|
XPOSE FOR ENDOPROSTH - FEMOR(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 34812
|
| Hospital Charge Code |
761P1352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$621.39
|
| Rate for Payer: Anthem Medicaid |
$276.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$587.46
|
| Rate for Payer: Healthspan PPO |
$610.95
|
| Rate for Payer: Humana Medicaid |
$276.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$281.72
|
| Rate for Payer: Molina Healthcare Passport |
$276.20
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.96
|
|
|
XR ABDOMEN 3V
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
320T0993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
XR ABDOMEN 3V
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
320P0993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$61.59
|
| Rate for Payer: Humana Medicaid |
$29.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.01
|
| Rate for Payer: Molina Healthcare Passport |
$29.42
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
|
|
XR ABDOMEN 3V
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
XR ABDOMEN 3V
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
XR ABDOMEN 3V
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$61.59
|
| Rate for Payer: Humana Medicaid |
$29.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.01
|
| Rate for Payer: Molina Healthcare Passport |
$29.42
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
|
|
XR ABDOMEN 3V
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
320T0993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem Medicaid |
$132.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Humana KY Medicaid |
$132.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$133.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$1,244.16 |
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Anthem Medicaid |
$445.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,010.88
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$1,075.68
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: Humana Commercial |
$1,101.60
|
| Rate for Payer: Humana KY Medicaid |
$445.69
|
| Rate for Payer: Kentucky WC Medicaid |
$450.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,062.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$956.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,140.48
|
| Rate for Payer: Ohio Health Group HMO |
$972.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.76
|
| Rate for Payer: PHCS Commercial |
$1,244.16
|
| Rate for Payer: United Healthcare All Payer |
$1,140.48
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$250.18
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,296.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$239.32
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$777.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$907.20
|
| Rate for Payer: UHCCP Medicaid |
$453.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$1,244.16 |
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,010.88
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna Commercial |
$1,075.68
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: Humana Commercial |
$1,101.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,062.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$956.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,140.48
|
| Rate for Payer: Ohio Health Group HMO |
$972.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.76
|
| Rate for Payer: PHCS Commercial |
$1,244.16
|
| Rate for Payer: United Healthcare All Payer |
$1,140.48
|
|
|
X-RAY BILE DUCT ENDOSCOPY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
320P0140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$250.18 |
| Rate for Payer: Aetna Commercial |
$250.18
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$239.32
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY BILE DUCT ENDOSCOPY(T
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
320T0140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem Medicaid |
$411.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Humana KY Medicaid |
$411.30
|
| Rate for Payer: Kentucky WC Medicaid |
$415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.76
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
X-RAY BILE DUCT ENDOSCOPY(T
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
320T0140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$370.76
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
X-RAY BILE/PANC ENDOSCOPY
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.52
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
X-RAY BILE/PANC ENDOSCOPY
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem Medicaid |
$269.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.52
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Humana KY Medicaid |
$269.62
|
| Rate for Payer: Kentucky WC Medicaid |
$272.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
X-RAY BILE/PANC ENDOSCOPY
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$261.19
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$784.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$249.96
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$470.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$548.80
|
| Rate for Payer: UHCCP Medicaid |
$274.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY BILE/PANC ENDOSCOPY(P
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
320P0141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$261.19 |
| Rate for Payer: Aetna Commercial |
$261.19
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$249.96
|
| Rate for Payer: Humana Medicaid |
$115.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.73
|
| Rate for Payer: Molina Healthcare Passport |
$115.42
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.00
|
| Rate for Payer: UHCCP Medicaid |
$66.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
X-RAY BILE/PANC ENDOSCOPY(T
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
320T0141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$570.24 |
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem Medicaid |
$204.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Humana KY Medicaid |
$204.28
|
| Rate for Payer: Kentucky WC Medicaid |
$206.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.14
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
|
|
X-RAY BILE/PANC ENDOSCOPY(T
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
320T0141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$570.24 |
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.14
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32000179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$627.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.64
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$376.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$438.90
|
| Rate for Payer: UHCCP Medicaid |
$219.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32000179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem Medicaid |
$215.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Humana KY Medicaid |
$215.63
|
| Rate for Payer: Kentucky WC Medicaid |
$217.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$627.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.64
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$376.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$438.90
|
| Rate for Payer: UHCCP Medicaid |
$219.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32000179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem Medicaid |
$215.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Humana KY Medicaid |
$215.63
|
| Rate for Payer: Kentucky WC Medicaid |
$217.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
