|
CT COLONOGRAPHY DX W/DYE
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CT COLONOGRAPHY DX W/DYE
|
Professional
|
Both
|
$1,941.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$155.04 |
| Max. Negotiated Rate |
$1,941.00 |
| Rate for Payer: Aetna Commercial |
$632.80
|
| Rate for Payer: Anthem Medicaid |
$332.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,941.00
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$712.46
|
| Rate for Payer: Healthspan PPO |
$510.98
|
| Rate for Payer: Humana Medicaid |
$332.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.07
|
| Rate for Payer: Molina Healthcare Passport |
$332.42
|
| Rate for Payer: Multiplan PHCS |
$1,164.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,358.70
|
| Rate for Payer: UHCCP Medicaid |
$679.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.74
|
|
|
CT COLONOGRAPHY DX W/DYE
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$252.33 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CT COLONOGRAPHY DX W/DYE(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
350P0009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$712.46 |
| Rate for Payer: Aetna Commercial |
$632.80
|
| Rate for Payer: Anthem Medicaid |
$332.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$712.46
|
| Rate for Payer: Healthspan PPO |
$510.98
|
| Rate for Payer: Humana Medicaid |
$332.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.07
|
| Rate for Payer: Molina Healthcare Passport |
$332.42
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.74
|
|
|
CT COLONOGRAPHY DX W/DYE(T
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
350T0009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$1,551.36 |
| Rate for Payer: Aetna Commercial |
$1,244.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,260.48
|
| Rate for Payer: Cash Price |
$808.00
|
| Rate for Payer: Cigna Commercial |
$1,341.28
|
| Rate for Payer: First Health Commercial |
$1,535.20
|
| Rate for Payer: Humana Commercial |
$1,373.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,325.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,192.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,422.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,212.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.96
|
| Rate for Payer: PHCS Commercial |
$1,551.36
|
| Rate for Payer: United Healthcare All Payer |
$1,422.08
|
|
|
CT COLONOGRAPHY DX W/DYE(T
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
HCPCS 74262
|
| Hospital Charge Code |
350T0009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$1,551.36 |
| Rate for Payer: Aetna Commercial |
$1,244.32
|
| Rate for Payer: Anthem Medicaid |
$555.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,260.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$808.00
|
| Rate for Payer: Cash Price |
$808.00
|
| Rate for Payer: Cigna Commercial |
$1,341.28
|
| Rate for Payer: First Health Commercial |
$1,535.20
|
| Rate for Payer: Humana Commercial |
$1,373.60
|
| Rate for Payer: Humana KY Medicaid |
$555.74
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$561.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,325.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,192.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$566.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,422.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,212.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.96
|
| Rate for Payer: PHCS Commercial |
$1,551.36
|
| Rate for Payer: United Healthcare All Payer |
$1,422.08
|
|
|
CT COLONOGRAPHY SCREENING
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$146.93 |
| Max. Negotiated Rate |
$2,098.00 |
| Rate for Payer: Aetna Commercial |
$1,058.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,098.00
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,087.64
|
| Rate for Payer: Healthspan PPO |
$779.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.93
|
| Rate for Payer: Multiplan PHCS |
$1,258.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,468.60
|
| Rate for Payer: UHCCP Medicaid |
$734.30
|
|
|
CT COLONOGRAPHY SCREENING
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$650.38
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
CT COLONOGRAPHY SCREENING
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$650.38
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
CT COLONOGRAPHY SCREENING(P
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
350P0010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$1,087.64 |
| Rate for Payer: Aetna Commercial |
$1,058.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$320.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$1,087.64
|
| Rate for Payer: Healthspan PPO |
$779.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.93
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.00
|
| Rate for Payer: UHCCP Medicaid |
$112.00
|
|
|
CT COLONOGRAPHY SCREENING(T
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
350T0010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$231.14 |
| Max. Negotiated Rate |
$1,706.88 |
| Rate for Payer: Aetna Commercial |
$1,369.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.84
|
| Rate for Payer: Cash Price |
$889.00
|
| Rate for Payer: Cigna Commercial |
$1,475.74
|
| Rate for Payer: First Health Commercial |
$1,689.10
|
| Rate for Payer: Humana Commercial |
$1,511.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,312.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,564.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,333.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$551.18
|
| Rate for Payer: PHCS Commercial |
$1,706.88
|
| Rate for Payer: United Healthcare All Payer |
$1,564.64
|
|
|
CT COLONOGRAPHY SCREENING(T
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
350T0010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$231.14 |
| Max. Negotiated Rate |
$1,706.88 |
| Rate for Payer: Aetna Commercial |
$1,369.06
|
| Rate for Payer: Anthem Medicaid |
$611.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.84
|
| Rate for Payer: Cash Price |
$889.00
|
| Rate for Payer: Cigna Commercial |
$1,475.74
|
| Rate for Payer: First Health Commercial |
$1,689.10
|
| Rate for Payer: Humana Commercial |
$1,511.30
|
| Rate for Payer: Humana KY Medicaid |
$611.45
|
| Rate for Payer: Kentucky WC Medicaid |
$617.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,312.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$623.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,564.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,333.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$551.18
|
| Rate for Payer: PHCS Commercial |
$1,706.88
|
| Rate for Payer: United Healthcare All Payer |
$1,564.64
|
|
|
CT COVID
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$317.46 |
| Max. Negotiated Rate |
$2,344.32 |
| Rate for Payer: Aetna Commercial |
$1,880.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,904.76
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$2,026.86
|
| Rate for Payer: First Health Commercial |
$2,319.90
|
| Rate for Payer: Humana Commercial |
$2,075.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,002.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,831.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.02
|
| Rate for Payer: PHCS Commercial |
$2,344.32
|
| Rate for Payer: United Healthcare All Payer |
$2,148.96
|
|
|
CT COVID
|
Professional
|
Both
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$2,442.00 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,442.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,465.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,709.40
|
| Rate for Payer: UHCCP Medicaid |
$854.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT COVID
|
Facility
|
OP
|
$2,442.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,344.32 |
| Rate for Payer: Aetna Commercial |
$1,880.34
|
| Rate for Payer: Anthem Medicaid |
$839.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,904.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cash Price |
$1,221.00
|
| Rate for Payer: Cigna Commercial |
$2,026.86
|
| Rate for Payer: First Health Commercial |
$2,319.90
|
| Rate for Payer: Humana Commercial |
$2,075.70
|
| Rate for Payer: Humana KY Medicaid |
$839.80
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$848.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,002.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$856.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,148.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,831.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.02
|
| Rate for Payer: PHCS Commercial |
$2,344.32
|
| Rate for Payer: United Healthcare All Payer |
$2,148.96
|
|
|
CT COVID (P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
320P0996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$425.87 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$425.87
|
| Rate for Payer: Healthspan PPO |
$265.77
|
| Rate for Payer: Humana Medicaid |
$209.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
|
|
CT COVID (T
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
320T0996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$291.46 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
| Rate for Payer: United Healthcare All Payer |
$1,972.96
|
|
|
CT COVID (T
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
320T0996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$2,152.32 |
| Rate for Payer: Aetna Commercial |
$1,726.34
|
| Rate for Payer: Anthem Medicaid |
$771.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,748.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cash Price |
$1,121.00
|
| Rate for Payer: Cigna Commercial |
$1,860.86
|
| Rate for Payer: First Health Commercial |
$2,129.90
|
| Rate for Payer: Humana Commercial |
$1,905.70
|
| Rate for Payer: Humana KY Medicaid |
$771.02
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$778.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,654.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,972.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$695.02
|
| Rate for Payer: PHCS Commercial |
$2,152.32
|
| Rate for Payer: United Healthcare All Payer |
$1,972.96
|
|
|
CT DRAIN BL W/CATH INSERTION
|
Professional
|
Both
|
$5,689.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
35000092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.02 |
| Max. Negotiated Rate |
$5,689.00 |
| Rate for Payer: Aetna Commercial |
$249.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.02
|
| Rate for Payer: Anthem Medicaid |
$205.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,689.00
|
| Rate for Payer: Cash Price |
$2,844.50
|
| Rate for Payer: Cash Price |
$2,844.50
|
| Rate for Payer: Cigna Commercial |
$368.54
|
| Rate for Payer: Healthspan PPO |
$299.76
|
| Rate for Payer: Humana Medicaid |
$205.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$209.43
|
| Rate for Payer: Molina Healthcare Passport |
$205.32
|
| Rate for Payer: Multiplan PHCS |
$3,413.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,982.30
|
| Rate for Payer: UHCCP Medicaid |
$100.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.37
|
|
|
CT DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$5,689.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
35000092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$739.57 |
| Max. Negotiated Rate |
$5,461.44 |
| Rate for Payer: Aetna Commercial |
$4,380.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.42
|
| Rate for Payer: Cash Price |
$2,844.50
|
| Rate for Payer: Cigna Commercial |
$4,721.87
|
| Rate for Payer: First Health Commercial |
$5,404.55
|
| Rate for Payer: Humana Commercial |
$4,835.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,006.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.59
|
| Rate for Payer: PHCS Commercial |
$5,461.44
|
| Rate for Payer: United Healthcare All Payer |
$5,006.32
|
|
|
CT DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$5,689.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
35000092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$739.57 |
| Max. Negotiated Rate |
$5,461.44 |
| Rate for Payer: Aetna Commercial |
$4,380.53
|
| Rate for Payer: Anthem Medicaid |
$1,956.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,844.50
|
| Rate for Payer: Cash Price |
$2,844.50
|
| Rate for Payer: Cigna Commercial |
$4,721.87
|
| Rate for Payer: First Health Commercial |
$5,404.55
|
| Rate for Payer: Humana Commercial |
$4,835.65
|
| Rate for Payer: Humana KY Medicaid |
$1,956.45
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,976.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,995.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,006.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.59
|
| Rate for Payer: PHCS Commercial |
$5,461.44
|
| Rate for Payer: United Healthcare All Payer |
$5,006.32
|
|
|
CT DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$5,039.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
350T0092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$655.07 |
| Max. Negotiated Rate |
$4,837.44 |
| Rate for Payer: Aetna Commercial |
$3,880.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,930.42
|
| Rate for Payer: Cash Price |
$2,519.50
|
| Rate for Payer: Cigna Commercial |
$4,182.37
|
| Rate for Payer: First Health Commercial |
$4,787.05
|
| Rate for Payer: Humana Commercial |
$4,283.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,434.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,779.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,562.09
|
| Rate for Payer: PHCS Commercial |
$4,837.44
|
| Rate for Payer: United Healthcare All Payer |
$4,434.32
|
|
|
CT DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$5,039.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
350T0092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$655.07 |
| Max. Negotiated Rate |
$4,837.44 |
| Rate for Payer: Aetna Commercial |
$3,880.03
|
| Rate for Payer: Anthem Medicaid |
$1,732.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,930.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,519.50
|
| Rate for Payer: Cash Price |
$2,519.50
|
| Rate for Payer: Cigna Commercial |
$4,182.37
|
| Rate for Payer: First Health Commercial |
$4,787.05
|
| Rate for Payer: Humana Commercial |
$4,283.15
|
| Rate for Payer: Humana KY Medicaid |
$1,732.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,434.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,779.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,562.09
|
| Rate for Payer: PHCS Commercial |
$4,837.44
|
| Rate for Payer: United Healthcare All Payer |
$4,434.32
|
|
|
CT DRAIN BL W/CATH INSERT (P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
350P0092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.02 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$249.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$96.02
|
| Rate for Payer: Anthem Medicaid |
$205.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$368.54
|
| Rate for Payer: Healthspan PPO |
$299.76
|
| Rate for Payer: Humana Medicaid |
$205.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$209.43
|
| Rate for Payer: Molina Healthcare Passport |
$205.32
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$100.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$207.37
|
|
|
CT FACIAL BONES W/CONTRAST
|
Professional
|
Both
|
$2,679.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Aetna Commercial |
$515.45
|
| Rate for Payer: Anthem Medicaid |
$208.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,679.00
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cash Price |
$1,339.50
|
| Rate for Payer: Cigna Commercial |
$450.67
|
| Rate for Payer: Healthspan PPO |
$354.19
|
| Rate for Payer: Humana Medicaid |
$208.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.87
|
| Rate for Payer: Molina Healthcare Passport |
$208.70
|
| Rate for Payer: Multiplan PHCS |
$1,607.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,875.30
|
| Rate for Payer: UHCCP Medicaid |
$937.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.79
|
|
