|
BALOON PERIPHL CUTTNG 7*2*50
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 7*2*90
|
Facility
|
IP
|
$5,090.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,527.18 |
| Max. Negotiated Rate |
$4,886.98 |
| Rate for Payer: Aetna Commercial |
$3,919.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.67
|
| Rate for Payer: Cash Price |
$2,545.30
|
| Rate for Payer: Cigna Commercial |
$4,225.20
|
| Rate for Payer: First Health Commercial |
$4,836.07
|
| Rate for Payer: Humana Commercial |
$4,327.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.51
|
| Rate for Payer: PHCS Commercial |
$4,886.98
|
| Rate for Payer: United Healthcare All Payer |
$4,479.73
|
|
|
BALOON PERIPHL CUTTNG 7*2*90
|
Facility
|
OP
|
$5,090.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,527.18 |
| Max. Negotiated Rate |
$4,886.98 |
| Rate for Payer: Aetna Commercial |
$3,919.76
|
| Rate for Payer: Anthem Medicaid |
$1,750.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.67
|
| Rate for Payer: Cash Price |
$2,545.30
|
| Rate for Payer: Cigna Commercial |
$4,225.20
|
| Rate for Payer: First Health Commercial |
$4,836.07
|
| Rate for Payer: Humana Commercial |
$4,327.01
|
| Rate for Payer: Humana KY Medicaid |
$1,750.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.51
|
| Rate for Payer: PHCS Commercial |
$4,886.98
|
| Rate for Payer: United Healthcare All Payer |
$4,479.73
|
|
|
BALOON PERIPHL CUTTNG 8*2*90
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BALOON PERIPHL CUTTNG 8*2*90
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BARACLUDE 0.5MG TABLET
|
Facility
|
OP
|
$9.33
|
|
|
Service Code
|
NDC 31722083330
|
| Hospital Charge Code |
25000311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.44
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
BARACLUDE 0.5MG TABLET
|
Facility
|
IP
|
$9.33
|
|
|
Service Code
|
NDC 31722083330
|
| Hospital Charge Code |
25000311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.86
|
| Rate for Payer: Humana Commercial |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.21
|
| Rate for Payer: Ohio Health Group HMO |
$7.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.44
|
| Rate for Payer: PHCS Commercial |
$8.96
|
| Rate for Payer: United Healthcare All Payer |
$8.21
|
|
|
BARD PTFE FELT 2*2*1.65MM
|
Facility
|
IP
|
$548.13
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$526.20 |
| Rate for Payer: Aetna Commercial |
$422.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.54
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cigna Commercial |
$454.95
|
| Rate for Payer: First Health Commercial |
$520.72
|
| Rate for Payer: Humana Commercial |
$465.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.35
|
| Rate for Payer: Ohio Health Group HMO |
$411.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.21
|
| Rate for Payer: PHCS Commercial |
$526.20
|
| Rate for Payer: United Healthcare All Payer |
$482.35
|
|
|
BARD PTFE FELT 2*2*1.65MM
|
Facility
|
OP
|
$548.13
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$526.20 |
| Rate for Payer: Aetna Commercial |
$422.06
|
| Rate for Payer: Anthem Medicaid |
$188.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.54
|
| Rate for Payer: Cash Price |
$274.06
|
| Rate for Payer: Cigna Commercial |
$454.95
|
| Rate for Payer: First Health Commercial |
$520.72
|
| Rate for Payer: Humana Commercial |
$465.91
|
| Rate for Payer: Humana KY Medicaid |
$188.50
|
| Rate for Payer: Kentucky WC Medicaid |
$190.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.35
|
| Rate for Payer: Ohio Health Group HMO |
$411.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.21
|
| Rate for Payer: PHCS Commercial |
$526.20
|
| Rate for Payer: United Healthcare All Payer |
$482.35
|
|
|
BAREWIRE 315CM
|
Facility
|
IP
|
$1,801.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.48 |
| Max. Negotiated Rate |
$1,729.54 |
| Rate for Payer: Aetna Commercial |
$1,387.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.25
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cigna Commercial |
$1,495.33
|
| Rate for Payer: First Health Commercial |
$1,711.52
|
| Rate for Payer: Humana Commercial |
$1,531.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.10
|
| Rate for Payer: PHCS Commercial |
$1,729.54
|
| Rate for Payer: United Healthcare All Payer |
$1,585.41
|
|
|
BAREWIRE 315CM
|
Facility
|
OP
|
$1,801.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.48 |
| Max. Negotiated Rate |
$1,729.54 |
| Rate for Payer: Aetna Commercial |
$1,387.23
|
| Rate for Payer: Anthem Medicaid |
$619.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.25
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cigna Commercial |
$1,495.33
|
| Rate for Payer: First Health Commercial |
$1,711.52
|
| Rate for Payer: Humana Commercial |
$1,531.36
|
| Rate for Payer: Humana KY Medicaid |
$619.57
|
| Rate for Payer: Kentucky WC Medicaid |
$625.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.10
|
| Rate for Payer: PHCS Commercial |
$1,729.54
|
| Rate for Payer: United Healthcare All Payer |
$1,585.41
|
|
|
BARIUM ENEMA
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
BARIUM ENEMA
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
BARIUM ENEMA
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
32000137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$188.06
|
| Rate for Payer: Ambetter Exchange |
$136.39
|
| Rate for Payer: Anthem Medicaid |
$115.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.67
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$170.82
|
| Rate for Payer: Healthspan PPO |
$176.22
|
| Rate for Payer: Humana Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.23
|
| Rate for Payer: Molina Healthcare Passport |
$115.91
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.31
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.39
|
|
|
BARIUM ENEMA(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320P0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$188.06 |
| Rate for Payer: Aetna Commercial |
$188.06
|
| Rate for Payer: Ambetter Exchange |
$136.39
|
| Rate for Payer: Anthem Medicaid |
$115.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.67
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$170.82
|
| Rate for Payer: Healthspan PPO |
$176.22
|
| Rate for Payer: Humana Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.23
|
| Rate for Payer: Molina Healthcare Passport |
$115.91
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.31
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.39
|
|
|
BARIUM ENEMA(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320T0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
BARIUM ENEMA(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
320T0137
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
BARIUM ESOPHAGRAM
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$551.04 |
| Rate for Payer: Aetna Commercial |
$441.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$447.72
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$476.42
|
| Rate for Payer: First Health Commercial |
$545.30
|
| Rate for Payer: Humana Commercial |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$470.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$423.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$505.12
|
| Rate for Payer: Ohio Health Group HMO |
$430.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.06
|
| Rate for Payer: PHCS Commercial |
$551.04
|
| Rate for Payer: United Healthcare All Payer |
$505.12
|
|
|
BARIUM ESOPHAGRAM
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$551.04 |
| Rate for Payer: Aetna Commercial |
$441.98
|
| Rate for Payer: Anthem Medicaid |
$197.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$447.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$476.42
|
| Rate for Payer: First Health Commercial |
$545.30
|
| Rate for Payer: Humana Commercial |
$487.90
|
| Rate for Payer: Humana KY Medicaid |
$197.40
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$199.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$470.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$423.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$505.12
|
| Rate for Payer: Ohio Health Group HMO |
$430.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.06
|
| Rate for Payer: PHCS Commercial |
$551.04
|
| Rate for Payer: United Healthcare All Payer |
$505.12
|
|
|
BARIUM ESOPHAGRAM
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
32000129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: Aetna Commercial |
$130.72
|
| Rate for Payer: Ambetter Exchange |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$72.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.10
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: Cigna Commercial |
$110.36
|
| Rate for Payer: Healthspan PPO |
$122.49
|
| Rate for Payer: Humana Medicaid |
$72.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.65
|
| Rate for Payer: Molina Healthcare Passport |
$72.21
|
| Rate for Payer: Multiplan PHCS |
$344.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.78
|
| Rate for Payer: UHCCP Medicaid |
$200.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.75
|
|
|
BARIUM ESOPHAGRAM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320P0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$130.72 |
| Rate for Payer: Aetna Commercial |
$130.72
|
| Rate for Payer: Ambetter Exchange |
$86.75
|
| Rate for Payer: Anthem Medicaid |
$72.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.10
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$110.36
|
| Rate for Payer: Healthspan PPO |
$122.49
|
| Rate for Payer: Humana Medicaid |
$72.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.65
|
| Rate for Payer: Molina Healthcare Passport |
$72.21
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.75
|
|
|
BARIUM ESOPHAGRAM(T
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320T0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.31
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
BARIUM ESOPHAGRAM(T
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 74220
|
| Hospital Charge Code |
320T0129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.31
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
BARIUM SULFATE ENEMA
|
Facility
|
IP
|
$3.25
|
|
| Hospital Charge Code |
27000233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.24
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
|
BARIUM SULFATE ENEMA
|
Facility
|
OP
|
$3.25
|
|
| Hospital Charge Code |
27000233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem Medicaid |
$1.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Humana KY Medicaid |
$1.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.24
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
