|
AIR CONTRAST ENEMA W/WO KUB(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
320P0138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$294.04 |
| Rate for Payer: Aetna Commercial |
$294.04
|
| Rate for Payer: Anthem Medicaid |
$165.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$231.47
|
| Rate for Payer: Healthspan PPO |
$275.52
|
| Rate for Payer: Humana Medicaid |
$165.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.22
|
| Rate for Payer: Molina Healthcare Passport |
$165.90
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.56
|
|
|
AIR CONTRAST ENEMA W/WO KUB(T
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
320T0138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.69 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.03
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
AIR CONTRAST ENEMA W/WO KUB(T
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
320T0138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.69 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem Medicaid |
$245.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Humana KY Medicaid |
$245.20
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$247.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.03
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
AIRWAY INHALATION TREAT
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Anthem Medicaid |
$11.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$296.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$19.72
|
| Rate for Payer: Healthspan PPO |
$15.61
|
| Rate for Payer: Humana Medicaid |
$11.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.41
|
| Rate for Payer: Molina Healthcare Passport |
$11.19
|
| Rate for Payer: Multiplan PHCS |
$177.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$207.20
|
| Rate for Payer: UHCCP Medicaid |
$103.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.30
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
92000010
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
41000076
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
76102495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
41000076
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT(T
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
761T2495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem Medicaid |
$101.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Humana KY Medicaid |
$101.79
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$102.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
AIRWAY INHALATION TREAT(T
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
761T2495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.88
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cigna Commercial |
$245.68
|
| Rate for Payer: First Health Commercial |
$281.20
|
| Rate for Payer: Humana Commercial |
$251.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.48
|
| Rate for Payer: Ohio Health Group HMO |
$222.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.76
|
| Rate for Payer: PHCS Commercial |
$284.16
|
| Rate for Payer: United Healthcare All Payer |
$260.48
|
|
|
A-KIT 6F 10CM
|
Facility
|
IP
|
$3,840.62
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.28 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna Commercial |
$2,957.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,995.68
|
| Rate for Payer: Cash Price |
$1,920.31
|
| Rate for Payer: Cigna Commercial |
$3,187.71
|
| Rate for Payer: First Health Commercial |
$3,648.59
|
| Rate for Payer: Humana Commercial |
$3,264.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,149.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,834.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,152.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,379.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,880.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$768.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.59
|
| Rate for Payer: PHCS Commercial |
$3,687.00
|
| Rate for Payer: United Healthcare All Payer |
$3,379.75
|
|
|
A-KIT 6F 10CM
|
Facility
|
OP
|
$3,840.62
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.28 |
| Max. Negotiated Rate |
$3,687.00 |
| Rate for Payer: Aetna Commercial |
$2,957.28
|
| Rate for Payer: Anthem Medicaid |
$1,320.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,995.68
|
| Rate for Payer: Cash Price |
$1,920.31
|
| Rate for Payer: Cigna Commercial |
$3,187.71
|
| Rate for Payer: First Health Commercial |
$3,648.59
|
| Rate for Payer: Humana Commercial |
$3,264.53
|
| Rate for Payer: Humana KY Medicaid |
$1,320.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,334.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,149.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,834.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,152.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,347.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,379.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,880.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$768.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.59
|
| Rate for Payer: PHCS Commercial |
$3,687.00
|
| Rate for Payer: United Healthcare All Payer |
$3,379.75
|
|
|
AL-1 CATH 5F
|
Facility
|
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem Medicaid |
$56.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Humana KY Medicaid |
$56.42
|
| Rate for Payer: Kentucky WC Medicaid |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
AL-1 CATH 5F
|
Facility
|
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
AL-2 CATH 5F
|
Facility
|
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
AL-2 CATH 5F
|
Facility
|
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem Medicaid |
$56.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Humana KY Medicaid |
$56.42
|
| Rate for Payer: Kentucky WC Medicaid |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
AL-3 CATH 5F
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
AL-3 CATH 5F
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
AL .75 GUIDE 6F
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
AL .75 GUIDE 6F
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
AL .75 SH 6F 100CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
