|
CHEMO IV INFUSION UP TO 1 HR
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
33100006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
CHEMO IV INFUSION UP TO 1 HR
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
33100006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Humana KY Medicaid |
$180.55
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$182.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.75
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
CHEMO IV PUSH
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$101.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$292.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$410.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$395.36
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$101.45
|
| Rate for Payer: Humana Medicare Advantage |
$292.86
|
| Rate for Payer: Kentucky WC Medicaid |
$102.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
CHEMO IV PUSH
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$38.35 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.10
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.45
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
CHEMO IV PUSH ADDTL DRUG
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$73.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$73.94
|
| Rate for Payer: Humana Medicare Advantage |
$60.92
|
| Rate for Payer: Kentucky WC Medicaid |
$74.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.65
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
CHEMO IV PUSH ADDTL DRUG
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.65
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$56,666.11
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$38,452.00 |
| Max. Negotiated Rate |
$56,666.11 |
| Rate for Payer: Anthem Medicaid |
$38,452.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40,475.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$56,666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$54,642.32
|
| Rate for Payer: Humana KY Medicaid |
$38,452.00
|
| Rate for Payer: Humana Medicare Advantage |
$40,475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$38,836.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48,570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,221.04
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$23,416.30
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$15,889.63 |
| Max. Negotiated Rate |
$23,416.30 |
| Rate for Payer: Anthem Medicaid |
$15,889.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,725.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,416.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,580.01
|
| Rate for Payer: Humana KY Medicaid |
$15,889.63
|
| Rate for Payer: Humana Medicare Advantage |
$16,725.93
|
| Rate for Payer: Kentucky WC Medicaid |
$16,048.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,071.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,207.43
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,243.93
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$10,344.09 |
| Max. Negotiated Rate |
$15,243.93 |
| Rate for Payer: Anthem Medicaid |
$10,344.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,888.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,243.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,699.50
|
| Rate for Payer: Humana KY Medicaid |
$10,344.09
|
| Rate for Payer: Humana Medicare Advantage |
$10,888.52
|
| Rate for Payer: Kentucky WC Medicaid |
$10,447.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,066.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,550.98
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$14,185.23
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$9,625.69 |
| Max. Negotiated Rate |
$14,185.23 |
| Rate for Payer: Anthem Medicaid |
$9,625.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,132.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,185.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,678.62
|
| Rate for Payer: Humana KY Medicaid |
$9,625.69
|
| Rate for Payer: Humana Medicare Advantage |
$10,132.31
|
| Rate for Payer: Kentucky WC Medicaid |
$9,721.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,158.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,818.21
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$28,590.42
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$19,400.64 |
| Max. Negotiated Rate |
$28,590.42 |
| Rate for Payer: Anthem Medicaid |
$19,400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,421.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,590.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,569.34
|
| Rate for Payer: Humana KY Medicaid |
$19,400.64
|
| Rate for Payer: Humana Medicare Advantage |
$20,421.73
|
| Rate for Payer: Kentucky WC Medicaid |
$19,594.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,506.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,788.66
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,782.04
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$6,637.81 |
| Max. Negotiated Rate |
$9,782.04 |
| Rate for Payer: Anthem Medicaid |
$6,637.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,987.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,782.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,432.68
|
| Rate for Payer: Humana KY Medicaid |
$6,637.81
|
| Rate for Payer: Humana Medicare Advantage |
$6,987.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,704.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,384.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,770.57
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Anthem Medicaid |
$23.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$385.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$48.18
|
| Rate for Payer: Humana Medicaid |
$23.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.49
|
| Rate for Payer: Molina Healthcare Passport |
$23.03
|
| Rate for Payer: Multiplan PHCS |
$231.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$269.50
|
| Rate for Payer: UHCCP Medicaid |
$134.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.26
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$296.45
|
| Rate for Payer: Anthem Medicaid |
$132.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$300.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$319.55
|
| Rate for Payer: First Health Commercial |
$365.75
|
| Rate for Payer: Humana Commercial |
$327.25
|
| Rate for Payer: Humana KY Medicaid |
$132.40
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$133.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$315.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$338.80
|
| Rate for Payer: Ohio Health Group HMO |
$288.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.35
|
| Rate for Payer: PHCS Commercial |
$369.60
|
| Rate for Payer: United Healthcare All Payer |
$338.80
|
|
|
CHEST (2 VIEWS) COMPLETE (P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
320P0035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Anthem Medicaid |
$23.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$48.18
|
| Rate for Payer: Humana Medicaid |
$23.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.49
|
| Rate for Payer: Molina Healthcare Passport |
$23.03
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.26
|
|
|
CHEST (2 VIEWS) COMPLETE (T
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
320T0035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CHEST (2 VIEWS) COMPLETE (T
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
320T0035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$31.53
|
| Rate for Payer: Humana Medicaid |
$15.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$15.39
|
| Rate for Payer: Molina Healthcare Passport |
$15.09
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.24
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CHEST AP/PA FRONTAL 1V (INSP(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
320P0034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$31.53
|
| Rate for Payer: Humana Medicaid |
$15.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$15.39
|
| Rate for Payer: Molina Healthcare Passport |
$15.09
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.24
|
|
|
CHEST AP/PA FRONTAL 1V (INSP(T
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
320T0034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
CHEST AP/PA FRONTAL 1V (INSP(T
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
320T0034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
CHEST LASER HAIR REMOVAL
|
Professional
|
Both
|
$550.00
|
|
| Hospital Charge Code |
22200184
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
|
