|
INJECTION FOR BLADDER X-RAY(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320P1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
|
|
INJECTION FOR BLADDER X-RAY (T
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761T2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.55
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INJECTION FOR BLADDER X-RAY (T
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761T2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.55
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INJECTION FOR BLADDER X-RAY(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320T1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJECTION FOR BLADDER X-RAY(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320T1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJECTION FOR BRONCHOGRAPHY
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
41000065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
INJECTION FOR BRONCHOGRAPHY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
410P0065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
INJECTION FOR CHOLANGIOGRAM
|
Professional
|
Both
|
$870.12
|
|
|
Service Code
|
HCPCS 47532
|
| Hospital Charge Code |
76102733
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$870.12 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.65
|
| Rate for Payer: Anthem Medicaid |
$177.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.12
|
| Rate for Payer: Cash Price |
$435.06
|
| Rate for Payer: Cash Price |
$435.06
|
| Rate for Payer: Cigna Commercial |
$361.99
|
| Rate for Payer: Humana Medicaid |
$177.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$305.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.64
|
| Rate for Payer: Molina Healthcare Passport |
$177.10
|
| Rate for Payer: Multiplan PHCS |
$522.07
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.08
|
| Rate for Payer: UHCCP Medicaid |
$184.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.87
|
|
|
INJECTION FOR MYELOGRAM
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
INJECTION FOR MYELOGRAM
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$106.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,865.00
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$131.88
|
| Rate for Payer: Healthspan PPO |
$266.48
|
| Rate for Payer: Humana Medicaid |
$106.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.69
|
| Rate for Payer: Molina Healthcare Passport |
$106.56
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,305.50
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.63
|
|
|
INJECTION FOR MYELOGRAM
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
INJECTION FOR MYELOGRAM(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761P2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$106.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$131.88
|
| Rate for Payer: Healthspan PPO |
$266.48
|
| Rate for Payer: Humana Medicaid |
$106.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.69
|
| Rate for Payer: Molina Healthcare Passport |
$106.56
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.63
|
|
|
INJECTION FOR MYELOGRAM(T
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761T2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
INJECTION FOR MYELOGRAM(T
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761T2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
INJECTION FOR SHOULDER X-RAY(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320P1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
|
|
INJECTION FOR SHOULDER X-RAY(T
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320T1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
INJECTION FOR SHOULDER X-RAY(T
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320T1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem Medicaid |
$221.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Humana KY Medicaid |
$221.82
|
| Rate for Payer: Kentucky WC Medicaid |
$224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
INJECTION FOR URETER X-RAY
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$113.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.95
|
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Healthspan PPO |
$125.15
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
INJECTION FOR WRIST X-RAY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
76100594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
INJECTION FOR WRIST X-RAY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
76100594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
