|
CHEMO IV INFUSION EA ADDL HR
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
33100007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
CHEMO IV INFUSION EA ADDL HR
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
33100007
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
CHEMO IV INFUSION UP TO 1 HR
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
33100006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$536.64 |
| Rate for Payer: Aetna Commercial |
$430.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.02
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cigna Commercial |
$463.97
|
| Rate for Payer: First Health Commercial |
$531.05
|
| Rate for Payer: Humana Commercial |
$475.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.92
|
| Rate for Payer: Ohio Health Group HMO |
$419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.71
|
| Rate for Payer: PHCS Commercial |
$536.64
|
| Rate for Payer: United Healthcare All Payer |
$491.92
|
|
|
CHEMO IV INFUSION UP TO 1 HR
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
33100006
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$192.24 |
| Max. Negotiated Rate |
$536.64 |
| Rate for Payer: Aetna Commercial |
$430.43
|
| Rate for Payer: Anthem Medicaid |
$192.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cigna Commercial |
$463.97
|
| Rate for Payer: First Health Commercial |
$531.05
|
| Rate for Payer: Humana Commercial |
$475.15
|
| Rate for Payer: Humana KY Medicaid |
$192.24
|
| Rate for Payer: Humana Medicare Advantage |
$306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$194.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.92
|
| Rate for Payer: Ohio Health Group HMO |
$419.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.71
|
| Rate for Payer: PHCS Commercial |
$536.64
|
| Rate for Payer: United Healthcare All Payer |
$491.92
|
|
|
CHEMO IV PUSH
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$107.98 |
| Max. Negotiated Rate |
$429.06 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$429.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.73
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
CHEMO IV PUSH
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
CHEMO IV PUSH ADDTL DRUG
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
CHEMO IV PUSH ADDTL DRUG
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
33100005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$78.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$92.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.78
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Humana KY Medicaid |
$78.75
|
| Rate for Payer: Humana Medicare Advantage |
$65.76
|
| Rate for Payer: Kentucky WC Medicaid |
$79.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$244.20 |
| Rate for Payer: Ambetter Exchange |
$30.47
|
| Rate for Payer: Anthem Medicaid |
$23.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.56
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.49
|
| Rate for Payer: Molina Healthcare Passport |
$23.03
|
| Rate for Payer: Multiplan PHCS |
$244.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.61
|
| Rate for Payer: UHCCP Medicaid |
$142.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.47
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem Medicaid |
$139.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Humana KY Medicaid |
$139.97
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$141.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
CHEST (2 VIEWS) COMPLETE
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$325.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$280.83
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
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 |
$48.18 |
| Rate for Payer: Ambetter Exchange |
$30.47
|
| Rate for Payer: Anthem Medicaid |
$23.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.47
|
| 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 |
$39.61
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.47
|
|
|
CHEST (2 VIEWS) COMPLETE (T
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
320T0035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.33
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
CHEST (2 VIEWS) COMPLETE (T
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
320T0035
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$342.72 |
| Rate for Payer: Aetna Commercial |
$274.89
|
| Rate for Payer: Anthem Medicaid |
$122.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$278.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$296.31
|
| Rate for Payer: First Health Commercial |
$339.15
|
| Rate for Payer: Humana Commercial |
$303.45
|
| Rate for Payer: Humana KY Medicaid |
$122.77
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$292.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$263.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$314.16
|
| Rate for Payer: Ohio Health Group HMO |
$267.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.33
|
| Rate for Payer: PHCS Commercial |
$342.72
|
| Rate for Payer: United Healthcare All Payer |
$314.16
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem Medicaid |
$109.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Humana KY Medicaid |
$109.02
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$110.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.73
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$304.32 |
| Rate for Payer: Aetna Commercial |
$244.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$247.26
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cigna Commercial |
$263.11
|
| Rate for Payer: First Health Commercial |
$301.15
|
| Rate for Payer: Humana Commercial |
$269.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$259.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$233.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$278.96
|
| Rate for Payer: Ohio Health Group HMO |
$237.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.73
|
| Rate for Payer: PHCS Commercial |
$304.32
|
| Rate for Payer: United Healthcare All Payer |
$278.96
|
|
|
CHEST AP/PA FRONTAL 1V (INSP)
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
32000034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Ambetter Exchange |
$23.58
|
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.30
|
| Rate for Payer: Cash Price |
$158.50
|
| Rate for Payer: Cash Price |
$158.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$23.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$15.39
|
| Rate for Payer: Molina Healthcare Passport |
$15.09
|
| Rate for Payer: Multiplan PHCS |
$190.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.65
|
| Rate for Payer: UHCCP Medicaid |
$110.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.58
|
|
|
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 |
$31.53 |
| Rate for Payer: Ambetter Exchange |
$23.58
|
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$23.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.58
|
| 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 |
$30.65
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$15.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.58
|
|
|
CHEST AP/PA FRONTAL 1V (INSP(T
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
320T0034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem Medicaid |
$95.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Humana KY Medicaid |
$95.26
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$96.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
CHEST AP/PA FRONTAL 1V (INSP(T
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
320T0034
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$213.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.06
|
| Rate for Payer: Cash Price |
$138.50
|
| Rate for Payer: Cigna Commercial |
$229.91
|
| Rate for Payer: First Health Commercial |
$263.15
|
| Rate for Payer: Humana Commercial |
$235.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$243.76
|
| Rate for Payer: Ohio Health Group HMO |
$207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.13
|
| Rate for Payer: PHCS Commercial |
$265.92
|
| Rate for Payer: United Healthcare All Payer |
$243.76
|
|
|
CHEST LASER HAIR REMOVAL
|
Professional
|
Both
|
$550.00
|
|
| Hospital Charge Code |
22200184
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$385.00 |
| 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
|
|
|
Chest Lsr HairRem-PP #1 50%
|
Professional
|
Both
|
$702.00
|
|
| Hospital Charge Code |
22200348
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Multiplan PHCS |
$421.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$491.40
|
| Rate for Payer: UHCCP Medicaid |
$245.70
|
|
|
Chest Lsr HairRem-PP#2/3 25%
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
22200464
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
|
|
CHEST ULTRASOUND
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Aetna Commercial |
$131.28
|
| Rate for Payer: Ambetter Exchange |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$59.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.76
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$118.97
|
| Rate for Payer: Healthspan PPO |
$123.02
|
| Rate for Payer: Humana Medicaid |
$59.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.48
|
| Rate for Payer: Molina Healthcare Passport |
$59.29
|
| Rate for Payer: Multiplan PHCS |
$561.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.07
|
| Rate for Payer: UHCCP Medicaid |
$327.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.13
|
|
|
CHEST ULTRASOUND
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Aetna Commercial |
$719.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$729.30
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cigna Commercial |
$776.05
|
| Rate for Payer: First Health Commercial |
$888.25
|
| Rate for Payer: Humana Commercial |
$794.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$766.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$822.80
|
| Rate for Payer: Ohio Health Group HMO |
$701.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.15
|
| Rate for Payer: PHCS Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Payer |
$822.80
|
|
