|
MRI UPPR EXTREMITY W/O&W/DYE
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$136.70 |
| Max. Negotiated Rate |
$4,249.00 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,249.00
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$1,475.22
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$2,549.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,974.30
|
| Rate for Payer: UHCCP Medicaid |
$1,487.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI UPPR EXTREMITY W/O&W/DYE
|
Facility
|
OP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem Medicaid |
$1,461.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Humana KY Medicaid |
$1,461.23
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI UPPR EXTREMITY W/O&W/DYE
|
Facility
|
IP
|
$4,249.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
61000029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$552.37 |
| Max. Negotiated Rate |
$4,079.04 |
| Rate for Payer: Aetna Commercial |
$3,271.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.22
|
| Rate for Payer: Cash Price |
$2,124.50
|
| Rate for Payer: Cigna Commercial |
$3,526.67
|
| Rate for Payer: First Health Commercial |
$4,036.55
|
| Rate for Payer: Humana Commercial |
$3,611.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.19
|
| Rate for Payer: PHCS Commercial |
$4,079.04
|
| Rate for Payer: United Healthcare All Payer |
$3,739.12
|
|
|
MRI UPPR EXTREMITY W/O&W/DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610P0029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,475.22 |
| Rate for Payer: Aetna Commercial |
$983.88
|
| Rate for Payer: Anthem Medicaid |
$366.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,475.22
|
| Rate for Payer: Healthspan PPO |
$676.07
|
| Rate for Payer: Humana Medicaid |
$366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$373.63
|
| Rate for Payer: Molina Healthcare Passport |
$366.30
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$369.96
|
|
|
MRI UPPR EXTREMITY W/O&W/DY(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610T0029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$519.87 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRI UPPR EXTREMITY W/O&W/DY(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
610T0029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MRSA PCR
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
MRSA PCR
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
MRSA PCR
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$127.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$148.40
|
| Rate for Payer: UHCCP Medicaid |
$74.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
MRS CEM STEM STR 13*127MM
|
Facility
|
IP
|
$18,100.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.04 |
| Max. Negotiated Rate |
$17,376.31 |
| Rate for Payer: Aetna Commercial |
$13,937.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,118.25
|
| Rate for Payer: Cash Price |
$9,050.16
|
| Rate for Payer: Cigna Commercial |
$15,023.27
|
| Rate for Payer: First Health Commercial |
$17,195.30
|
| Rate for Payer: Humana Commercial |
$15,385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,842.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,358.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,430.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,928.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,575.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,620.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,353.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,611.10
|
| Rate for Payer: PHCS Commercial |
$17,376.31
|
| Rate for Payer: United Healthcare All Payer |
$15,928.28
|
|
|
MRS CEM STEM STR 13*127MM
|
Facility
|
OP
|
$18,100.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.04 |
| Max. Negotiated Rate |
$17,376.31 |
| Rate for Payer: Aetna Commercial |
$13,937.25
|
| Rate for Payer: Anthem Medicaid |
$6,224.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,118.25
|
| Rate for Payer: Cash Price |
$9,050.16
|
| Rate for Payer: Cigna Commercial |
$15,023.27
|
| Rate for Payer: First Health Commercial |
$17,195.30
|
| Rate for Payer: Humana Commercial |
$15,385.27
|
| Rate for Payer: Humana KY Medicaid |
$6,224.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,288.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,842.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,358.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,430.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,349.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,928.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,575.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,620.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,353.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,611.10
|
| Rate for Payer: PHCS Commercial |
$17,376.31
|
| Rate for Payer: United Healthcare All Payer |
$15,928.28
|
|
|
MSCU ROOM RATE
|
Facility
|
IP
|
$1,679.00
|
|
| Hospital Charge Code |
11000007
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
M-SPEC FEMORAL HEAD 36MM-12/14
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
M-SPEC FEMORAL HEAD 36MM-12/14
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
MSSA SCREEN
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
MSSA SCREEN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
30001262
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Anthem Medicaid |
$6.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$82.17
|
| Rate for Payer: First Health Commercial |
$94.05
|
| Rate for Payer: Humana Commercial |
$84.15
|
| Rate for Payer: Humana KY Medicaid |
$6.63
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.12
|
| Rate for Payer: Ohio Health Group HMO |
$74.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.69
|
| Rate for Payer: PHCS Commercial |
$95.04
|
| Rate for Payer: United Healthcare All Payer |
$87.12
|
|
|
MTP FUSION MEDIUM 0 DEG L
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 0 DEG L
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 0 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 0 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 10 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 10 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 5 DEG L
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 5 DEG L
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION MEDIUM 5 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
