|
XPOSE FOR ENDOPROSTH - FEMORL
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 34812
|
| Hospital Charge Code |
76101352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
XPOSE FOR ENDOPROSTH - FEMORL
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 34812
|
| Hospital Charge Code |
76101352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.02 |
| Max. Negotiated Rate |
$621.39 |
| Rate for Payer: Aetna Commercial |
$621.39
|
| Rate for Payer: Ambetter Exchange |
$193.02
|
| Rate for Payer: Anthem Medicaid |
$276.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$193.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$193.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.02
|
| 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 |
$250.93
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.02
|
|
|
XPOSE FOR ENDOPROSTH - FEMOR(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 34812
|
| Hospital Charge Code |
761P1352
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.02 |
| Max. Negotiated Rate |
$621.39 |
| Rate for Payer: Aetna Commercial |
$621.39
|
| Rate for Payer: Ambetter Exchange |
$193.02
|
| Rate for Payer: Anthem Medicaid |
$276.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$193.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$231.62
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$193.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.02
|
| 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 |
$250.93
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$193.02
|
|
|
XR ABDOMEN 3V
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
320T0993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem Medicaid |
$140.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Humana KY Medicaid |
$140.66
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$142.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.21
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
XR ABDOMEN 3V
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$599.04 |
| Rate for Payer: Aetna Commercial |
$480.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$486.72
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$517.92
|
| Rate for Payer: First Health Commercial |
$592.80
|
| Rate for Payer: Humana Commercial |
$530.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$511.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$460.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$549.12
|
| Rate for Payer: Ohio Health Group HMO |
$468.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$499.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.56
|
| Rate for Payer: PHCS Commercial |
$599.04
|
| Rate for Payer: United Healthcare All Payer |
$549.12
|
|
|
XR ABDOMEN 3V
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$599.04 |
| Rate for Payer: Aetna Commercial |
$480.48
|
| Rate for Payer: Anthem Medicaid |
$214.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$486.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$517.92
|
| Rate for Payer: First Health Commercial |
$592.80
|
| Rate for Payer: Humana Commercial |
$530.40
|
| Rate for Payer: Humana KY Medicaid |
$214.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$216.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$511.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$460.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$549.12
|
| Rate for Payer: Ohio Health Group HMO |
$468.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$499.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.56
|
| Rate for Payer: PHCS Commercial |
$599.04
|
| Rate for Payer: United Healthcare All Payer |
$549.12
|
|
|
XR ABDOMEN 3V
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
32000993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Ambetter Exchange |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.28
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.01
|
| Rate for Payer: Molina Healthcare Passport |
$29.42
|
| Rate for Payer: Multiplan PHCS |
$374.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.14
|
| Rate for Payer: UHCCP Medicaid |
$218.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.57
|
|
|
XR ABDOMEN 3V
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
320T0993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$392.64 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.02
|
| Rate for Payer: Cash Price |
$204.50
|
| Rate for Payer: Cigna Commercial |
$339.47
|
| Rate for Payer: First Health Commercial |
$388.55
|
| Rate for Payer: Humana Commercial |
$347.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.92
|
| Rate for Payer: Ohio Health Group HMO |
$306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.21
|
| Rate for Payer: PHCS Commercial |
$392.64
|
| Rate for Payer: United Healthcare All Payer |
$359.92
|
|
|
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 |
$129.00 |
| Rate for Payer: Ambetter Exchange |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$29.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.57
|
| 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 |
$50.14
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.57
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem Medicaid |
$472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Humana KY Medicaid |
$472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
X-RAY BILE DUCT ENDOSCOPY
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
32000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$961.80 |
| Rate for Payer: Aetna Commercial |
$250.18
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| 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 |
$824.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$961.80
|
| Rate for Payer: UHCCP Medicaid |
$480.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.57
|
|
|
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: 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
|
$1,274.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
320T0140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$1,223.04 |
| Rate for Payer: Aetna Commercial |
$980.98
|
| Rate for Payer: Anthem Medicaid |
$438.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$993.72
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cigna Commercial |
$1,057.42
|
| Rate for Payer: First Health Commercial |
$1,210.30
|
| Rate for Payer: Humana Commercial |
$1,082.90
|
| Rate for Payer: Humana KY Medicaid |
$438.13
|
| Rate for Payer: Kentucky WC Medicaid |
$442.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,044.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,121.12
|
| Rate for Payer: Ohio Health Group HMO |
$955.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,019.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.06
|
| Rate for Payer: PHCS Commercial |
$1,223.04
|
| Rate for Payer: United Healthcare All Payer |
$1,121.12
|
|
|
X-RAY BILE DUCT ENDOSCOPY(T
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
HCPCS 74328
|
| Hospital Charge Code |
320T0140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$1,223.04 |
| Rate for Payer: Aetna Commercial |
$980.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$993.72
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: Cigna Commercial |
$1,057.42
|
| Rate for Payer: First Health Commercial |
$1,210.30
|
| Rate for Payer: Humana Commercial |
$1,082.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,044.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,121.12
|
| Rate for Payer: Ohio Health Group HMO |
$955.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,019.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.06
|
| Rate for Payer: PHCS Commercial |
$1,223.04
|
| Rate for Payer: United Healthcare All Payer |
$1,121.12
|
|
|
X-RAY BILE/PANC ENDOSCOPY
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 74330
|
| Hospital Charge Code |
32000141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.20 |
| 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 |
$627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.96
|
| 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 |
$235.20 |
| 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 |
$627.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.96
|
| 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 |
$548.80 |
| Rate for Payer: Aetna Commercial |
$261.19
|
| Rate for Payer: Anthem Medicaid |
$115.42
|
| 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: 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 |
$178.20 |
| 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 |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| 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 |
$178.20 |
| 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 |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| 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 |
$376.20 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Ambetter Exchange |
$86.02
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.22
|
| 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 |
$163.63
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.02
|
| 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 |
$111.83
|
| Rate for Payer: UHCCP Medicaid |
$219.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.02
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32000179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.10 |
| 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 |
$501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.63
|
| 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 |
32000179
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.10 |
| 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 |
$501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.63
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
XRAY CONTROL CATHETER CHANGE
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 75984
|
| Hospital Charge Code |
32001021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$382.20 |
| Rate for Payer: Aetna Commercial |
$174.63
|
| Rate for Payer: Ambetter Exchange |
$86.02
|
| Rate for Payer: Anthem Medicaid |
$84.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.22
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Healthspan PPO |
$163.63
|
| Rate for Payer: Humana Medicaid |
$84.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.68
|
| Rate for Payer: Molina Healthcare Passport |
$84.00
|
| Rate for Payer: Multiplan PHCS |
$382.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.83
|
| Rate for Payer: UHCCP Medicaid |
$222.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.02
|
|
