|
CT COLONOGRAPHY DX(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350P0008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$634.38 |
| Rate for Payer: Aetna Commercial |
$464.72
|
| Rate for Payer: Ambetter Exchange |
$375.89
|
| Rate for Payer: Anthem Medicaid |
$296.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$375.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$375.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$451.07
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$634.38
|
| Rate for Payer: Healthspan PPO |
$399.18
|
| Rate for Payer: Humana Medicaid |
$296.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$375.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.97
|
| Rate for Payer: Molina Healthcare Passport |
$296.05
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$488.66
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$375.89
|
|
|
CT COLONOGRAPHY DX(T
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350T0008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$716.10 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$716.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
CT COLONOGRAPHY DX(T
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
HCPCS 74261
|
| Hospital Charge Code |
350T0008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,291.52 |
| Rate for Payer: Aetna Commercial |
$1,837.99
|
| Rate for Payer: Anthem Medicaid |
$820.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,861.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna Commercial |
$1,981.21
|
| Rate for Payer: First Health Commercial |
$2,267.65
|
| Rate for Payer: Humana Commercial |
$2,028.95
|
| Rate for Payer: Humana KY Medicaid |
$820.89
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$829.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,957.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,761.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$837.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,100.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,790.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,076.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.03
|
| Rate for Payer: PHCS Commercial |
$2,291.52
|
| Rate for Payer: United Healthcare All Payer |
$2,100.56
|
|
|
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 |
$1,164.60 |
| Rate for Payer: Aetna Commercial |
$632.80
|
| Rate for Payer: Ambetter Exchange |
$421.85
|
| Rate for Payer: Anthem Medicaid |
$332.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$421.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$506.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$421.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.85
|
| 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 |
$548.40
|
| Rate for Payer: UHCCP Medicaid |
$679.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$421.85
|
|
|
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 |
$582.30 |
| 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 |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
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 |
$164.49 |
| 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 |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| 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 |
$164.49
|
| 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 |
$197.39
|
| 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 |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| 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: Ambetter Exchange |
$421.85
|
| Rate for Payer: Anthem Medicaid |
$332.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$421.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$506.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$421.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.85
|
| 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 |
$548.40
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$421.85
|
|
|
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 |
$484.80 |
| 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 |
$1,292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.04
|
| 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 |
$164.49 |
| 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 |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,260.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| 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 |
$164.49
|
| 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 |
$197.39
|
| 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 |
$1,292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.04
|
| Rate for Payer: PHCS Commercial |
$1,551.36
|
| Rate for Payer: United Healthcare All Payer |
$1,422.08
|
|
|
CT COLONOGRAPHY SCREENING
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$223.34 |
| 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 Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,049.00
|
| 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: Humana Medicare Advantage |
$223.34
|
| 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 |
$268.01
|
| 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 |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
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 |
$1,258.80 |
| Rate for Payer: Aetna Commercial |
$1,058.03
|
| Rate for Payer: Ambetter Exchange |
$644.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$644.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.60
|
| Rate for Payer: Multiplan PHCS |
$1,258.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$837.98
|
| Rate for Payer: UHCCP Medicaid |
$734.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.60
|
|
|
CT COLONOGRAPHY SCREENING
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.40 |
| 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 |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| 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: Ambetter Exchange |
$644.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$644.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.60
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$837.98
|
| Rate for Payer: UHCCP Medicaid |
$112.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.60
|
|
|
CT COLONOGRAPHY SCREENING(T
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
HCPCS 74263
|
| Hospital Charge Code |
350T0010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$533.40 |
| 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 |
$1,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,546.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.82
|
| 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 |
$223.34 |
| 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 Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$889.00
|
| 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: Humana Medicare Advantage |
$223.34
|
| 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 |
$268.01
|
| 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 |
$1,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,546.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.82
|
| Rate for Payer: PHCS Commercial |
$1,706.88
|
| Rate for Payer: United Healthcare All Payer |
$1,564.64
|
|
|
CT COVID
|
Professional
|
Both
|
$2,520.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$386.77
|
| Rate for Payer: Ambetter Exchange |
$122.69
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.23
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$122.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.61
|
| Rate for Payer: Molina Healthcare Passport |
$209.42
|
| Rate for Payer: Multiplan PHCS |
$1,512.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$882.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.69
|
|
|
CT COVID
|
Facility
|
IP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
CT COVID
|
Facility
|
OP
|
$2,520.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
32000996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,419.20 |
| Rate for Payer: Aetna Commercial |
$1,940.40
|
| Rate for Payer: Anthem Medicaid |
$866.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,965.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$2,091.60
|
| Rate for Payer: First Health Commercial |
$2,394.00
|
| Rate for Payer: Humana Commercial |
$2,142.00
|
| Rate for Payer: Humana KY Medicaid |
$866.63
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$875.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,066.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,859.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$884.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,217.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,890.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.80
|
| Rate for Payer: PHCS Commercial |
$2,419.20
|
| Rate for Payer: United Healthcare All Payer |
$2,217.60
|
|
|
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: Ambetter Exchange |
$122.69
|
| Rate for Payer: Anthem Medicaid |
$209.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.23
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$122.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.69
|
| 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 |
$159.50
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.69
|
|
|
CT COVID (T
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
320T0996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$2,227.20 |
| Rate for Payer: Aetna Commercial |
$1,786.40
|
| Rate for Payer: Anthem Medicaid |
$797.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,809.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cigna Commercial |
$1,925.60
|
| Rate for Payer: First Health Commercial |
$2,204.00
|
| Rate for Payer: Humana Commercial |
$1,972.00
|
| Rate for Payer: Humana KY Medicaid |
$797.85
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$805.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,902.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,712.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$813.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,041.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,018.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,600.80
|
| Rate for Payer: PHCS Commercial |
$2,227.20
|
| Rate for Payer: United Healthcare All Payer |
$2,041.60
|
|
|
CT COVID (T
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS 71250
|
| Hospital Charge Code |
320T0996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$696.00 |
| Max. Negotiated Rate |
$2,227.20 |
| Rate for Payer: Aetna Commercial |
$1,786.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,809.60
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cigna Commercial |
$1,925.60
|
| Rate for Payer: First Health Commercial |
$2,204.00
|
| Rate for Payer: Humana Commercial |
$1,972.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,902.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,712.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$696.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,041.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,018.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,600.80
|
| Rate for Payer: PHCS Commercial |
$2,227.20
|
| Rate for Payer: United Healthcare All Payer |
$2,041.60
|
|
|
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 |
$1,732.91 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,930.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$4,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,383.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,476.91
|
| 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
|
IP
|
$5,689.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
35000092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,706.70 |
| 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 |
$4,551.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,949.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.41
|
| 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 |
$1,892.78 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$4,551.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,949.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.41
|
| 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 |
$1,511.70 |
| 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 |
$4,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,383.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,476.91
|
| Rate for Payer: PHCS Commercial |
$4,837.44
|
| Rate for Payer: United Healthcare All Payer |
$4,434.32
|
|
