|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
76101396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
76101408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
ARTERY BYPASS GRAFT
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
76101414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,541.00
|
| Rate for Payer: Anthem Medicaid |
$1,134.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,739.00
|
| Rate for Payer: First Health Commercial |
$3,135.00
|
| Rate for Payer: Humana Commercial |
$2,805.00
|
| Rate for Payer: Humana KY Medicaid |
$1,134.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.00
|
| Rate for Payer: PHCS Commercial |
$3,168.00
|
| Rate for Payer: United Healthcare All Payer |
$2,904.00
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
HCPCS 35666
|
| Hospital Charge Code |
761P1414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.86 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$2,248.34
|
| Rate for Payer: Anthem Medicaid |
$1,103.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,300.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cash Price |
$1,650.00
|
| Rate for Payer: Cigna Commercial |
$2,161.54
|
| Rate for Payer: Healthspan PPO |
$2,210.56
|
| Rate for Payer: Humana Medicaid |
$1,103.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,748.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,125.94
|
| Rate for Payer: Molina Healthcare Passport |
$1,103.86
|
| Rate for Payer: Multiplan PHCS |
$1,980.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,310.00
|
| Rate for Payer: UHCCP Medicaid |
$1,155.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,114.90
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35621
|
| Hospital Charge Code |
761P1408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.91 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,964.95
|
| Rate for Payer: Anthem Medicaid |
$934.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,883.40
|
| Rate for Payer: Healthspan PPO |
$1,931.93
|
| Rate for Payer: Humana Medicaid |
$934.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.61
|
| Rate for Payer: Molina Healthcare Passport |
$934.91
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$944.26
|
|
|
ARTERY BYPASS GRAFT(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35556
|
| Hospital Charge Code |
761P1396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,045.93 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Anthem Medicaid |
$1,045.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,297.28
|
| Rate for Payer: Healthspan PPO |
$2,390.93
|
| Rate for Payer: Humana Medicaid |
$1,045.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,921.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,066.85
|
| Rate for Payer: Molina Healthcare Passport |
$1,045.93
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,056.39
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$635.05 |
| Max. Negotiated Rate |
$4,689.60 |
| Rate for Payer: Aetna Commercial |
$3,761.45
|
| Rate for Payer: Anthem Medicaid |
$1,679.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,810.30
|
| 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 |
$2,442.50
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$4,054.55
|
| Rate for Payer: First Health Commercial |
$4,640.75
|
| Rate for Payer: Humana Commercial |
$4,152.25
|
| Rate for Payer: Humana KY Medicaid |
$1,679.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,697.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,605.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.35
|
| Rate for Payer: PHCS Commercial |
$4,689.60
|
| Rate for Payer: United Healthcare All Payer |
$4,298.80
|
|
|
ARTERY X-RAYS LUNG
|
Professional
|
Both
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$4,885.00 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Anthem Medicaid |
$396.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,885.00
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$690.01
|
| Rate for Payer: Healthspan PPO |
$402.04
|
| Rate for Payer: Humana Medicaid |
$396.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.47
|
| Rate for Payer: Molina Healthcare Passport |
$396.54
|
| Rate for Payer: Multiplan PHCS |
$2,931.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,419.50
|
| Rate for Payer: UHCCP Medicaid |
$1,709.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.51
|
|
|
ARTERY X-RAYS LUNG
|
Professional
|
Both
|
$2,961.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$2,961.00 |
| Rate for Payer: Aetna Commercial |
$431.92
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,961.00
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cigna Commercial |
$682.80
|
| Rate for Payer: Healthspan PPO |
$404.72
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$1,776.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,072.70
|
| Rate for Payer: UHCCP Medicaid |
$1,036.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$2,961.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.93 |
| Max. Negotiated Rate |
$2,842.56 |
| Rate for Payer: Aetna Commercial |
$2,279.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,309.58
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cigna Commercial |
$2,457.63
|
| Rate for Payer: First Health Commercial |
$2,812.95
|
| Rate for Payer: Humana Commercial |
$2,516.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,428.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,185.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$888.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,605.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.91
|
| Rate for Payer: PHCS Commercial |
$2,842.56
|
| Rate for Payer: United Healthcare All Payer |
$2,605.68
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
OP
|
$2,961.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
32000284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.93 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,279.97
|
| Rate for Payer: Anthem Medicaid |
$1,018.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,309.58
|
| 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 |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cigna Commercial |
$2,457.63
|
| Rate for Payer: First Health Commercial |
$2,812.95
|
| Rate for Payer: Humana Commercial |
$2,516.85
|
| Rate for Payer: Humana KY Medicaid |
$1,018.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,028.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,428.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,185.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,038.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,605.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,220.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.91
|
| Rate for Payer: PHCS Commercial |
$2,842.56
|
| Rate for Payer: United Healthcare All Payer |
$2,605.68
|
|
|
ARTERY X-RAYS LUNG
|
Facility
|
IP
|
$4,885.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$635.05 |
| Max. Negotiated Rate |
$4,689.60 |
| Rate for Payer: Aetna Commercial |
$3,761.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,810.30
|
| Rate for Payer: Cash Price |
$2,442.50
|
| Rate for Payer: Cigna Commercial |
$4,054.55
|
| Rate for Payer: First Health Commercial |
$4,640.75
|
| Rate for Payer: Humana Commercial |
$4,152.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,605.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.35
|
| Rate for Payer: PHCS Commercial |
$4,689.60
|
| Rate for Payer: United Healthcare All Payer |
$4,298.80
|
|
|
ARTERY X-RAYS LUNG(P
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320P0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$682.80 |
| Rate for Payer: Aetna Commercial |
$431.92
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$256.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$682.80
|
| Rate for Payer: Healthspan PPO |
$404.72
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$153.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.20
|
| Rate for Payer: UHCCP Medicaid |
$89.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ARTERY X-RAYS LUNG(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320P0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.98 |
| Max. Negotiated Rate |
$690.01 |
| Rate for Payer: Aetna Commercial |
$429.07
|
| Rate for Payer: Anthem Medicaid |
$396.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$690.01
|
| Rate for Payer: Healthspan PPO |
$402.04
|
| Rate for Payer: Humana Medicaid |
$396.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.47
|
| Rate for Payer: Molina Healthcare Passport |
$396.54
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.50
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.51
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320T0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| 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 |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320T0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.65 |
| Max. Negotiated Rate |
$2,596.80 |
| Rate for Payer: Aetna Commercial |
$2,082.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,109.90
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cigna Commercial |
$2,245.15
|
| Rate for Payer: First Health Commercial |
$2,569.75
|
| Rate for Payer: Humana Commercial |
$2,299.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,218.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,996.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$811.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,028.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.55
|
| Rate for Payer: PHCS Commercial |
$2,596.80
|
| Rate for Payer: United Healthcare All Payer |
$2,380.40
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320T0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320T0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.65 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,082.85
|
| Rate for Payer: Anthem Medicaid |
$930.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,109.90
|
| 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 |
$1,352.50
|
| Rate for Payer: Cash Price |
$1,352.50
|
| Rate for Payer: Cigna Commercial |
$2,245.15
|
| Rate for Payer: First Health Commercial |
$2,569.75
|
| Rate for Payer: Humana Commercial |
$2,299.25
|
| Rate for Payer: Humana KY Medicaid |
$930.25
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$939.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,218.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,996.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$948.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,028.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$541.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.55
|
| Rate for Payer: PHCS Commercial |
$2,596.80
|
| Rate for Payer: United Healthcare All Payer |
$2,380.40
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
761P0781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,300.74 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$2,170.65
|
| Rate for Payer: Anthem Medicaid |
$1,300.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,100.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$2,330.19
|
| Rate for Payer: Healthspan PPO |
$1,966.14
|
| Rate for Payer: Humana Medicaid |
$1,300.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,812.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.74
|
| Rate for Payer: Multiplan PHCS |
$2,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,870.00
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.75
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,300.74 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$2,170.65
|
| Rate for Payer: Anthem Medicaid |
$1,300.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,100.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$2,330.19
|
| Rate for Payer: Healthspan PPO |
$1,966.14
|
| Rate for Payer: Humana Medicaid |
$1,300.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,812.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.74
|
| Rate for Payer: Multiplan PHCS |
$2,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,870.00
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.75
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
ARTH ACRO STCV JT EXP/DRG/RMFB
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
76100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
