|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
340T0047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
99M-TC SESTAMIBI PER STDY DOSE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34000047
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,397.00
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$838.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.90
|
| Rate for Payer: UHCCP Medicaid |
$488.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
ABCESS FLUID DRAIN COMP PROC
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
ABCESS FLUID DRAIN COMPPROC (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| 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: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
ABCESS FLUID DRAIN COMPPROC (T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
ABCESS FLUID DRAIN COMPPROC (T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320T0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem Medicaid |
$1,573.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Humana KY Medicaid |
$1,573.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$633.75 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.75
|
| Rate for Payer: Anthem Medicaid |
$1,676.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,802.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,437.50
|
| Rate for Payer: Cash Price |
$2,437.50
|
| Rate for Payer: Cigna Commercial |
$4,046.25
|
| Rate for Payer: First Health Commercial |
$4,631.25
|
| Rate for Payer: Humana Commercial |
$4,143.75
|
| Rate for Payer: Humana KY Medicaid |
$1,676.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,693.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,997.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,597.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,290.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,511.25
|
| Rate for Payer: PHCS Commercial |
$4,680.00
|
| Rate for Payer: United Healthcare All Payer |
$4,290.00
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320P0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$760.20 |
| Rate for Payer: Aetna Commercial |
$492.09
|
| Rate for Payer: Anthem Medicaid |
$410.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$760.20
|
| Rate for Payer: Healthspan PPO |
$461.10
|
| Rate for Payer: Humana Medicaid |
$410.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.14
|
| Rate for Payer: Molina Healthcare Passport |
$410.92
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.03
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Professional
|
Both
|
$4,875.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.61 |
| Max. Negotiated Rate |
$4,875.00 |
| Rate for Payer: Aetna Commercial |
$492.09
|
| Rate for Payer: Anthem Medicaid |
$410.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,875.00
|
| Rate for Payer: Cash Price |
$2,437.50
|
| Rate for Payer: Cash Price |
$2,437.50
|
| Rate for Payer: Cigna Commercial |
$760.20
|
| Rate for Payer: Healthspan PPO |
$461.10
|
| Rate for Payer: Humana Medicaid |
$410.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.14
|
| Rate for Payer: Molina Healthcare Passport |
$410.92
|
| Rate for Payer: Multiplan PHCS |
$2,925.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,412.50
|
| Rate for Payer: UHCCP Medicaid |
$1,706.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.03
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
320T0154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ABD AORTAGRAM BI LOWER EXTREMT
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
HCPCS 75630
|
| Hospital Charge Code |
32000154
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$633.75 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,802.50
|
| Rate for Payer: Cash Price |
$2,437.50
|
| Rate for Payer: Cigna Commercial |
$4,046.25
|
| Rate for Payer: First Health Commercial |
$4,631.25
|
| Rate for Payer: Humana Commercial |
$4,143.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,997.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,597.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,290.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,511.25
|
| Rate for Payer: PHCS Commercial |
$4,680.00
|
| Rate for Payer: United Healthcare All Payer |
$4,290.00
|
|
|
Abd LsrHairRem-PP #1 50%
|
Professional
|
Both
|
$192.00
|
|
| Hospital Charge Code |
22200322
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
Abd LsrHairRem-PP #2/3 25%
|
Professional
|
Both
|
$95.00
|
|
| Hospital Charge Code |
22200526
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Facility
|
IP
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.28
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Facility
|
OP
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$564.48 |
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Anthem Medicaid |
$202.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$458.64
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$488.04
|
| Rate for Payer: First Health Commercial |
$558.60
|
| Rate for Payer: Humana Commercial |
$499.80
|
| Rate for Payer: Humana KY Medicaid |
$202.21
|
| Rate for Payer: Kentucky WC Medicaid |
$204.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$482.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$517.44
|
| Rate for Payer: Ohio Health Group HMO |
$441.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.28
|
| Rate for Payer: PHCS Commercial |
$564.48
|
| Rate for Payer: United Healthcare All Payer |
$517.44
|
|
|
ABDOMEN 3 OR MORE VIEWS
|
Professional
|
Both
|
$588.00
|
|
| Hospital Charge Code |
32000992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$588.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Multiplan PHCS |
$352.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$411.60
|
| Rate for Payer: UHCCP Medicaid |
$205.80
|
|
|
ABDOMEN 3 OR MORE VIEWS(P
|
Professional
|
Both
|
$215.00
|
|
| Hospital Charge Code |
320P0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
|
|
ABDOMEN 3 OR MORE VIEWS(T
|
Facility
|
OP
|
$373.00
|
|
| Hospital Charge Code |
320T0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$358.08 |
| Rate for Payer: Aetna Commercial |
$287.21
|
| Rate for Payer: Anthem Medicaid |
$128.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.94
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$309.59
|
| Rate for Payer: First Health Commercial |
$354.35
|
| Rate for Payer: Humana Commercial |
$317.05
|
| Rate for Payer: Humana KY Medicaid |
$128.27
|
| Rate for Payer: Kentucky WC Medicaid |
$129.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$275.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$328.24
|
| Rate for Payer: Ohio Health Group HMO |
$279.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.63
|
| Rate for Payer: PHCS Commercial |
$358.08
|
| Rate for Payer: United Healthcare All Payer |
$328.24
|
|
|
ABDOMEN 3 OR MORE VIEWS(T
|
Facility
|
IP
|
$373.00
|
|
| Hospital Charge Code |
320T0992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$358.08 |
| Rate for Payer: Aetna Commercial |
$287.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.94
|
| Rate for Payer: Cash Price |
$186.50
|
| Rate for Payer: Cigna Commercial |
$309.59
|
| Rate for Payer: First Health Commercial |
$354.35
|
| Rate for Payer: Humana Commercial |
$317.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$275.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$328.24
|
| Rate for Payer: Ohio Health Group HMO |
$279.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.63
|
| Rate for Payer: PHCS Commercial |
$358.08
|
| Rate for Payer: United Healthcare All Payer |
$328.24
|
|
|
Abdomen Laser Hair Removal
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200321
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
ABDOMEN - UPRIGHT AP
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem Medicaid |
$20.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$43.07
|
| Rate for Payer: Humana Medicaid |
$20.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.98
|
| Rate for Payer: Molina Healthcare Passport |
$20.57
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.78
|
|
|
ABDOMEN - UPRIGHT AP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
