|
BONE IMAGING 3 PHASE(T
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
340T0015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,528.32 |
| Rate for Payer: Aetna Commercial |
$1,225.84
|
| Rate for Payer: Anthem Medicaid |
$547.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,241.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cigna Commercial |
$1,321.36
|
| Rate for Payer: First Health Commercial |
$1,512.40
|
| Rate for Payer: Humana Commercial |
$1,353.20
|
| Rate for Payer: Humana KY Medicaid |
$547.49
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$553.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,305.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$558.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,385.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,098.48
|
| Rate for Payer: PHCS Commercial |
$1,528.32
|
| Rate for Payer: United Healthcare All Payer |
$1,400.96
|
|
|
BONE IMAGING 3 PHASE(T
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
340T0015
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$477.60 |
| Max. Negotiated Rate |
$1,528.32 |
| Rate for Payer: Aetna Commercial |
$1,225.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,241.76
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cigna Commercial |
$1,321.36
|
| Rate for Payer: First Health Commercial |
$1,512.40
|
| Rate for Payer: Humana Commercial |
$1,353.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,305.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,174.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,400.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,194.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,385.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,098.48
|
| Rate for Payer: PHCS Commercial |
$1,528.32
|
| Rate for Payer: United Healthcare All Payer |
$1,400.96
|
|
|
BONE IMAGING LIMITED AREA
|
Facility
|
IP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$452.40 |
| Max. Negotiated Rate |
$1,447.68 |
| Rate for Payer: Aetna Commercial |
$1,161.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,176.24
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cigna Commercial |
$1,251.64
|
| Rate for Payer: First Health Commercial |
$1,432.60
|
| Rate for Payer: Humana Commercial |
$1,281.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,236.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,112.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,327.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.52
|
| Rate for Payer: PHCS Commercial |
$1,447.68
|
| Rate for Payer: United Healthcare All Payer |
$1,327.04
|
|
|
BONE IMAGING LIMITED AREA
|
Professional
|
Both
|
$1,508.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$904.80 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Ambetter Exchange |
$181.19
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.43
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$904.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.55
|
| Rate for Payer: UHCCP Medicaid |
$527.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.19
|
|
|
BONE IMAGING LIMITED AREA
|
Facility
|
OP
|
$1,508.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,447.68 |
| Rate for Payer: Aetna Commercial |
$1,161.16
|
| Rate for Payer: Anthem Medicaid |
$518.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,176.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cigna Commercial |
$1,251.64
|
| Rate for Payer: First Health Commercial |
$1,432.60
|
| Rate for Payer: Humana Commercial |
$1,281.80
|
| Rate for Payer: Humana KY Medicaid |
$518.60
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$523.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,236.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,112.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$529.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,327.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.52
|
| Rate for Payer: PHCS Commercial |
$1,447.68
|
| Rate for Payer: United Healthcare All Payer |
$1,327.04
|
|
|
BONE IMAGING LIMITED AREA(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340P0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Ambetter Exchange |
$181.19
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.43
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.55
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.19
|
|
|
BONE IMAGING LIMITED AREA(T
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,394.88 |
| Rate for Payer: Aetna Commercial |
$1,118.81
|
| Rate for Payer: Anthem Medicaid |
$499.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,133.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cigna Commercial |
$1,205.99
|
| Rate for Payer: First Health Commercial |
$1,380.35
|
| Rate for Payer: Humana Commercial |
$1,235.05
|
| Rate for Payer: Humana KY Medicaid |
$499.69
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$504.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,191.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,072.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$509.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,278.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.57
|
| Rate for Payer: PHCS Commercial |
$1,394.88
|
| Rate for Payer: United Healthcare All Payer |
$1,278.64
|
|
|
BONE IMAGING LIMITED AREA(T
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0077
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$435.90 |
| Max. Negotiated Rate |
$1,394.88 |
| Rate for Payer: Aetna Commercial |
$1,118.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,133.34
|
| Rate for Payer: Cash Price |
$726.50
|
| Rate for Payer: Cigna Commercial |
$1,205.99
|
| Rate for Payer: First Health Commercial |
$1,380.35
|
| Rate for Payer: Humana Commercial |
$1,235.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,191.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,072.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,278.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,089.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,162.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.57
|
| Rate for Payer: PHCS Commercial |
$1,394.88
|
| Rate for Payer: United Healthcare All Payer |
$1,278.64
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340P0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$371.61 |
| Rate for Payer: Aetna Commercial |
$371.61
|
| Rate for Payer: Ambetter Exchange |
$236.18
|
| Rate for Payer: Anthem Medicaid |
$152.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.42
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$327.09
|
| Rate for Payer: Healthspan PPO |
$371.42
|
| Rate for Payer: Humana Medicaid |
$152.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.69
|
| Rate for Payer: Molina Healthcare Passport |
$152.64
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.03
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.18
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(T
|
Facility
|
OP
|
$2,129.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340T0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$2,043.84 |
| Rate for Payer: Aetna Commercial |
$1,639.33
|
| Rate for Payer: Anthem Medicaid |
$732.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$1,064.50
|
| Rate for Payer: Cash Price |
$1,064.50
|
| Rate for Payer: Cigna Commercial |
$1,767.07
|
| Rate for Payer: First Health Commercial |
$2,022.55
|
| Rate for Payer: Humana Commercial |
$1,809.65
|
| Rate for Payer: Humana KY Medicaid |
$732.16
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,873.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,852.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.01
|
| Rate for Payer: PHCS Commercial |
$2,043.84
|
| Rate for Payer: United Healthcare All Payer |
$1,873.52
|
|
|
BONE +/- JNT IMAGE WHOLE BOD(T
|
Facility
|
IP
|
$2,129.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
340T0014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$638.70 |
| Max. Negotiated Rate |
$2,043.84 |
| Rate for Payer: Aetna Commercial |
$1,639.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.62
|
| Rate for Payer: Cash Price |
$1,064.50
|
| Rate for Payer: Cigna Commercial |
$1,767.07
|
| Rate for Payer: First Health Commercial |
$2,022.55
|
| Rate for Payer: Humana Commercial |
$1,809.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,873.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,852.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.01
|
| Rate for Payer: PHCS Commercial |
$2,043.84
|
| Rate for Payer: United Healthcare All Payer |
$1,873.52
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$371.61
|
| Rate for Payer: Ambetter Exchange |
$236.18
|
| Rate for Payer: Anthem Medicaid |
$152.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$283.42
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cigna Commercial |
$327.09
|
| Rate for Payer: Healthspan PPO |
$371.42
|
| Rate for Payer: Humana Medicaid |
$152.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.69
|
| Rate for Payer: Molina Healthcare Passport |
$152.64
|
| Rate for Payer: Multiplan PHCS |
$1,382.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.03
|
| Rate for Payer: UHCCP Medicaid |
$806.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.18
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Facility
|
IP
|
$2,304.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$691.20 |
| Max. Negotiated Rate |
$2,211.84 |
| Rate for Payer: Aetna Commercial |
$1,774.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,797.12
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cigna Commercial |
$1,912.32
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Humana Commercial |
$1,958.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,889.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,700.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$691.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,027.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,004.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.76
|
| Rate for Payer: PHCS Commercial |
$2,211.84
|
| Rate for Payer: United Healthcare All Payer |
$2,027.52
|
|
|
BONE +/- JNT IMAGE WHOLE BODY
|
Facility
|
OP
|
$2,304.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
34000014
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$2,211.84 |
| Rate for Payer: Aetna Commercial |
$1,774.08
|
| Rate for Payer: Anthem Medicaid |
$792.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,797.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cigna Commercial |
$1,912.32
|
| Rate for Payer: First Health Commercial |
$2,188.80
|
| Rate for Payer: Humana Commercial |
$1,958.40
|
| Rate for Payer: Humana KY Medicaid |
$792.35
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$800.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,889.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,700.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$808.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,027.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,004.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,589.76
|
| Rate for Payer: PHCS Commercial |
$2,211.84
|
| Rate for Payer: United Healthcare All Payer |
$2,027.52
|
|
|
BONE/JOINT IMG LMT AREA
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA
|
Professional
|
Both
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
34000117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$818.40 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Ambetter Exchange |
$181.19
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.43
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$818.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.55
|
| Rate for Payer: UHCCP Medicaid |
$477.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.19
|
|
|
BONE/JOINT IMG LMT AREA(P
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340P0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna Commercial |
$252.34
|
| Rate for Payer: Ambetter Exchange |
$181.19
|
| Rate for Payer: Anthem Medicaid |
$94.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.43
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$208.14
|
| Rate for Payer: Healthspan PPO |
$252.21
|
| Rate for Payer: Humana Medicaid |
$94.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.29
|
| Rate for Payer: Molina Healthcare Passport |
$94.40
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.55
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.19
|
|
|
BONE/JOINT IMG LMT AREA(T
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE/JOINT IMG LMT AREA(T
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
340T0117
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
BONE MARROW ASP W/ BX
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$92.67
|
| Rate for Payer: Ambetter Exchange |
$63.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.38
|
| Rate for Payer: Anthem Medicaid |
$151.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.70
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Healthspan PPO |
$178.94
|
| Rate for Payer: Humana Medicaid |
$151.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.63
|
| Rate for Payer: Molina Healthcare Passport |
$151.60
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.00
|
| Rate for Payer: UHCCP Medicaid |
$44.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.08
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.76 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
76101588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
