|
C-SECTION EMERGENCY ROOM
|
Facility
|
OP
|
$3,329.00
|
|
| Hospital Charge Code |
45000319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.77 |
| Max. Negotiated Rate |
$3,195.84 |
| Rate for Payer: Aetna Commercial |
$2,563.33
|
| Rate for Payer: Anthem Medicaid |
$1,144.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.62
|
| Rate for Payer: Cash Price |
$1,664.50
|
| Rate for Payer: Cigna Commercial |
$2,763.07
|
| Rate for Payer: First Health Commercial |
$3,162.55
|
| Rate for Payer: Humana Commercial |
$2,829.65
|
| Rate for Payer: Humana KY Medicaid |
$1,144.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,156.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.99
|
| Rate for Payer: PHCS Commercial |
$3,195.84
|
| Rate for Payer: United Healthcare All Payer |
$2,929.52
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
IP
|
$3,193.00
|
|
| Hospital Charge Code |
76102549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.09 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$989.83
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
IP
|
$3,329.00
|
|
| Hospital Charge Code |
45000319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.77 |
| Max. Negotiated Rate |
$3,195.84 |
| Rate for Payer: Aetna Commercial |
$2,563.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,596.62
|
| Rate for Payer: Cash Price |
$1,664.50
|
| Rate for Payer: Cigna Commercial |
$2,763.07
|
| Rate for Payer: First Health Commercial |
$3,162.55
|
| Rate for Payer: Humana Commercial |
$2,829.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,729.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,456.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,929.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,496.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.99
|
| Rate for Payer: PHCS Commercial |
$3,195.84
|
| Rate for Payer: United Healthcare All Payer |
$2,929.52
|
|
|
C-SECTION(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
720P0023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,537.35
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,417.36
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,417.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
C-SECTION W/PRENATAL CARE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
C-SECTION W/PRENATAL CARE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,974.03
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
|
|
C-SECTION W/PRENATAL CARE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
72000022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
C-SECTION W/PRENATAL CARE(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
720P0022
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,974.03
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
|
|
[C]SERAX (OXAZEPAM) 10MG/1CAP
|
Facility
|
OP
|
$60.96
|
|
|
Service Code
|
NDC 228206710
|
| Hospital Charge Code |
25000121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.55
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: First Health Commercial |
$57.91
|
| Rate for Payer: Humana Commercial |
$51.82
|
| Rate for Payer: Humana KY Medicaid |
$20.96
|
| Rate for Payer: Kentucky WC Medicaid |
$21.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.99
|
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.64
|
| Rate for Payer: Ohio Health Group HMO |
$45.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.90
|
| Rate for Payer: PHCS Commercial |
$58.52
|
| Rate for Payer: United Healthcare All Payer |
$53.64
|
|
|
[C]SERAX (OXAZEPAM) 10MG/1CAP
|
Facility
|
IP
|
$60.96
|
|
|
Service Code
|
NDC 228206710
|
| Hospital Charge Code |
25000121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.52 |
| Rate for Payer: Aetna Commercial |
$46.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.55
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: First Health Commercial |
$57.91
|
| Rate for Payer: Humana Commercial |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.64
|
| Rate for Payer: Ohio Health Group HMO |
$45.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.90
|
| Rate for Payer: PHCS Commercial |
$58.52
|
| Rate for Payer: United Healthcare All Payer |
$53.64
|
|
|
[C]SERAX (OXAZEPAM) 15MG/1CAP
|
Facility
|
OP
|
$61.21
|
|
|
Service Code
|
NDC 228206910
|
| Hospital Charge Code |
25000122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Anthem Medicaid |
$21.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$50.80
|
| Rate for Payer: First Health Commercial |
$58.15
|
| Rate for Payer: Humana Commercial |
$52.03
|
| Rate for Payer: Humana KY Medicaid |
$21.05
|
| Rate for Payer: Kentucky WC Medicaid |
$21.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.98
|
| Rate for Payer: PHCS Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Payer |
$53.86
|
|
|
[C]SERAX (OXAZEPAM) 15MG/1CAP
|
Facility
|
IP
|
$61.21
|
|
|
Service Code
|
NDC 228206910
|
| Hospital Charge Code |
25000122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$50.80
|
| Rate for Payer: First Health Commercial |
$58.15
|
| Rate for Payer: Humana Commercial |
$52.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.86
|
| Rate for Payer: Ohio Health Group HMO |
$45.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.98
|
| Rate for Payer: PHCS Commercial |
$58.76
|
| Rate for Payer: United Healthcare All Payer |
$53.86
|
|
|
CSF CELL COUNT W DIFF ADD TUBE
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
CSF CELL COUNT W DIFF ADD TUBE
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.79
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
CT 3D STUDY WITH WORKSTATION
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
40000003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,109.00
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$665.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$776.30
|
| Rate for Payer: UHCCP Medicaid |
$388.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
|
|
CT 3D STUDY WITH WORKSTATION(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400P0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Anthem Medicaid |
$127.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$234.40
|
| Rate for Payer: Healthspan PPO |
$123.22
|
| Rate for Payer: Humana Medicaid |
$127.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.51
|
| Rate for Payer: Molina Healthcare Passport |
$127.95
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.23
|
|
|
CT 3D STUDY WITH WORKSTATION(T
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
CT 3D STUDY WITH WORKSTATION(T
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
400T0003
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$121.42 |
| Max. Negotiated Rate |
$896.64 |
| Rate for Payer: Aetna Commercial |
$719.18
|
| Rate for Payer: Anthem Medicaid |
$321.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$728.52
|
| Rate for Payer: Cash Price |
$467.00
|
| Rate for Payer: Cigna Commercial |
$775.22
|
| Rate for Payer: First Health Commercial |
$887.30
|
| Rate for Payer: Humana Commercial |
$793.90
|
| Rate for Payer: Humana KY Medicaid |
$321.20
|
| Rate for Payer: Kentucky WC Medicaid |
$324.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$689.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.92
|
| Rate for Payer: Ohio Health Group HMO |
$700.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.54
|
| Rate for Payer: PHCS Commercial |
$896.64
|
| Rate for Payer: United Healthcare All Payer |
$821.92
|
|
|
CT ABD & PELV 1/> REGNS
|
Facility
|
IP
|
$5,456.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
35000064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$709.28 |
| Max. Negotiated Rate |
$5,237.76 |
| Rate for Payer: Aetna Commercial |
$4,201.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,255.68
|
| Rate for Payer: Cash Price |
$2,728.00
|
| Rate for Payer: Cigna Commercial |
$4,528.48
|
| Rate for Payer: First Health Commercial |
$5,183.20
|
| Rate for Payer: Humana Commercial |
$4,637.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,026.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,801.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,092.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.36
|
| Rate for Payer: PHCS Commercial |
$5,237.76
|
| Rate for Payer: United Healthcare All Payer |
$4,801.28
|
|
|
CT ABD & PELV 1/> REGNS
|
Professional
|
Both
|
$5,456.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
35000064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$5,456.00 |
| Rate for Payer: Aetna Commercial |
$668.41
|
| Rate for Payer: Anthem Medicaid |
$375.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,456.00
|
| Rate for Payer: Cash Price |
$2,728.00
|
| Rate for Payer: Cash Price |
$2,728.00
|
| Rate for Payer: Cigna Commercial |
$706.69
|
| Rate for Payer: Healthspan PPO |
$346.20
|
| Rate for Payer: Humana Medicaid |
$375.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$383.44
|
| Rate for Payer: Molina Healthcare Passport |
$375.92
|
| Rate for Payer: Multiplan PHCS |
$3,273.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,819.20
|
| Rate for Payer: UHCCP Medicaid |
$1,909.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$379.68
|
|
|
CT ABD & PELV 1/> REGNS
|
Facility
|
OP
|
$5,456.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
35000064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$5,237.76 |
| Rate for Payer: Aetna Commercial |
$4,201.12
|
| Rate for Payer: Anthem Medicaid |
$1,876.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,255.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,728.00
|
| Rate for Payer: Cash Price |
$2,728.00
|
| Rate for Payer: Cigna Commercial |
$4,528.48
|
| Rate for Payer: First Health Commercial |
$5,183.20
|
| Rate for Payer: Humana Commercial |
$4,637.60
|
| Rate for Payer: Humana KY Medicaid |
$1,876.32
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,026.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,801.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,092.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.36
|
| Rate for Payer: PHCS Commercial |
$5,237.76
|
| Rate for Payer: United Healthcare All Payer |
$4,801.28
|
|
|
CT ABD & PELV 1/> REGNS(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
350P0064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$706.69 |
| Rate for Payer: Aetna Commercial |
$668.41
|
| Rate for Payer: Anthem Medicaid |
$375.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$706.69
|
| Rate for Payer: Healthspan PPO |
$346.20
|
| Rate for Payer: Humana Medicaid |
$375.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$383.44
|
| Rate for Payer: Molina Healthcare Passport |
$375.92
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$379.68
|
|
|
CT ABD & PELV 1/> REGNS(T
|
Facility
|
OP
|
$5,231.00
|
|
|
Service Code
|
HCPCS 74178
|
| Hospital Charge Code |
350T0064
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$5,021.76 |
| Rate for Payer: Aetna Commercial |
$4,027.87
|
| Rate for Payer: Anthem Medicaid |
$1,798.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,080.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,615.50
|
| Rate for Payer: Cash Price |
$2,615.50
|
| Rate for Payer: Cigna Commercial |
$4,341.73
|
| Rate for Payer: First Health Commercial |
$4,969.45
|
| Rate for Payer: Humana Commercial |
$4,446.35
|
| Rate for Payer: Humana KY Medicaid |
$1,798.94
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,817.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,289.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,860.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,835.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,603.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,923.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,046.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.61
|
| Rate for Payer: PHCS Commercial |
$5,021.76
|
| Rate for Payer: United Healthcare All Payer |
$4,603.28
|
|
