|
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
|
|
|
BONE IMAGING LIMITED AREA
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$184.47 |
| Max. Negotiated Rate |
$1,362.24 |
| Rate for Payer: Aetna Commercial |
$1,092.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,106.82
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$1,177.77
|
| Rate for Payer: First Health Commercial |
$1,348.05
|
| Rate for Payer: Humana Commercial |
$1,206.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,163.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$425.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,248.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,064.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.89
|
| Rate for Payer: PHCS Commercial |
$1,362.24
|
| Rate for Payer: United Healthcare All Payer |
$1,248.72
|
|
|
BONE IMAGING LIMITED AREA
|
Professional
|
Both
|
$1,419.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$1,419.00 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,419.00
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$851.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$993.30
|
| Rate for Payer: UHCCP Medicaid |
$496.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
|
|
BONE IMAGING LIMITED AREA
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$184.47 |
| Max. Negotiated Rate |
$1,362.24 |
| Rate for Payer: Aetna Commercial |
$1,092.63
|
| Rate for Payer: Anthem Medicaid |
$487.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,106.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$1,177.77
|
| Rate for Payer: First Health Commercial |
$1,348.05
|
| Rate for Payer: Humana Commercial |
$1,206.15
|
| Rate for Payer: Humana KY Medicaid |
$487.99
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$492.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,163.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$497.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,248.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,064.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$439.89
|
| Rate for Payer: PHCS Commercial |
$1,362.24
|
| Rate for Payer: United Healthcare All Payer |
$1,248.72
|
|
|
BONE IMAGING LIMITED AREA(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340P0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
|
|
BONE IMAGING LIMITED AREA(T
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE IMAGING LIMITED AREA(T
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340P0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$371.61 |
| Rate for Payer: Aetna Commercial |
$371.61
|
| Rate for Payer: Anthem Medicaid |
$152.64
|
| 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 |
$327.09
|
| Rate for Payer: Healthspan PPO |
$371.42
|
| Rate for Payer: Humana Medicaid |
$152.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.69
|
| Rate for Payer: Molina Healthcare Passport |
$152.64
|
| 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 |
$154.17
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(T
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340T0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$259.87 |
| Max. Negotiated Rate |
$1,919.04 |
| Rate for Payer: Aetna Commercial |
$1,539.23
|
| Rate for Payer: Anthem Medicaid |
$687.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$999.50
|
| Rate for Payer: Cash Price |
$999.50
|
| Rate for Payer: Cigna Commercial |
$1,659.17
|
| Rate for Payer: First Health Commercial |
$1,899.05
|
| Rate for Payer: Humana Commercial |
$1,699.15
|
| Rate for Payer: Humana KY Medicaid |
$687.46
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$694.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.69
|
| Rate for Payer: PHCS Commercial |
$1,919.04
|
| Rate for Payer: United Healthcare All Payer |
$1,759.12
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(T
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340T0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$259.87 |
| Max. Negotiated Rate |
$1,919.04 |
| Rate for Payer: Aetna Commercial |
$1,539.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.22
|
| Rate for Payer: Cash Price |
$999.50
|
| Rate for Payer: Cigna Commercial |
$1,659.17
|
| Rate for Payer: First Health Commercial |
$1,899.05
|
| Rate for Payer: Humana Commercial |
$1,699.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.69
|
| Rate for Payer: PHCS Commercial |
$1,919.04
|
| Rate for Payer: United Healthcare All Payer |
$1,759.12
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$282.62 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.94
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$2,174.00 |
| Rate for Payer: Aetna Commercial |
$371.61
|
| Rate for Payer: Anthem Medicaid |
$152.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,174.00
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$327.09
|
| Rate for Payer: Healthspan PPO |
$371.42
|
| Rate for Payer: Humana Medicaid |
$152.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.69
|
| Rate for Payer: Molina Healthcare Passport |
$152.64
|
| Rate for Payer: Multiplan PHCS |
$1,304.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,521.80
|
| Rate for Payer: UHCCP Medicaid |
$760.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.17
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$282.62 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.94
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
BONE/JOINT IMG LMT AREA
|
Professional
|
Both
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$1,364.00 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,364.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$818.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$954.80
|
| Rate for Payer: UHCCP Medicaid |
$477.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
|
|
BONE/JOINT IMG LMT AREA
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340P0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
|
|
BONE/JOINT IMG LMT AREA(T
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA(T
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.84
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$92.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.38
|
| Rate for Payer: Anthem Medicaid |
$43.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Healthspan PPO |
$178.94
|
| Rate for Payer: Humana Medicaid |
$43.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.05
|
| Rate for Payer: Molina Healthcare Passport |
$43.19
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,662.50
|
| Rate for Payer: UHCCP Medicaid |
$44.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.62
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
