|
BODY COMPOSITION SCAN
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem Medicaid |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.34
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Humana KY Medicaid |
$35.42
|
| Rate for Payer: Kentucky WC Medicaid |
$35.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.93
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
BODY COMPOSITION SCAN
|
Professional
|
Both
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$103.00
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Multiplan PHCS |
$61.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$36.05
|
|
|
BONE AGE STUDIES
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$303.36 |
| Rate for Payer: Aetna Commercial |
$243.32
|
| Rate for Payer: Anthem Medicaid |
$108.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$262.28
|
| Rate for Payer: First Health Commercial |
$300.20
|
| Rate for Payer: Humana Commercial |
$268.60
|
| Rate for Payer: Humana KY Medicaid |
$108.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$109.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.08
|
| Rate for Payer: Ohio Health Group HMO |
$237.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.96
|
| Rate for Payer: PHCS Commercial |
$303.36
|
| Rate for Payer: United Healthcare All Payer |
$278.08
|
|
|
BONE AGE STUDIES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$316.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$33.24
|
| Rate for Payer: Healthspan PPO |
$33.84
|
| Rate for Payer: Humana Medicaid |
$16.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.45
|
| Rate for Payer: Molina Healthcare Passport |
$16.13
|
| Rate for Payer: Multiplan PHCS |
$189.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.20
|
| Rate for Payer: UHCCP Medicaid |
$110.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.29
|
|
|
BONE AGE STUDIES
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$303.36 |
| Rate for Payer: Aetna Commercial |
$243.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$246.48
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna Commercial |
$262.28
|
| Rate for Payer: First Health Commercial |
$300.20
|
| Rate for Payer: Humana Commercial |
$268.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.08
|
| Rate for Payer: Ohio Health Group HMO |
$237.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.96
|
| Rate for Payer: PHCS Commercial |
$303.36
|
| Rate for Payer: United Healthcare All Payer |
$278.08
|
|
|
BONE AGE STUDIES(P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320P0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$36.11 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$33.24
|
| Rate for Payer: Healthspan PPO |
$33.84
|
| Rate for Payer: Humana Medicaid |
$16.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.45
|
| Rate for Payer: Molina Healthcare Passport |
$16.13
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.29
|
|
|
BONE AGE STUDIES(T
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320T0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
BONE AGE STUDIES(T
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320T0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$98.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$98.36
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$99.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
BONE CANCELLOUS CRUSHED 30CC
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
BONE CANCELLOUS CRUSHED 30CC
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
BONE CANCELLOUS CRUSHED 50CC
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
BONE CANCELLOUS CRUSHED 50CC
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem Medicaid |
$1,430.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Humana KY Medicaid |
$1,430.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,445.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,459.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
BONE CANCELLOUS CUBES 15CC
|
Facility
|
IP
|
$3,184.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.97 |
| Max. Negotiated Rate |
$3,057.00 |
| Rate for Payer: Aetna Commercial |
$2,451.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,483.82
|
| Rate for Payer: Cash Price |
$1,592.19
|
| Rate for Payer: Cigna Commercial |
$2,643.04
|
| Rate for Payer: First Health Commercial |
$3,025.16
|
| Rate for Payer: Humana Commercial |
$2,706.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$987.16
|
| Rate for Payer: PHCS Commercial |
$3,057.00
|
| Rate for Payer: United Healthcare All Payer |
$2,802.25
|
|
|
BONE CANCELLOUS CUBES 15CC
|
Facility
|
OP
|
$3,184.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.97 |
| Max. Negotiated Rate |
$3,057.00 |
| Rate for Payer: Aetna Commercial |
$2,451.97
|
| Rate for Payer: Anthem Medicaid |
$1,095.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,483.82
|
| Rate for Payer: Cash Price |
$1,592.19
|
| Rate for Payer: Cigna Commercial |
$2,643.04
|
| Rate for Payer: First Health Commercial |
$3,025.16
|
| Rate for Payer: Humana Commercial |
$2,706.72
|
| Rate for Payer: Humana KY Medicaid |
$1,095.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$987.16
|
| Rate for Payer: PHCS Commercial |
$3,057.00
|
| Rate for Payer: United Healthcare All Payer |
$2,802.25
|
|
|
BONE CANCELLOUS CUBES 30CC
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
BONE CANCELLOUS CUBES 30CC
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$15,810.13
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$10,728.30 |
| Max. Negotiated Rate |
$15,810.13 |
| Rate for Payer: Anthem Medicaid |
$10,728.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,292.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,810.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,245.48
|
| Rate for Payer: Humana KY Medicaid |
$10,728.30
|
| Rate for Payer: Humana Medicare Advantage |
$11,292.95
|
| Rate for Payer: Kentucky WC Medicaid |
$10,835.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,551.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,942.87
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$9,613.59
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$6,523.51 |
| Max. Negotiated Rate |
$9,613.59 |
| Rate for Payer: Anthem Medicaid |
$6,523.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,866.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,613.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,270.25
|
| Rate for Payer: Humana KY Medicaid |
$6,523.51
|
| Rate for Payer: Humana Medicare Advantage |
$6,866.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,240.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,653.98
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
BONE IMAGING 3 PHASE
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$1,670.00 |
| Rate for Payer: Aetna Commercial |
$451.14
|
| Rate for Payer: Anthem Medicaid |
$172.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,670.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$393.88
|
| Rate for Payer: Healthspan PPO |
$450.91
|
| Rate for Payer: Humana Medicaid |
$172.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.25
|
| Rate for Payer: Molina Healthcare Passport |
$172.79
|
| Rate for Payer: Multiplan PHCS |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,169.00
|
| Rate for Payer: UHCCP Medicaid |
$584.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.52
|
|
|
BONE IMAGING 3 PHASE
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$217.10 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Aetna Commercial |
$1,285.90
|
| Rate for Payer: Anthem Medicaid |
$574.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,302.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$1,386.10
|
| Rate for Payer: First Health Commercial |
$1,586.50
|
| Rate for Payer: Humana Commercial |
$1,419.50
|
| Rate for Payer: Humana KY Medicaid |
$574.31
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$580.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,369.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,232.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$585.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,469.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.70
|
| Rate for Payer: PHCS Commercial |
$1,603.20
|
| Rate for Payer: United Healthcare All Payer |
$1,469.60
|
|
|
BONE IMAGING 3 PHASE
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$217.10 |
| Max. Negotiated Rate |
$1,603.20 |
| Rate for Payer: Aetna Commercial |
$1,285.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,302.60
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$1,386.10
|
| Rate for Payer: First Health Commercial |
$1,586.50
|
| Rate for Payer: Humana Commercial |
$1,419.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,369.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,232.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,469.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,252.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.70
|
| Rate for Payer: PHCS Commercial |
$1,603.20
|
| Rate for Payer: United Healthcare All Payer |
$1,469.60
|
|
|
BONE IMAGING 3 PHASE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
340P0015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Aetna Commercial |
$451.14
|
| Rate for Payer: Anthem Medicaid |
$172.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$393.88
|
| Rate for Payer: Healthspan PPO |
$450.91
|
| Rate for Payer: Humana Medicaid |
$172.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.25
|
| Rate for Payer: Molina Healthcare Passport |
$172.79
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.52
|
|
|
BONE IMAGING 3 PHASE(T
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
340T0015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.45
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
