|
ACU-LOC .054 KWIRE GUIDE
|
Facility
|
IP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
ACU-LOC .054 KWIRE GUIDE
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
ACUTE ABDOMEN EXAM
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$194.10 |
| Max. Negotiated Rate |
$621.12 |
| Rate for Payer: Aetna Commercial |
$498.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$504.66
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$537.01
|
| Rate for Payer: First Health Commercial |
$614.65
|
| Rate for Payer: Humana Commercial |
$549.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$477.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$569.36
|
| Rate for Payer: Ohio Health Group HMO |
$485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.43
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
ACUTE ABDOMEN EXAM
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$621.12 |
| Rate for Payer: Aetna Commercial |
$498.19
|
| Rate for Payer: Anthem Medicaid |
$222.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$504.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$537.01
|
| Rate for Payer: First Health Commercial |
$614.65
|
| Rate for Payer: Humana Commercial |
$549.95
|
| Rate for Payer: Humana KY Medicaid |
$222.50
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$224.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$477.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$569.36
|
| Rate for Payer: Ohio Health Group HMO |
$485.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.43
|
| Rate for Payer: PHCS Commercial |
$621.12
|
| Rate for Payer: United Healthcare All Payer |
$569.36
|
|
|
ACUTE ABDOMEN EXAM
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$388.20 |
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Ambetter Exchange |
$45.24
|
| Rate for Payer: Anthem Medicaid |
$36.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.29
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$67.40
|
| Rate for Payer: Healthspan PPO |
$68.95
|
| Rate for Payer: Humana Medicaid |
$36.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare Passport |
$36.30
|
| Rate for Payer: Multiplan PHCS |
$388.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.81
|
| Rate for Payer: UHCCP Medicaid |
$226.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.24
|
|
|
ACUTE ABDOMEN EXAM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320P0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$73.59 |
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Ambetter Exchange |
$45.24
|
| Rate for Payer: Anthem Medicaid |
$36.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.29
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$67.40
|
| Rate for Payer: Healthspan PPO |
$68.95
|
| Rate for Payer: Humana Medicaid |
$36.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare Passport |
$36.30
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.81
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.24
|
|
|
ACUTE ABDOMEN EXAM(T
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320T0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
ACUTE ABDOMEN EXAM(T
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320T0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem Medicaid |
$196.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Humana KY Medicaid |
$196.71
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$198.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$293.70 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$783.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$675.51
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Professional
|
Both
|
$979.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$587.40 |
| Rate for Payer: Aetna Commercial |
$444.42
|
| Rate for Payer: Ambetter Exchange |
$279.32
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.18
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$395.43
|
| Rate for Payer: Healthspan PPO |
$444.19
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$587.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.12
|
| Rate for Payer: UHCCP Medicaid |
$342.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.32
|
|
|
ACUTE GI BLOOD LOSS IMAGING
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
34000012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$336.68 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem Medicaid |
$336.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Humana KY Medicaid |
$336.68
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$340.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$783.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$851.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$675.51
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
ACUTE GI BLOOD LOSS IMAGING(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340P0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$444.42 |
| Rate for Payer: Aetna Commercial |
$444.42
|
| Rate for Payer: Ambetter Exchange |
$279.32
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.18
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$395.43
|
| Rate for Payer: Healthspan PPO |
$444.19
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.12
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.32
|
|
|
ACUTE GI BLOOD LOSS IMAGING(T
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340T0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$771.84 |
| Rate for Payer: Aetna Commercial |
$619.08
|
| Rate for Payer: Anthem Medicaid |
$276.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$667.32
|
| Rate for Payer: First Health Commercial |
$763.80
|
| Rate for Payer: Humana Commercial |
$683.40
|
| Rate for Payer: Humana KY Medicaid |
$276.50
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$279.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$659.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$707.52
|
| Rate for Payer: Ohio Health Group HMO |
$603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.76
|
| Rate for Payer: PHCS Commercial |
$771.84
|
| Rate for Payer: United Healthcare All Payer |
$707.52
|
|
|
ACUTE GI BLOOD LOSS IMAGING(T
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
340T0012
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$771.84 |
| Rate for Payer: Aetna Commercial |
$619.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.12
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$667.32
|
| Rate for Payer: First Health Commercial |
$763.80
|
| Rate for Payer: Humana Commercial |
$683.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$659.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$707.52
|
| Rate for Payer: Ohio Health Group HMO |
$603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.76
|
| Rate for Payer: PHCS Commercial |
$771.84
|
| Rate for Payer: United Healthcare All Payer |
$707.52
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.54
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$258.96
|
| Rate for Payer: First Health Commercial |
$296.40
|
| Rate for Payer: Humana Commercial |
$265.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.56
|
| Rate for Payer: Ohio Health Group HMO |
$234.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.28
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
|
ACUTE HEPATITIS PANEL
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$96.18
|
| Rate for Payer: Ambetter Exchange |
$47.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.16
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$47.95
|
| Rate for Payer: Healthspan PPO |
$44.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.63
|
| Rate for Payer: Multiplan PHCS |
$187.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.92
|
| Rate for Payer: UHCCP Medicaid |
$109.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.63
|
|
|
ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
30000013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Anthem Medicaid |
$47.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.63
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$258.96
|
| Rate for Payer: First Health Commercial |
$296.40
|
| Rate for Payer: Humana Commercial |
$265.20
|
| Rate for Payer: Humana KY Medicaid |
$47.63
|
| Rate for Payer: Humana Medicare Advantage |
$47.63
|
| Rate for Payer: Kentucky WC Medicaid |
$48.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.56
|
| Rate for Payer: Ohio Health Group HMO |
$234.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.28
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
|
ACUTE HOSPICE ROOM RATE
|
Facility
|
IP
|
$1,022.19
|
|
| Hospital Charge Code |
11000011
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$306.66 |
| Max. Negotiated Rate |
$981.30 |
| Rate for Payer: Aetna Commercial |
$787.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$797.31
|
| Rate for Payer: Cash Price |
$511.10
|
| Rate for Payer: Cigna Commercial |
$848.42
|
| Rate for Payer: First Health Commercial |
$971.08
|
| Rate for Payer: Humana Commercial |
$868.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$838.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$754.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$899.53
|
| Rate for Payer: Ohio Health Group HMO |
$766.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$705.31
|
| Rate for Payer: PHCS Commercial |
$981.30
|
| Rate for Payer: United Healthcare All Payer |
$899.53
|
|
|
ACUTE INITIAL OBS PERDAY LVL 1
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE INITIAL OBS PERDAY LVL 1
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
ACUTE INITIAL OBS PERDAY LVL 2
|
Facility
|
OP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem Medicaid |
$1,112.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Humana KY Medicaid |
$1,112.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,123.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,134.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE INITIAL OBS PERDAY LVL 2
|
Facility
|
IP
|
$3,234.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$3,104.64 |
| Rate for Payer: Aetna Commercial |
$2,490.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,522.52
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna Commercial |
$2,684.22
|
| Rate for Payer: First Health Commercial |
$3,072.30
|
| Rate for Payer: Humana Commercial |
$2,748.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,651.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,386.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$970.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,845.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,425.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,813.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,231.46
|
| Rate for Payer: PHCS Commercial |
$3,104.64
|
| Rate for Payer: United Healthcare All Payer |
$2,845.92
|
|
|
ACUTE INITIAL OBS PERDAY LVL 3
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem Medicaid |
$1,257.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Humana KY Medicaid |
$1,257.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTE INITIAL OBS PERDAY LVL 3
|
Facility
|
IP
|
$3,658.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
ACUTE INTENSIVE HEMODIALYSIS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
80000001
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.32
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$410.02
|
| Rate for Payer: First Health Commercial |
$469.30
|
| Rate for Payer: Humana Commercial |
$419.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.72
|
| Rate for Payer: Ohio Health Group HMO |
$370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.86
|
| Rate for Payer: PHCS Commercial |
$474.24
|
| Rate for Payer: United Healthcare All Payer |
$434.72
|
|
