|
BALOON PERIPHL CUTTNG 8*2*90
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 8*2*90
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BAMLAN AND ETESEV INFUSION
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS M0245
|
| Hospital Charge Code |
26000019
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$585.60 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
BAMLAN AND ETESEV INFUSION
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS M0245
|
| Hospital Charge Code |
26000019
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$585.60 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem Medicaid |
$209.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$572.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$551.97
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Humana KY Medicaid |
$209.78
|
| Rate for Payer: Humana Medicare Advantage |
$408.87
|
| Rate for Payer: Kentucky WC Medicaid |
$211.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$490.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
BARACLUDE 0.5MG TABLET
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 31722083330
|
| Hospital Charge Code |
25000311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
BARACLUDE 0.5MG TABLET
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 31722083330
|
| Hospital Charge Code |
25000311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.89
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
BARD PTFE FELT 2*2*1.65MM
|
Facility
|
IP
|
$541.34
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.37 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$416.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.25
|
| Rate for Payer: Cash Price |
$270.67
|
| Rate for Payer: Cigna Commercial |
$449.31
|
| Rate for Payer: First Health Commercial |
$514.27
|
| Rate for Payer: Humana Commercial |
$460.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.38
|
| Rate for Payer: Ohio Health Group HMO |
$406.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.82
|
| Rate for Payer: PHCS Commercial |
$519.69
|
| Rate for Payer: United Healthcare All Payer |
$476.38
|
|
|
BARD PTFE FELT 2*2*1.65MM
|
Facility
|
OP
|
$541.34
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.37 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$416.83
|
| Rate for Payer: Anthem Medicaid |
$186.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.25
|
| Rate for Payer: Cash Price |
$270.67
|
| Rate for Payer: Cigna Commercial |
$449.31
|
| Rate for Payer: First Health Commercial |
$514.27
|
| Rate for Payer: Humana Commercial |
$460.14
|
| Rate for Payer: Humana KY Medicaid |
$186.17
|
| Rate for Payer: Kentucky WC Medicaid |
$188.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.38
|
| Rate for Payer: Ohio Health Group HMO |
$406.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.82
|
| Rate for Payer: PHCS Commercial |
$519.69
|
| Rate for Payer: United Healthcare All Payer |
$476.38
|
|
|
BAREWIRE 315CM
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem Medicaid |
$623.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Humana KY Medicaid |
$623.15
|
| Rate for Payer: Kentucky WC Medicaid |
$629.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
BAREWIRE 315CM
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
BARIUM ENEMA
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
BARIUM ENEMA
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
BARIUM ENEMA
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna Commercial |
$188.06
|
| Rate for Payer: Anthem Medicaid |
$115.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$170.82
|
| Rate for Payer: Healthspan PPO |
$176.22
|
| Rate for Payer: Humana Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.23
|
| Rate for Payer: Molina Healthcare Passport |
$115.91
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$301.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.07
|
|
|
BARIUM ENEMA(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320P0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$188.06 |
| Rate for Payer: Aetna Commercial |
$188.06
|
| Rate for Payer: Anthem Medicaid |
$115.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$170.82
|
| Rate for Payer: Healthspan PPO |
$176.22
|
| Rate for Payer: Humana Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.23
|
| Rate for Payer: Molina Healthcare Passport |
$115.91
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.07
|
|
|
BARIUM ENEMA(T
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320T0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem Medicaid |
$253.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Humana KY Medicaid |
$253.45
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$256.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
BARIUM ENEMA(T
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320T0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$707.52 |
| Rate for Payer: Aetna Commercial |
$567.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$574.86
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna Commercial |
$611.71
|
| Rate for Payer: First Health Commercial |
$700.15
|
| Rate for Payer: Humana Commercial |
$626.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$543.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$648.56
|
| Rate for Payer: Ohio Health Group HMO |
$552.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.47
|
| Rate for Payer: PHCS Commercial |
$707.52
|
| Rate for Payer: United Healthcare All Payer |
$648.56
|
|
|
BARIUM ESOPHAGRAM
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.64
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
BARIUM ESOPHAGRAM
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna Commercial |
$130.72
|
| Rate for Payer: Anthem Medicaid |
$72.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$110.36
|
| Rate for Payer: Healthspan PPO |
$122.49
|
| Rate for Payer: Humana Medicaid |
$72.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.65
|
| Rate for Payer: Molina Healthcare Passport |
$72.21
|
| Rate for Payer: Multiplan PHCS |
$326.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$380.80
|
| Rate for Payer: UHCCP Medicaid |
$190.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.93
|
|
|
BARIUM ESOPHAGRAM
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem Medicaid |
$187.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Humana KY Medicaid |
$187.08
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$188.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.64
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
BARIUM ESOPHAGRAM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320P0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Aetna Commercial |
$130.72
|
| Rate for Payer: Anthem Medicaid |
$72.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$110.36
|
| Rate for Payer: Healthspan PPO |
$122.49
|
| Rate for Payer: Humana Medicaid |
$72.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.65
|
| Rate for Payer: Molina Healthcare Passport |
$72.21
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.93
|
|
|
BARIUM ESOPHAGRAM(T
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320T0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
BARIUM ESOPHAGRAM(T
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320T0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem Medicaid |
$161.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Humana KY Medicaid |
$161.29
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
BARIUM SULFATE ENEMA
|
Facility
|
OP
|
$3.25
|
|
| Hospital Charge Code |
27000233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem Medicaid |
$1.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Humana KY Medicaid |
$1.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.01
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
|
BARIUM SULFATE ENEMA
|
Facility
|
IP
|
$3.25
|
|
| Hospital Charge Code |
27000233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.01
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
|
BARRX 360 EXPRESS BALLOON CATH
|
Facility
|
IP
|
$12,428.65
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.72 |
| Max. Negotiated Rate |
$11,931.50 |
| Rate for Payer: Aetna Commercial |
$9,570.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,694.35
|
| Rate for Payer: Cash Price |
$6,214.32
|
| Rate for Payer: Cigna Commercial |
$10,315.78
|
| Rate for Payer: First Health Commercial |
$11,807.22
|
| Rate for Payer: Humana Commercial |
$10,564.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,191.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,172.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,728.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,937.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,321.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,852.88
|
| Rate for Payer: PHCS Commercial |
$11,931.50
|
| Rate for Payer: United Healthcare All Payer |
$10,937.21
|
|
