|
BMW2 190CM STRAIGHT
|
Facility
|
IP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
|
BMW2 190CM STRAIGHT
|
Facility
|
OP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem Medicaid |
$515.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Humana KY Medicaid |
$515.92
|
| Rate for Payer: Kentucky WC Medicaid |
$521.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
|
BODY COMPOSITION SCAN
|
Facility
|
IP
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.34
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
BODY COMPOSITION SCAN
|
Facility
|
OP
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$98.88 |
| Rate for Payer: Aetna Commercial |
$79.31
|
| Rate for Payer: Anthem Medicaid |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.34
|
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Cigna Commercial |
$85.49
|
| Rate for Payer: First Health Commercial |
$97.85
|
| Rate for Payer: Humana Commercial |
$87.55
|
| Rate for Payer: Humana KY Medicaid |
$35.42
|
| Rate for Payer: Kentucky WC Medicaid |
$35.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.64
|
| Rate for Payer: Ohio Health Group HMO |
$77.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.07
|
| Rate for Payer: PHCS Commercial |
$98.88
|
| Rate for Payer: United Healthcare All Payer |
$90.64
|
|
|
BODY COMPOSITION SCAN
|
Professional
|
Both
|
$103.00
|
|
| Hospital Charge Code |
32000997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Cash Price |
$51.50
|
| Rate for Payer: Multiplan PHCS |
$61.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$36.05
|
|
|
BONE AGE STUDIES
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$114.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$114.86
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$116.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
BONE AGE STUDIES
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$200.40 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Ambetter Exchange |
$23.32
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.98
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$33.24
|
| Rate for Payer: Healthspan PPO |
$33.84
|
| Rate for Payer: Humana Medicaid |
$16.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.45
|
| Rate for Payer: Molina Healthcare Passport |
$16.13
|
| Rate for Payer: Multiplan PHCS |
$200.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.32
|
| Rate for Payer: UHCCP Medicaid |
$116.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.32
|
|
|
BONE AGE STUDIES
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
32000234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$267.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.46
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
BONE AGE STUDIES(P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320P0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$36.11 |
| Rate for Payer: Aetna Commercial |
$36.11
|
| Rate for Payer: Ambetter Exchange |
$23.32
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.98
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$33.24
|
| Rate for Payer: Healthspan PPO |
$33.84
|
| Rate for Payer: Humana Medicaid |
$16.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.45
|
| Rate for Payer: Molina Healthcare Passport |
$16.13
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.32
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.32
|
|
|
BONE AGE STUDIES(T
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320T0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
BONE AGE STUDIES(T
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
320T0234
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
BONE CANCELLOUS CRUSHED 30CC
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
BONE CANCELLOUS CRUSHED 30CC
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
BONE CANCELLOUS CRUSHED 50CC
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
BONE CANCELLOUS CRUSHED 50CC
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
BONE CANCELLOUS CUBES 15CC
|
Facility
|
IP
|
$3,054.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.41 |
| Max. Negotiated Rate |
$2,932.50 |
| Rate for Payer: Aetna Commercial |
$2,352.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,382.66
|
| Rate for Payer: Cash Price |
$1,527.34
|
| Rate for Payer: Cigna Commercial |
$2,535.39
|
| Rate for Payer: First Health Commercial |
$2,901.96
|
| Rate for Payer: Humana Commercial |
$2,596.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,504.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,254.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,688.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,291.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,443.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,657.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.74
|
| Rate for Payer: PHCS Commercial |
$2,932.50
|
| Rate for Payer: United Healthcare All Payer |
$2,688.13
|
|
|
BONE CANCELLOUS CUBES 15CC
|
Facility
|
OP
|
$3,054.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.41 |
| Max. Negotiated Rate |
$2,932.50 |
| Rate for Payer: Aetna Commercial |
$2,352.11
|
| Rate for Payer: Anthem Medicaid |
$1,050.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,382.66
|
| Rate for Payer: Cash Price |
$1,527.34
|
| Rate for Payer: Cigna Commercial |
$2,535.39
|
| Rate for Payer: First Health Commercial |
$2,901.96
|
| Rate for Payer: Humana Commercial |
$2,596.49
|
| Rate for Payer: Humana KY Medicaid |
$1,050.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,061.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,504.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,254.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,071.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,688.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,291.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,443.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,657.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.74
|
| Rate for Payer: PHCS Commercial |
$2,932.50
|
| Rate for Payer: United Healthcare All Payer |
$2,688.13
|
|
|
BONE CANCELLOUS CUBES 30CC
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
BONE CANCELLOUS CUBES 30CC
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
BONE IMAGING 3 PHASE
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$1,060.20 |
| Rate for Payer: Aetna Commercial |
$451.14
|
| Rate for Payer: Ambetter Exchange |
$277.34
|
| Rate for Payer: Anthem Medicaid |
$172.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$277.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$277.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.81
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$393.88
|
| Rate for Payer: Healthspan PPO |
$450.91
|
| Rate for Payer: Humana Medicaid |
$172.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$277.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.25
|
| Rate for Payer: Molina Healthcare Passport |
$172.79
|
| Rate for Payer: Multiplan PHCS |
$1,060.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$360.54
|
| Rate for Payer: UHCCP Medicaid |
$618.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$277.34
|
|
|
BONE IMAGING 3 PHASE
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,696.32 |
| Rate for Payer: Aetna Commercial |
$1,360.59
|
| Rate for Payer: Anthem Medicaid |
$607.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$1,466.61
|
| Rate for Payer: First Health Commercial |
$1,678.65
|
| Rate for Payer: Humana Commercial |
$1,501.95
|
| Rate for Payer: Humana KY Medicaid |
$607.67
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$613.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,304.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.23
|
| Rate for Payer: PHCS Commercial |
$1,696.32
|
| Rate for Payer: United Healthcare All Payer |
$1,554.96
|
|
|
BONE IMAGING 3 PHASE
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
34000015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$530.10 |
| Max. Negotiated Rate |
$1,696.32 |
| Rate for Payer: Aetna Commercial |
$1,360.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.26
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$1,466.61
|
| Rate for Payer: First Health Commercial |
$1,678.65
|
| Rate for Payer: Humana Commercial |
$1,501.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,304.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.23
|
| Rate for Payer: PHCS Commercial |
$1,696.32
|
| Rate for Payer: United Healthcare All Payer |
$1,554.96
|
|
|
BONE IMAGING 3 PHASE(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
340P0015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Aetna Commercial |
$451.14
|
| Rate for Payer: Ambetter Exchange |
$277.34
|
| Rate for Payer: Anthem Medicaid |
$172.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$277.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$277.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.81
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$393.88
|
| Rate for Payer: Healthspan PPO |
$450.91
|
| Rate for Payer: Humana Medicaid |
$172.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$277.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.25
|
| Rate for Payer: Molina Healthcare Passport |
$172.79
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$360.54
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$277.34
|
|
