|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$455.10 |
| Max. Negotiated Rate |
$1,456.32 |
| Rate for Payer: Aetna Commercial |
$1,168.09
|
| Rate for Payer: Anthem Medicaid |
$521.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,183.26
|
| Rate for Payer: Cash Price |
$758.50
|
| Rate for Payer: Cigna Commercial |
$1,259.11
|
| Rate for Payer: First Health Commercial |
$1,441.15
|
| Rate for Payer: Humana Commercial |
$1,289.45
|
| Rate for Payer: Humana KY Medicaid |
$521.70
|
| Rate for Payer: Kentucky WC Medicaid |
$527.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,243.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,119.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,334.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,137.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,319.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.73
|
| Rate for Payer: PHCS Commercial |
$1,456.32
|
| Rate for Payer: United Healthcare All Payer |
$1,334.96
|
|
|
SCP EA 1ST ABD PEL L EXT AR(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761P1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.81 |
| Max. Negotiated Rate |
$1,954.05 |
| Rate for Payer: Aetna Commercial |
$434.13
|
| Rate for Payer: Ambetter Exchange |
$220.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.81
|
| Rate for Payer: Anthem Medicaid |
$239.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$265.04
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$395.31
|
| Rate for Payer: Healthspan PPO |
$1,954.05
|
| Rate for Payer: Humana Medicaid |
$239.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.37
|
| Rate for Payer: Molina Healthcare Passport |
$239.58
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.13
|
| Rate for Payer: UHCCP Medicaid |
$172.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.87
|
|
|
SCP EA 1ST ABD PEL L EXT AR(T
|
Facility
|
OP
|
$3,250.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761T1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.29 |
| Max. Negotiated Rate |
$3,120.92 |
| Rate for Payer: Aetna Commercial |
$2,503.24
|
| Rate for Payer: Anthem Medicaid |
$1,118.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.75
|
| Rate for Payer: Cash Price |
$1,625.48
|
| Rate for Payer: Cigna Commercial |
$2,698.30
|
| Rate for Payer: First Health Commercial |
$3,088.41
|
| Rate for Payer: Humana Commercial |
$2,763.32
|
| Rate for Payer: Humana KY Medicaid |
$1,118.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,600.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.16
|
| Rate for Payer: PHCS Commercial |
$3,120.92
|
| Rate for Payer: United Healthcare All Payer |
$2,860.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR(T
|
Facility
|
IP
|
$3,250.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761T1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.29 |
| Max. Negotiated Rate |
$3,120.92 |
| Rate for Payer: Aetna Commercial |
$2,503.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.75
|
| Rate for Payer: Cash Price |
$1,625.48
|
| Rate for Payer: Cigna Commercial |
$2,698.30
|
| Rate for Payer: First Health Commercial |
$3,088.41
|
| Rate for Payer: Humana Commercial |
$2,763.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,600.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,243.16
|
| Rate for Payer: PHCS Commercial |
$3,120.92
|
| Rate for Payer: United Healthcare All Payer |
$2,860.84
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.16 |
| Max. Negotiated Rate |
$1,925.66 |
| Rate for Payer: Aetna Commercial |
$475.77
|
| Rate for Payer: Ambetter Exchange |
$235.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.16
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$235.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.14
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$437.88
|
| Rate for Payer: Healthspan PPO |
$1,925.66
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$235.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$1,879.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$306.74
|
| Rate for Payer: UHCCP Medicaid |
$188.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$235.95
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
OP
|
$1,471.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$441.30 |
| Max. Negotiated Rate |
$1,412.16 |
| Rate for Payer: Aetna Commercial |
$1,132.67
|
| Rate for Payer: Anthem Medicaid |
$505.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,147.38
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$1,220.93
|
| Rate for Payer: First Health Commercial |
$1,397.45
|
| Rate for Payer: Humana Commercial |
$1,250.35
|
| Rate for Payer: Humana KY Medicaid |
$505.88
|
| Rate for Payer: Kentucky WC Medicaid |
$511.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,206.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,085.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$516.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,294.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,103.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.99
|
| Rate for Payer: PHCS Commercial |
$1,412.16
|
| Rate for Payer: United Healthcare All Payer |
$1,294.48
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$441.30 |
| Max. Negotiated Rate |
$1,412.16 |
| Rate for Payer: Aetna Commercial |
$1,132.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,147.38
|
| Rate for Payer: Cash Price |
$735.50
|
| Rate for Payer: Cigna Commercial |
$1,220.93
|
| Rate for Payer: First Health Commercial |
$1,397.45
|
| Rate for Payer: Humana Commercial |
$1,250.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,206.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,085.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,294.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,103.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.99
|
| Rate for Payer: PHCS Commercial |
$1,412.16
|
| Rate for Payer: United Healthcare All Payer |
$1,294.48
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
OP
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.90 |
| Max. Negotiated Rate |
$3,007.68 |
| Rate for Payer: Aetna Commercial |
$2,412.41
|
| Rate for Payer: Anthem Medicaid |
$1,077.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.74
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$2,600.39
|
| Rate for Payer: First Health Commercial |
$2,976.35
|
| Rate for Payer: Humana Commercial |
$2,663.05
|
| Rate for Payer: Humana KY Medicaid |
$1,077.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,088.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,099.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,757.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.77
|
| Rate for Payer: PHCS Commercial |
$3,007.68
|
| Rate for Payer: United Healthcare All Payer |
$2,757.04
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
IP
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.90 |
| Max. Negotiated Rate |
$3,007.68 |
| Rate for Payer: Aetna Commercial |
$2,412.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.74
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$2,600.39
|
| Rate for Payer: First Health Commercial |
$2,976.35
|
| Rate for Payer: Humana Commercial |
$2,663.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,757.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.77
|
| Rate for Payer: PHCS Commercial |
$3,007.68
|
| Rate for Payer: United Healthcare All Payer |
$2,757.04
|
|
|
SCP INIT 2ND ABDPELL EXT AR(P
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761P1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.16 |
| Max. Negotiated Rate |
$1,925.66 |
| Rate for Payer: Aetna Commercial |
$475.77
|
| Rate for Payer: Ambetter Exchange |
$235.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.16
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$235.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.14
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$437.88
|
| Rate for Payer: Healthspan PPO |
$1,925.66
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$235.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$1,103.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$306.74
|
| Rate for Payer: UHCCP Medicaid |
$188.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$235.95
|
|
|
SCP INIT 2ND ABDPELL EXT AR(T
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761T1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem Medicaid |
$445.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Humana KY Medicaid |
$445.01
|
| Rate for Payer: Kentucky WC Medicaid |
$449.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.86
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP INIT 2ND ABDPELL EXT AR(T
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761T1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.86
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$42.26
|
| Rate for Payer: Ambetter Exchange |
$22.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.47
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.76
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.89
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401T0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401P0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$88.73 |
| Rate for Payer: Ambetter Exchange |
$48.11
|
| Rate for Payer: Anthem Medicaid |
$42.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.73
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: Humana Medicaid |
$42.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.67
|
| Rate for Payer: Molina Healthcare Passport |
$42.81
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.54
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.11
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$88.73 |
| Rate for Payer: Ambetter Exchange |
$48.11
|
| Rate for Payer: Anthem Medicaid |
$42.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.73
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$88.73
|
| Rate for Payer: Humana Medicaid |
$42.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.67
|
| Rate for Payer: Molina Healthcare Passport |
$42.81
|
| Rate for Payer: Multiplan PHCS |
$85.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.54
|
| Rate for Payer: UHCCP Medicaid |
$49.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.11
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401T0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$83.52 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$29.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.86
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$72.21
|
| Rate for Payer: First Health Commercial |
$82.65
|
| Rate for Payer: Humana Commercial |
$73.95
|
| Rate for Payer: Humana KY Medicaid |
$29.92
|
| Rate for Payer: Kentucky WC Medicaid |
$30.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.56
|
| Rate for Payer: Ohio Health Group HMO |
$65.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.03
|
| Rate for Payer: PHCS Commercial |
$83.52
|
| Rate for Payer: United Healthcare All Payer |
$76.56
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
40100012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$109.34
|
| Rate for Payer: Anthem Medicaid |
$48.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.76
|
| Rate for Payer: Cash Price |
$71.00
|
| Rate for Payer: Cigna Commercial |
$117.86
|
| Rate for Payer: First Health Commercial |
$134.90
|
| Rate for Payer: Humana Commercial |
$120.70
|
| Rate for Payer: Humana KY Medicaid |
$48.83
|
| Rate for Payer: Kentucky WC Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$116.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.96
|
| Rate for Payer: Ohio Health Group HMO |
$106.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.98
|
| Rate for Payer: PHCS Commercial |
$136.32
|
| Rate for Payer: United Healthcare All Payer |
$124.96
|
|
|
SCREEN COLON HIGH RISK
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
SCREEN COLON HIGH RISK
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
SCREEN COLON HIGH RISK
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS G0105
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.56 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Ambetter Exchange |
$172.56
|
| Rate for Payer: Anthem Medicaid |
$270.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.07
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Humana Medicaid |
$270.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.28
|
| Rate for Payer: Molina Healthcare Passport |
$270.86
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.33
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.56
|
|
|
SCREEN COLONOSCOPY NOT HIGH RI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.52 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
