR ABD LMB/VENT
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00752
|
| Hospital Charge Code |
37000053
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES LWR INTST NDSC NOS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00811
|
| Hospital Charge Code |
37000062
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES LWR INTST NDSC NOS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 811
|
| Hospital Charge Code |
37000062
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES LWR INTST NDSC NOS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00811
|
| Hospital Charge Code |
37000062
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES LWR INTST SCR COLSC
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00812
|
| Hospital Charge Code |
37000063
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES LWR INTST SCR COLSC
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 812
|
| Hospital Charge Code |
37000063
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES LWR INTST SCR COLSC
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00812
|
| Hospital Charge Code |
37000063
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES MEDIASCPY & DX THORSCPY
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 528
|
| Hospital Charge Code |
37000032
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES MEDIASCPY & DX THORSCPY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00528
|
| Hospital Charge Code |
37000032
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES MEDIASCPY & DX THORSCPY
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00528
|
| Hospital Charge Code |
37000032
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES MEDSCPY&THORSCPY 1 LUNG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 529
|
| Hospital Charge Code |
37000033
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES MEDSCPY&THORSCPY 1 LUNG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00529
|
| Hospital Charge Code |
37000033
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
